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Fan S, Cheng X, Wang X, Liu Y, He W, Chen H. Bronchial artery embolization versus conservative treatment for hemoptysis: a systematic review and meta-analysis. BMC Pulm Med 2024; 24:428. [PMID: 39215233 PMCID: PMC11365234 DOI: 10.1186/s12890-024-03244-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Bronchial artery embolization (BAE) is currently an important treatment for hemoptysis. However, there is no consensus in the efficacy and safety of BAE compared to conservative treatment for hemoptysis, which limits the widespread use of BAE in hemoptysis. The objective was to assess the clinical benefit of BAE versus conservative treatment in patients with hemoptysis. METHODS A systematic search was conducted on the PubMed, Embase, ScienceDirect, CochraneLibrary, and ClinicalTrials up to March 2023. Both randomized controlled trials (RCTs) and cohort studies reporting rates of recurrent hemoptysis, clinical success, mortality, and complication by BAE and conservative treatment alone for hemoptysis were included. Data were pooled and compared by the use of odds ratio (OR) and 95% confidence interval (CI). RESULTS Twelve studies (three RCTs, nine cohorts) involving 1231 patients met the eligibility criteria. Patients treated with BAE had lower recurrence rates of hemoptysis (26.5% vs. 34.6%; OR 0.37, 95% CI 0.14-0.98), higher clinical success rates (92.2% vs. 80.9%; OR 2.77, 95% CI 1.66-4.61), and lower hemoptysis-related mortality (0.8% vs. 3.2%; OR 0.20, 95% CI 0.05-0.84) compared with conservative treatment alone. There was no significant difference in all-cause mortality between the two groups. In terms of security, the incidence of major complications and minor complications in patients undergoing BAE treatment was 0.2% (1/422) and 15.6%, respectively. CONCLUSIONS BAE was more effective than conservative treatment alone in controlling hemoptysis, reducing recurrence, and decreasing hemoptysis-related mortality, with an almost negligible risk of major complications.
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Affiliation(s)
- Shengxin Fan
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Xiaocheng Cheng
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Xiaohui Wang
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Yuliang Liu
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Wei He
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
| | - Hong Chen
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
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2
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Sheehan F, Graham A, Tait NP, Ind P, Alsafi A, Jackson JE. Bronchial artery embolization using small particles is safe and effective: a single center 12-year experience. Eur Radiol 2024:10.1007/s00330-024-10836-y. [PMID: 38861163 DOI: 10.1007/s00330-024-10836-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/21/2024] [Accepted: 05/04/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Bronchial artery embolization (BAE) using particles is an established treatment for hemoptysis. The use of polyvinyl alcohol (PVA) with a particle size of 300 µm or larger is thought to reduce the risk of non-target embolization but may result in more proximal vessel occlusion than is ideal, resulting in a high rate of early recurrent hemorrhage. OBJECTIVE This study evaluates the safety and efficacy of BAE using PVA particles with a size of less than 300 µm. METHODS All patients who underwent BAE between 2010 and 2022 at a tertiary center were included. Demographic data, etiology and volume of hemoptysis, technical and clinical success, procedure-related complications, and follow-up information were collected from patients' electronic records. 150-250 µm PVA particles were used to commence embolization in all patients with the subsequent use of larger-sized particles in some individuals. The Kaplan-Meier method was used to estimate recurrence and survival rates. RESULTS One hundred forty-four patients underwent 189 embolization procedures between 2010 and 2022 and were followed up for a median of 35 months [IQR 19-89]. 150 µm to 250 µm PVA particles were used as the sole embolic agent in 137 cases. Hemoptysis recurred within 30 days in 7%. The median time to repeat intervention was 144 days [IQR 42-441]. Seventeen out of 144 patients had a pulmonary artery branch pseudoaneurysm. The rate of major complications was 1% with no instances of stroke or spinal artery ischemia. Thirty-day mortality was 2% (4/189). CONCLUSION BAE using 150-250 µm PVA particles is safe and effective with few complications and low rates of early hemoptysis recurrence. CLINICAL RELEVANCE STATEMENT BAE using small particles is likely to improve outcomes, particularly the rate of early recurrence, in patients with hemoptysis, without an increase in procedural complications. KEY POINTS BAE is a safe and effective treatment for patients with hemoptysis. Using small PVA particles in BAE has few complications and low rates of early recurrence. Pulmonary artery pseudoaneurysms should be actively sought in those with hemoptysis undergoing BAE.
