Abstract
RATIONALE: Primary racemose hemangioma of the bronchial artery (RHBA) is a rare congenital vascular malformation, typically confined to the bronchial artery. Concomitant vascular supply originating from multiple non-bronchial systemic arteries (NBSAs) is exceedingly rare and significantly complicates treatment procedures. PATIENT CONCERNS: We report an asymptomatic 66-year-old woman in whom incidental imaging revealed RHBA sustained by a complicated network of multiple systemic feeding arteries. DIAGNOSES: Chest computed tomography angiography and confirmatory selective arteriography revealed 6 markedly dilated, tortuous mediastinal arteries extending from the right subclavian artery to the abdominal aorta, terminating in multiple aneurysms clustered at the right hilum. INTERVENTIONS: Successful endovascular embolization was achieved via super-selective catheterization and microcoils deployment. Six-month follow-up confirmed durable occlusion without recurrence. LESSONS: RHBA with multi-source NBSAs involvement is rare. During interventional procedure, it must carefully consider the influence of diverse arterial blood flow on distal ectopic embolization, and omission of any feeding NBSAs can precipitate RHBA recurrence. In this case, carefully super-selective catheterization combined with microcoils deployment offered a safe, effective therapeutic option.