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Recurrent haemoptysis in a child with advanced cystic fibrosis lung disease

A 12 year old boy with cystic fibrosis has advanced lung disease (FEV1 30%-40% predicted) and needs monthly intravenous antibiotics given through an implanted venous access device (visible in the radiograph in fig 1). He has experienced recurrent life threatening haemoptysis, for which he was treated with tranexamic acid and propranolol. His condition has not improved. What further intervention, seen on the radiograph (arrows), has he undergone?



Fig 1 
Chest radiography of a child with advanced cystic fibrosis lung disease and an implanted venous …