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Affiliation(s)
- Frances Sheehan
- Imaging Department, Imperial College Healthcare NHS Trust, London, UK
| | - Alison Graham
- Imaging Department, Imperial College Healthcare NHS Trust, London, UK
| | - N Paul Tait
- Imaging Department, Imperial College Healthcare NHS Trust, London, UK
| | - Philip Ind
- Department of Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Ali Alsafi
- Imaging Department, Imperial College Healthcare NHS Trust, London, UK.
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | - James E Jackson
- Imaging Department, Imperial College Healthcare NHS Trust, London, UK
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Fukamatsu F, Yamada A, Yamada K, Nonaka T, Aonuma T, Tsukahara Y, Kawakami S, Sasaki H, Fujinaga Y. Serial assessment of computed tomography angiography for pulmonary and systemic arteries using a reduced contrast agent dose for the diagnosis of systemic artery-to-pulmonary artery shunts. Jpn J Radiol 2024; 42:460-467. [PMID: 38148339 PMCID: PMC11056326 DOI: 10.1007/s11604-023-01520-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/23/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE To evaluate the diagnostic performance and feasibility of a modified computed tomography (CT) scan protocol, we performed a serial assessment of the computed tomography angiography for pulmonary artery (CTA-P) and systemic artery (CTA-S) (CTA-PS) using a reduced contrast agent dose to diagnose systemic artery-to-pulmonary artery shunts (SPSs). MATERIALS AND METHODS Twenty-five patients who underwent multiphase contrast-enhanced chest CT and conventional chest angiography were included. Three image sets (CTA-P, CTA-S, and CTA-PS) were evaluated by two board-certified radiologists. The visualization of the CT image findings associated with SPSs, such as filling defects and enhancement in the pulmonary arteries, was evaluated using a 5-point scale. RESULTS The diagnostic performance (sensitivity, specificity, and accuracy) of CT imaging findings associated with SPSs in CTA-P and CTA-PS were as follows: CTA-P, 57.1%, 87.5%, and 62.0%; CTA-PS, 81.0%, 100.0%, and 84.0%. CT findings associated with SPSs in CTA-P were significantly sensitive to the CTA-PS protocol. There were no significant differences between the CTA-S and CTA-PS protocols. The area under the curve (AUC) of the CT imaging findings associated with SPSs in the CTA-P and CTA-PS groups was 0.835 and 0.911, respectively (P = 0.191). The AUC of the CT imaging findings associated with SPSs in CTA-S and CTA-PS were 0.891 and 0.926, respectively (P = 0.373). CONCLUSION CTA-PS using a reduced contrast agent dose protocol could improve the overall diagnostic confidence of SPSs, owing to better visualization of CT imaging findings associated with SPSs compared to individual assessments of CTA-P or CTA-S. Therefore, CTA-PS can be used as an alternative preembolization evaluation modality to conventional angiography in patients with hemoptysis suspected of having SPSs.
