Ashraf O, Aslam F, Irfan M, Zubairi ABS, Azeemuddin M.
Percutaneous Embolisation and Transverse Myelitis: a rare association.
J Pak Med Assoc Jan ;54(6):340-1.

A 27 year old gentleman, on anti-tuberculous therapy for pulmonary TB, presented with a four day history of mild haemoptysis followed by one episode of massive (>300m1 in 24 hours) haemoptysis. A chest radiograph revealed left mid-zone consolidation and bilateral upper lobe fibro-cavitary changes. A fiber optic bronchoscopy showed large volume of blood in the left bronchial tree and active bleeding from the superior segment of the left lower lobe. Thoracic angiography and percutaneous embolisation (PE) with digital subtraction angiography was planned. The patient was sedated and a 4Fr Cerebral H1 catheter was used. It was selectively placed into each of the intercostal arteries (ICA) with non-ionic contrast. Abnormal vascularity with extravasation of the contrast was seen on injection of left ICA at the level of the 4th thoracic vertebra. It was embolised using polyvinyl alcohol particles of size 250-355 tm (Trufill: Cordis, Inc.Miami, USA). Post-embolisation angiography revealed cessation of bleeding. No spinal artery branch was identified throughout the procedure. Next morning he developed an inability to move his left leg along with urinary retention. A sensory level to pinprick sensation, proprioception, vibration and light touch was identified at the 6th thoracic vertebra. Spinal MRI scans revealed spinal cord edema and increased signals on T2 weighted images from 2nd to 5th thoracic vertebrae. A diagnosis of Transverse Myelitis (TM) due to spinal ischemia was made and patient started on intravenous Dexamethasone. At three months of follow-up the patient had a slight weakness in the left lower limb. Since the embolisation he has had no further episode of hemoptysis.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com