Transverse Myelitis Following Selective Bronchial Arteriography

Abstract

Selective bronchial arteriography is a relatively new, simple radiographic technic of theoretical interest but undetermined clinical value. It has been employed to differentiate malignant from inflammatory and nonmalignant pulmonary masses and may be of value in assessing the extent of bronchiectasis. There is some evidence, derived from the early studies of bronchial arteriography, of an alteration in the vascular supply of the lung in bronchiectasis. Because the intercostal arteries, which must be catheterized to visualize most bronchial arteries, also give rise to the accessory segmental blood supply of the thoracic spinal cord, one might anticipate spinal cord complications of this procedure (1, 2). In the several reports on bronchial arteriography reviewed to date, however, no mention has been made of any such neurologic complication (3–6). A case of transverse myelitis following catheterization of the right fifth intercostal artery is reported here to emphasize the fact that bronchial arteriography does carry some hazard which must be assessed in the light of the presenting clinical problem. The catheterization procedure is reviewed in some detail, although the complication does not appear to have been related to technic. A clinical sign that was not appreciated during the procedure is noted, and a precautionary step suggested that might further reduce the hazard of transverse myelitis. Case Report V. M., a 46-year-old housewife with a long history of recurrent productive cough, was admitted to Sinai Hospital of Detroit on Jan. 25, 1965, for a possible right middle lobe lobectomy for bronchiectasis. Bronchial and pulmonary arteriography were performed on Jan. 26 to evaluate the extent and anatomical detail of vascular abnormalities associated with the bronchiectatic lobe. A catheter prepared according to Viamonte was inserted by the Seldinger method via the right femoral artery to the upper thoracic aorta. The right fourth intercostal artery was entered, and 1 cc of 70 per cent Hypaque was injected. The catheter was then repositioned, and several 1 cc injections were made into the thoracic aorta and the sixth intercostal artery. Repositioning, followed by a 3–4 cc injection, still demonstrated the intercostal arteries but not the bronchial artery. The catheter tip was again repositioned, and 4 cc was injected. The bronchial artery and many others were now visualized. A 5 cc hand injection with multiple films then followed. The total dose injected was approximately 20 cc. The arteriogram (Fig. 1) revealed a right bronchial artery of normal caliber extending obliquely downward along the course of the right bronchus. The vessel in the region of the right middle lobe was larger than the others. The fifth intercostal artery, as well as the right supreme intercostal artery, was visualized. In addition, the right subclavian artery and several left intercostal arteries were demonstrated.