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Affiliation(s)
- Fumiaki Fukamatsu
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Akira Yamada
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
| | - Keiichi Yamada
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Tomofumi Nonaka
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Takanori Aonuma
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Yoshinori Tsukahara
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Satoshi Kawakami
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Hiroyuki Sasaki
- Division of Radiology, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Yasunari Fujinaga
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
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4
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Xu HD, Yang L, Hu SB. Embosphere microspheres size for bronchial artery embolization in patients with hemoptysis caused by bronchiectasis: a retrospective comparative analysis of 500-750 versus 700-900 μm microspheres. BMC Pulm Med 2024; 24:203. [PMID: 38658883 PMCID: PMC11044458 DOI: 10.1186/s12890-024-03019-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 04/16/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Bronchial arterial embolization (BAE) has been accepted as an effective treatment for bronchiectasis-related hemoptysis. However, rare clinical trials compare different sizes of specific embolic agents. This study aims to evaluate whether different Embosphere microsphere sizes change the outcome of BAE. METHODS A retrospective review was conducted on consecutive patients with bronchiectatic hemoptysis who were scheduled to undergo BAE treatment during a period from January 2018 to December 2022. The patients received BAE using microspheres of different sizes: group A patients were treated with 500-750 μm microspheres, and group B patients were treated with 700-900 μm microspheres. The cost of embolic microspheres (Chinese Yuan, CNY), duration of hospitalization, complications, and hemoptysis-free survival were compared between patients in group A and those in group B. A Cox proportional hazards regression model was used to identify predictors of recurrent hemoptysis. RESULTS Median follow-up was 30.2 months (range, 20.3-56.5 months). The final analysis included a total of 112 patients (49-77 years of age; 45 men). The patients were divided into two groups: group A (N = 68), which received 500-750 μm Embosphere microspheres, and group B (N = 44), which received 700-900 μm Embosphere microspheres. Except for the cost of embolic microspheres(group A,5314.8 + 1301.5 CNY; group B, 3644.5 + 1192.3 CNY; p = 0.042), there were no statistically significant differences in duration of hospitalization (group A,7.2 + 1.4 days; group B, 8 + 2.4days; p = 0.550), hemoptysis-free survival (group A, 1-year, 2-year, 3-year, 85.9%, 75.8%, 62.9%; group B, 1-year, 2-year, 3-year, 88.4%, 81.2%,59.4%;P = 0.060), and complications(group A,26.5%; group B, 38.6%; p = 0.175) between the two groups. No major complications were observed. The multivariate analysis results revealed that the presence of cystic bronchiectasis (OR 1.61, 95% CI 1.12-2.83; P = 0.001) and systemic arterial-pulmonary shunts (SPSs) (OR 1.52, 95% CI 1.10-2.72; P = 0.028) were independent risk factors for recurrent bleeding. CONCLUSIONS For the treatment of BAE in patients with bronchiectasis-related hemoptysis, 500-750 μm diameter Embosphere microspheres have a similar efficacy and safety profile compared to 700-900 μm diameter Embosphere microspheres, especially for those without SPSs or cystic bronchiectasis. Furthermore, the utilization of large-sized (700-900 μm) Embosphere microspheres is associated with the reduced cost of an embolic agent.
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Affiliation(s)
- Hong-Dou Xu
- Department of Interventional Radiology, Gaochun Peoples Hospital Affiliated to Jiangsu University, 53 Maoshan Road, Gaochun District, Nanjing, 211302, Jiangsu, China
| | - Liang Yang
- Department of Interventional Radiology, Gaochun Peoples Hospital Affiliated to Jiangsu University, 53 Maoshan Road, Gaochun District, Nanjing, 211302, Jiangsu, China
| | - Shi-Bing Hu
- Department of Interventional Radiology, Gaochun Peoples Hospital Affiliated to Jiangsu University, 53 Maoshan Road, Gaochun District, Nanjing, 211302, Jiangsu, China.
