Radiological Findings and Outcomes of Bronchial Artery Embolization in Cryptogenic Hemoptysis

Abstract

Management of cryptogenic massive hemoptysis is difficult, and conservative treatment may be inadequate to stop the hemorrhage. Surgery is not a reasonable option because there is no underlying identifiable pathology. This study aimed to investigate the radiologic findings and bronchial artery embolization outcomes in cryptogenic hemoptysis, and to compare the results with non-cryptogenic hemoptysis. We evaluated 26 patients with cryptogenic hemoptysis and 152 patients with non-cryptogenic hemoptysis. A comparison of the bronchial artery abnormalities between the cryptogenic and non-cryptogenic hemoptysis groups showed that only extravasation was more statistically significant in the cryptogenic hemoptysis group than in the non-cryptogenic hemoptysis group, while the other bronchial artery abnormalities, such as bronchial artery dilatation, hypervascularity, and bronchial-to-pulmonary shunting, showed no significant difference between groups. Involvement of the non-bronchial systemic artery was significantly greater in the non-cryptogenic hemoptysis group than in the cryptogenic hemoptysis group. While 69.2% of patients with cryptogenic hemoptysis also had hypervascularity in the contralateral bronchial arteries and/or ipsilateral bronchial artery branches other than the bleeding lobar branches, this finding was not detected in non-cryptogenic hemoptysis. Embolization was performed on all patients using polyvinyl alcohol particles of 355-500 µm. Hemoptysis ceased in all patients immediately after embolization. While recurrence of hemoptysis showed no statistically significant difference between the cryptogenic and non-cryptogenic hemoptysis groups, it was mild in cryptogenic hemoptysis in contrast to mostly severe in non-cryptogenic hemoptysis. Transarterial embolization is a safe and effective technique to manage cryptogenic hemoptysis.

“Peanut saves the day”: an innovative solution to massive, cryptogenic haemoptysis—a case study

“…A Korean study described a mild recurrence of haemoptysis in 11.5% of the cryptogenic cases, requiring re‐embolization. However, long‐term follow‐up data on recurrence and the role of BAE in cryptogenic haemoptysis is insufficient [10].…”

Potential Factors Affected Safety and Efficacy of Transcatheter Plug Closure for Pediatric Hemoptysis with Anomalous Bronchial Arteries

“…According to the estimated standard [10, 11], we created a relative standard of hemoptysis severity based on the volume of blood lost in 24 h per kilogram (20ml-100ml as moderate), in addition to avoiding a bias of weight displayed as follows: <0.71 ml/24 h per kilogram (mild), 0.71-3.56 ml/24 h per kilogram (moderate), > 3.56 ml/24 h per kilogram (massive), > 8 ml/24 h per kilogram which was considered a life-threatening threshold. The preliminary diagnostics included routine blood examination, sputum or gastric juice analyses (sputum culture, sputum for antiresistant Bacillus sp., and iron macrophages), chest X-ray (CXR), computed tomography (CT), CT angiography (CTA), and bronchoscope.…”

“…For patients who were diagnosed with pneumonia, antibiotics including penicillin, cephalosporin, and macrolides drugs were selected preoperatively. CTA only afforded an approximate view of the vascular anomalies because of an inability of this approach to visually distinguish highly dense tissues and an inability to completely display overlapping tissues, especially for the aberrant BA which is a tortuous route when appearing either congenitally or when acquired [11]. Hence, etiological evaluation indicated a possible diagnosis of vascular anomalies, which consequently indicates a requirement for further digital subtraction angiography (DSA) [12, 13].…”

Management of life-threatening hemoptysis in the ICU

“…The incidence of cryptogenic hemoptysis reported in the literature ranges from 7-25% (36,37). Angiographic factors associated with cryptogenic hemoptysis include bronchial artery dilation, hypervascularization, and increased bronchial-pulmonary shunting (38). Hemoptysis without an underlying diagnosis may be a harbinger for an undiagnosed thoracic malignancy.…”