A young man with pulmonary tuberculosis presents with massive recurrent hemoptysis. For angiographic treatment, which vascular structure should be evaluated first -

Massive Hemoptysis Hemoptysis of >200-600cc in 24 hours. Massive Hemoptysis should be considered as a medical emergency Treatment Large-volume, life threatening Hemoptysis generally require immediate intervention regardless of the cause The first step is to establish a patent airway usually by endotracheal intubation and subsequent mechanical ventilation As most large - volume Hemoptysis Arises from an airway lesion, it is ideal if the site of the bleeding can be identified either by chest imaging or bronchoscopy (more commonly rigid than flexible) If bleeding doesnot stop with therapies of the underlying cause and passage of time, severe Hemoptysis from bronchial aeries can be treated with angiogrophic embolization of the culprit bronchial aery Bronchial aery are the major source of Hemoptysis Ref: Grainger Radiology 4th edition Pgno : 609