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5
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Parrot A, Canellas A, Barral M, Gibelin A, Cadranel J. [Severe hemoptysis in the onco-hematology patient]. Rev Mal Respir 2024; 41:303-316. [PMID: 38155073 DOI: 10.1016/j.rmr.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 11/04/2023] [Indexed: 12/30/2023]
Abstract
In France, even though it occurs only exceptionally in cases of hemopathy, severe hemoptysis in cancer is the leading cause of hemoptysis. Without adequate treatment, in-hospital mortality exceeds 60%, even reaching 100% at 6 months. The management of severe hemoptysis should be discussed with the oncologist. Aside from situations of threatening hemoptysis, in which bronchoscopy should be performed immediately, CT angiography is an essential means of localizing the bleeding and determining the causes and the vascular mechanisms involved. In more than 90% of cases, hemoptysis is linked to systemic bronchial or non-bronchial hypervascularization, whereas in fewer than 5%, it is associated with pulmonary arterial origin or, exceptionally, with damage to the alveolar-capillary barrier. The most severely ill patients must be treated in intensive care in centers equipped with interventional radiology, thoracic surgery and, ideally, with interventional bronchoscopy. Interventional radiology is the first-line symptomatic treatment. In over 80% of cases, bronchial arteriography with embolization allows immediate control. Emergency surgery should be avoided, as it is associated with significant mortality. Appropriate and adequate care reduces hospital mortality to 30%, enabling patients to benefit from the most recent, survival-prolonging treatments.
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Affiliation(s)
- A Parrot
- Service de pneumologie et oncologie thoracique, Assistance publique-Hôpitaux de Paris, hôpital Tenon, Sorbonne université, 75970 Paris, France.
| | - A Canellas
- Service de pneumologie et oncologie thoracique, Assistance publique-Hôpitaux de Paris, hôpital Tenon, Sorbonne université, 75970 Paris, France
| | - M Barral
- Service de radiologie, Assistance publique-Hôpitaux de Paris, hôpital Tenon, Sorbonne université, 75970 Paris, France; UFR médecine, Sorbonne université, 75006 Paris, France
| | - A Gibelin
- Service de médecine intensive et réanimation, Assistance publique-Hôpitaux de Paris, hôpital Tenon, Sorbonne université, 75970 Paris, France
| | - J Cadranel
- Service de pneumologie et oncologie thoracique, Assistance publique-Hôpitaux de Paris, hôpital Tenon, Sorbonne université, 75970 Paris, France; UFR médecine, Sorbonne université, 75006 Paris, France
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Samadi Takaldani AH, Javanshir N, Mansour A, Salmani A, Negaresh M. Pulmonary apoplexy following severe mitral valve stenosis: A case report. Respir Med Case Rep 2024; 48:101997. [PMID: 38496782 PMCID: PMC10940169 DOI: 10.1016/j.rmcr.2024.101997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/09/2024] [Accepted: 02/21/2024] [Indexed: 03/19/2024] Open
Abstract
Hemoptysis is a common clinical symptom in emergency patients. It is characterized by the discharge of bloody sputum, which originates from the lower respiratory tract. In the majority of cases, this event is self-limiting, and only in less than 5% of cases, it is massive. Mitral valve stenosis is an uncommon cause of hemoptysis, with a prevalence of 4.2%. In rare cases of this condition, massive and sudden hemoptysis occurs, which is called pulmonary apoplexy. Here, a 35-year-old woman with a history of mitral valve stenosis is introduced who was referred to the hospital with a complaint of massive hemoptysis and sudden shortness of breath. According to the history of mitral valve stenosis, the patient was diagnosed with pulmonary apoplexy. After treatment, both the imaging findings and the patient's symptoms resolved within a short period of time. Even though pulmonary apoplexy is often severe, it can still respond well to conservative treatments and may indicate a need for immediate attention to the stenosis of the mitral valve.
