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Thoracic Viva Questions

Oral-exam style questions and answers on thoracic for MD, DNB and super-specialty practical examinations. Each answer links back to the playbook or Library entry it was written from.

What is the commonest arterial source of life-threatening hemoptysis?: Approximately **90% arises from the bronchial circulation** because hypertrophied bronchial arteries are exposed to systemic pressure. Pulmonary arteries and nonbronchial systemic arteries account for most remaining cases.
How do you distinguish an ectopic bronchial artery from a nonbronchial systemic collateral?: An ectopic bronchial artery has an origin outside the T5–T6 level but follows the bronchial tree toward the hilum. A nonbronchial systemic artery enters through pleural adhesions, extrapleural tissues or the pulmonary ligament and does not parallel the bronchi.
What CT findings predict a nonbronchial systemic arterial supply?: **Pleural thickening greater than 3 mm** adjacent to the pulmonary lesion and tortuous enhancing vessels in hypertrophied extrapleural fat are classic predictors. Asymmetric enlargement of an intercostal, internal thoracic or other systemic artery is another clue.
What angiographic abnormalities indicate embolization?: Hypertrophy, tortuosity, abnormal parenchymal blush, neovascularity, systemic-to-pulmonary shunting, active extravasation and aneurysm or pseudoaneurysm are indications. Extravasation is uncommon and is not required.
What is the preferred particle size for bronchial artery embolization?: **PVA particles or calibrated microspheres of 300–500 μm** are commonly used. Larger particles such as 500–700 μm are preferred when a significant systemic-to-pulmonary shunt is present; particles smaller than 300 μm are not routinely recommended.
How do you prevent spinal cord infarction during BAE?: Review CTA, perform careful selective angiography, identify radiculomedullary branches, advance the microcatheter beyond their origin and repeat angiography as flow changes. Never inject particles or liquid embolic when a spinal branch cannot be safely bypassed.
Why are coils not routinely used for every bronchial artery?: Proximal coil occlusion may prevent future distal access despite persistent collateral supply and can complicate repeat embolization. Coils are best reserved for pseudoaneurysm, selected high-flow shunts, protection of a critical branch or other specific anatomy.
What are the main causes of recurrent hemoptysis after BAE?: Early recurrence results from incomplete embolization, a missed ectopic or nonbronchial artery or an untreated pulmonary arterial source. Late recurrence results from recanalization, recruitment of new collaterals and progression or reactivation of the underlying disease.

Thoracic Viva Questions

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