Radiologic Management of Haemoptysis: Diagnostic and Interventional Bronchial Arterial Embolisation

Abstract

Hemoptysis can be a life-threatening pulmonary emergency with high mortality, is symptomatic of an underlying severe pulmonary disease and requires immediate diagnosis and treatment. Diagnostically, bronchoscopy, conventional chest x-ray and contrast-enhanced multislice computed tomography (MSCT) with CT angiography (CTA) provide information regarding the underlying pulmonary disease, bleeding site, the vascular anatomy of the bronchial arteries (BA) and extrabronchial branches, as well a basis for planning of endovascular intervention. Therapeutically, bronchial artery embolization (BAE) is a safe and effective technique in the hands of an experienced interventionist with profound knowledge of the BA anatomy and possible pitfalls as well as experience with first-line therapy of recurrent and massive hemoptysis or as an intervention prior to elective surgery. Recurrent episodes of hemoptysis are not uncommon and require a prompt repeat BAE after exclusion of extrabronchial systemic and pulmonary artery bleeding sources. This review article should give an overview of the history, anatomical and pathophysiological basics and the clinical context of hemoptysis and diagnosis, as well as a survey of management, treatment and results of BAE. Key Points: ??Hemoptyses are life threatening and require urgent diagnostic and therapy. ??Chest x-ray, bronchoscopy, and contrast-enhanced MSCT with CTA should be carried out before therapeutic bronchial artery embolization (BAE). ??BAE for the treatment of massive and recurrent hemoptysis is safe and effective. ??False embolization in spinal branches of BA are the most serious complication of a BAE. ??Repeatedly BAE refractory cases should undergo elective surgery. Citation Format: ??Ittrich H, Klose H, Adam G Radiologisches Management von H?moptysen: Diagnostik und Interventionelle Bronchialarterienembolisation. Fortschr R?ntgenstr 2015; 187: 248???259

Mechanisms of recurrent haemoptysis after super-selective bronchial artery coil embolisation: a single-centre retrospective observational study

“…The median time from the 1st ssBACE to recurrent haemoptysis was 218 (57-452) days, and there were significant differences among underlying diseases (p = 0.020): the shortest time was 7 (5-9) days for patients with cryptogenic haemoptysis, and the longest time was 354 (165-534) days for patients with NTM pulmonary infection. The number of HRAs was 5 (3)(4)(5)(6)(7)(8) and 50% of patients showed exacerbation of underlying diseases at 2nd series ssBACE. The procedural success rate of 2nd series ssBACE was 97.7%, and no major and one minor complication of slight asymptomatic mediastinal haematoma due to wire perforation of an internal thoracic artery which did not need additional management were reported.…”

“…Before the 2nd series ssBACE, all patients underwent e-CT angiography again to evaluate possible HRAs for procedural planning [5,6,9,16,19]. Primary signs of a possible HRA consisted of dilatation of the vessel compared to the normal size for that site, tortuosity of the vessels, direct shunting of vessels, aneurysmal formation, pleural adhesion, ground glass opacity suggesting inhaled blood, and new enhancement of the distal part of the HRA embolised at the 1st series ssBACE [1,5,6,8,9,16]. Considering the normal arterial vessel size, we defined relatively large-diameter HRAs as those occurring in the bronchial, intercostal and internal thoracic arteries, and relatively small-diameter HRAs as those occurring in all other arteries.…”

“…Haemoptysis affects patients with a wide variety of respiratory diseases, such as bronchiectasis, non-tuberculous mycobacterium (NTM) pulmonary infection and pulmonary aspergillosis [1][2][3][4][5][6]. As a result of the significant negative impact of massive haemoptysis on a patient's quality of life and risk of mortality, an interventional radiological approach known as bronchial artery embolisation (BAE) has been introduced and evaluated extensively [7][8][9][10][11][12][13][14].…”

Massive hemoptysis in a patient with pulmonary embolism, a real therapeutic conundrum

“…In this case NBCA was used. According to the literature, both NBCA and microspheres result in satisfactory technical success rates without any significant difference in complication rates, if used following super-selective catheterization by experienced Interventional Radiologists [5].…”

“…Less common but more significant complications include dysphagia, bronchial necrosis and the most fearful event of spinal cord ischemia due to embolization of spinal branches, with reported prevalence ranging from 1.4 to 6.5%. Super-selective, more distal embolization has been proposed as to avoid non-targeted embolization of spinal branches [5].…”