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Affiliation(s)
- Ali Hossein Samadi Takaldani
- Department of Internal Medicine (Pulmonology Division), School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Nima Javanshir
- Faculty of Medicine, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Amirpasha Mansour
- Department of Anesthesiology and Pain Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Asma Salmani
- Department of Internal Medicine, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mohammad Negaresh
- Department of Internal Medicine, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
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7
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Claudinot A, Douane F, Morla O, Perret C, Neveu M, Thouveny F, Bouvier A, Hureaux J, Le Guen A, Jouan J, Heautot JF, Larralde A, Cerasuolo D, Bergot E, Fohlen A, Pelage JP. Pulmonary Artery Embolization in the Management of Hemoptysis Related to Lung Tumors. J Pers Med 2023; 13:1597. [PMID: 38003912 PMCID: PMC10672290 DOI: 10.3390/jpm13111597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/04/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
(1) Background: Bronchial artery embolization has been shown to be effective in the management of neoplastic hemoptysis. However, knowledge of pulmonary artery embolization is lacking. The aim of this study was to evaluate the safety and efficacy of pulmonary artery embolization in patients presenting with hemoptysis related to lung tumors. (2) Methods: This retrospective study reviewed all consecutive patients with cancer and at least one episode of hemoptysis that required pulmonary artery embolization from December 2008 to December 2020. The endpoints of the study were technical success, clinical success, recurrence of hemoptysis and complications. (3) Results: A total of 92 patients were treated with pulmonary artery embolization (63.1 years ± 9.9; 70 men). Most patients had stage III or IV advanced disease. Pulmonary artery embolization was technically successful in 82 (89%) patients and clinically successful in 77 (84%) patients. Recurrence occurred in 49% of patients. Infectious complications occurred in 15 patients (16%). The 30-day mortality rate was 31%. At 3 years, the survival rate was 3.6%. Tumor size, tumor cavitation and necrosis and pulmonary artery pseudoaneurysm were significantly associated with recurrence and higher mortality. (4) Conclusions: Pulmonary artery embolization is an effective treatment to initially control hemoptysis in patients with lung carcinoma, but the recurrence rate remains high and overall survival remains poor.
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Affiliation(s)
- Amandine Claudinot
- Department of Radiology, CHU de Caen, 14000 Caen, France; (A.F.); (J.-P.P.)
| | - Frédéric Douane
- Department of Radiology, CHU de Nantes, 44000 Nantes, France; (F.D.); (O.M.); (C.P.); (M.N.)
| | - Olivier Morla
- Department of Radiology, CHU de Nantes, 44000 Nantes, France; (F.D.); (O.M.); (C.P.); (M.N.)
| | - Christophe Perret
- Department of Radiology, CHU de Nantes, 44000 Nantes, France; (F.D.); (O.M.); (C.P.); (M.N.)
| | - Marine Neveu
- Department of Radiology, CHU de Nantes, 44000 Nantes, France; (F.D.); (O.M.); (C.P.); (M.N.)
| | - Francine Thouveny
- Department of Radiology, CHU d’Angers, 49933 Angers, France; (F.T.); (A.B.); (J.H.)
| | - Antoine Bouvier
- Department of Radiology, CHU d’Angers, 49933 Angers, France; (F.T.); (A.B.); (J.H.)
| | - José Hureaux
- Department of Radiology, CHU d’Angers, 49933 Angers, France; (F.T.); (A.B.); (J.H.)
| | - Arnaud Le Guen
- Department of Radiology, Centre Hospitalier Bretagne Atlantique, 56000 Vannes, France; (A.L.G.); (J.J.)
| | - Jérémy Jouan
- Department of Radiology, Centre Hospitalier Bretagne Atlantique, 56000 Vannes, France; (A.L.G.); (J.J.)
| | | | - Antoine Larralde
- Department of Radiology, CHU de Rennes, 35000 Rennes, France; (J.-F.H.); (A.L.)
| | - Damiano Cerasuolo
- Department of Biostatistics and Clinical Research, CHU de Caen, 14000 Caen, France
| | - Emmanuel Bergot
- Department of Pulmonology and Respiratory Disease, CHU de Caen, 14000 Caen, France;
| | - Audrey Fohlen
- Department of Radiology, CHU de Caen, 14000 Caen, France; (A.F.); (J.-P.P.)
- Normandy University, UNICAEN, CEA, CNRS, ISTCT-CERVOxy, 14000 Caen, France
| | - Jean-Pierre Pelage
- Department of Radiology, CHU de Caen, 14000 Caen, France; (A.F.); (J.-P.P.)
- Normandy University, UNICAEN, CEA, CNRS, ISTCT-CERVOxy, 14000 Caen, France
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Le Tat T, Carlier R, Zhang N, Bouchet A, Amar R, Zhou J, El Hajjam M. Endovascular Management of Life-Threatening Hemoptysis in Primary Lung Cancer: A Retrospective Study. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03488-w. [PMID: 37311841 DOI: 10.1007/s00270-023-03488-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/29/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the efficacy and safety of endovascular treatment of hemoptysis caused by primary lung cancer. METHODS We conducted a single-center retrospective study (2005-2021), including patients who underwent thoracic embolization for life-threatening hemoptysis complication of lung cancer. Exclusion criteria were hemoptysis caused by a benign lung tumor or by a lung metastasis of a primary non-lung tumor. Depending on the origin of the bleeding, determined by CT-angiography, systemic arteries were treated with microspheres or coils, and pulmonary arteries with coils, plugs or covered stents. Outcomes were assessed from patients' medical records in April 2022. Primary endpoints were clinical success at one month and at one year. Secondary endpoints were incidence of complications, 1 year overall survival, and relative risk of recurrence of hemoptysis. Survival was compared with a log-rank test. RESULTS Sixty-two patients underwent 68 systemic artery embolizations and 14 pulmonary artery procedures. Clinical success defined as cessation of hemoptysis without any recurrence was 81% at one month and 74% at one year. Three major complications occurred: spinal cord ischemia, stroke, and acute pancreatitis. 5% of patient died from hemoptysis. One-year overall survival was 29% and was significantly higher in patients without hemoptysis recurrence when compared to patients with recurring hemoptysis (p = 0.021). In univariate analysis, recurrence of hemoptysis at one year was associated with massive hemoptysis (RR = 2.50; p = 0.044) and with tumor cavitation (RR = 2.51; p = 0.033). CONCLUSION Endovascular treatment for primary lung cancer-related hemoptysis is effective but not uneventful.
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Affiliation(s)
- Thomas Le Tat
- Imaging Department, Ambroise Paré Hospital (AP-HP), 9 Av. Charles de Gaulle, 92100, Boulogne-Billancourt, France.
| | - Robert Carlier
- Imaging Department, Ambroise Paré Hospital (AP-HP), 9 Av. Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Norbert Zhang
- Imaging Department, Ambroise Paré Hospital (AP-HP), 9 Av. Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Antoine Bouchet
- Imaging Department, Ambroise Paré Hospital (AP-HP), 9 Av. Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Raphaël Amar
- Imaging Department, Ambroise Paré Hospital (AP-HP), 9 Av. Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Jeffery Zhou
- Imaging Department, Ambroise Paré Hospital (AP-HP), 9 Av. Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Mostafa El Hajjam
- Imaging Department, Ambroise Paré Hospital (AP-HP), 9 Av. Charles de Gaulle, 92100, Boulogne-Billancourt, France
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9
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Fu Z, Guo J, Huang Q, Li D, Zhou H, Tan C, Sun P, Qin J, Xie Y, Zhang X, Chen H. Efficacy and Safety of Drug-Eluting Beads Bronchial Arterial Chemoembolization in Treating Patients with Lung Cancer Who Were Complicated with Hemoptysis. Cancer Biother Radiopharm 2023; 38:347-352. [PMID: 33052699 DOI: 10.1089/cbr.2020.3954] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: This study explored the effectiveness and safety of drug-eluting beads bronchial arterial chemoembolization (DEB-BACE) in patients with lung cancer who were complicated with hemoptysis. Materials and Methods: In total, 11 patients with lung cancer who were complicated with hemoptysis and underwent DEB-BACE treatment were analyzed. Clinical success was defined as no hemoptysis or reduction of hemoptysis volume >50% after treatment. Hemoptysis recurrence was recorded, and overall survival (OS) was calculated. Results: After DEB-BACE treatment, the clinical and technical success was 100%: in detail, 10 (90.0%) patients presented with no hemoptysis and 1 (9.1%) patient exhibited a reduction of hemoptysis volume >50%. Regarding the prognosis, 1 (9.1%) patient had hemoptysis recurrence at 46 d after DEB-BACE treatment. Furthermore, 4 (36.4%) patients died (1 [9.1%] patient died of nonhemoptysis asphyxia; 1 [9.1%] patient died of massive gastrointestinal hemorrhage; 1 [9.1%] patient died of respiratory failure; and 1 [9.1%] patient died of hemoptysis recurrence). Additionally, the mean OS in total patients was 14.2 (95% confidence interval: 8.2-20.3) months. As to adverse events, 1 (9.1%) patient showed high fever, 2 (18.2%) patients exhibited low fever, and 1 (9.1%) patient suffered from chest pain. Conclusions: DEB-BACE can be considered an effective and safe treatment in treating hemoptysis in patients with lung cancer.
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Affiliation(s)
- Zhigang Fu
- Department of Radiology, Yichang Central People's Hospital, First College of Clinical Medical Science, China Three Gorges University, Yichang, China
| | - Jianqiang Guo
- Department of Radiology, Yichang Central People's Hospital, First College of Clinical Medical Science, China Three Gorges University, Yichang, China
| | - Qiao Huang
- Department of Radiology, Yichang Central People's Hospital, First College of Clinical Medical Science, China Three Gorges University, Yichang, China
| | - Daojun Li
- Department of Radiology, Yichang Central People's Hospital, First College of Clinical Medical Science, China Three Gorges University, Yichang, China
| | - Haibo Zhou
- Department of Radiology, Yichang Central People's Hospital, First College of Clinical Medical Science, China Three Gorges University, Yichang, China
| | - Chenhong Tan
- Department of Radiology, People's Hospital of Changyang County, Changyang, China
| | - Peng Sun
- Department of Radiology, People's Hospital of Changyang County, Changyang, China
| | - Jingxia Qin
- Department of Radiology, Yichang Central People's Hospital, First College of Clinical Medical Science, China Three Gorges University, Yichang, China
| | - Yingchun Xie
- Department of Radiology, Yichang Central People's Hospital, First College of Clinical Medical Science, China Three Gorges University, Yichang, China
| | - Xiaolin Zhang
- Department of Radiology, Yichang Central People's Hospital, First College of Clinical Medical Science, China Three Gorges University, Yichang, China
| | - Hua Chen
- Department of Radiology, Yichang First People's Hospital, Yichang, China
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10
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Herrera DG, Ostad BJ, Wilkins LR, Sheeran DP, Park AW, Goode AR, Patrie JT, Angle JF. Effect of computed tomography angiography prior to bronchial embolization on radiation dose and recurrent hemoptysis. Clin Imaging 2023; 100:48-53. [PMID: 37207442 DOI: 10.1016/j.clinimag.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/10/2023] [Accepted: 04/13/2023] [Indexed: 05/21/2023]
Abstract
PURPOSE To investigate whether pre-procedure Computed Tomography Angiography (CTA) improves radiation exposure, procedure complexity, and symptom recurrence after bronchial embolization for massive hemoptysis. MATERIAL AND METHODS A single-center retrospective review of bronchial artery embolization (BAE) for massive hemoptysis was performed for procedures between 2008 and 2019. Multi-variate analysis was performed to determine the significance of pre-procedure CTA and etiology of hemoptysis on patient radiation exposure (reference point air kerma, RPAK) and rate of recurrent hemoptysis. RESULTS There were 61 patients (mean age 52.5 years; SD = 19.2 years, and 57.3% male) and CTA was obtained for 42.6% (26/61). Number of vessels selected was a mean of 7.2 (SD = 3.4) in those without CTA and 7.4 (SD = 3.4) in those with CTA (p = 0.923). Mean procedure duration was 1.8 h (SD = 1.6 h) in those without CTA and 1.3 h (SD = 1.0 h) in those with CTA (p = 0.466). Mean fluoroscopy time and RPAK per procedure were 34.9 min (SD = 21.5 min) and 1091.7 mGy (SD = 1316.6 mGy) for those without a CTA and 30.7 min (SD = 30.7 min) and 771.5 mGy (SD = 590.0 mGy) for those with a CTA (p = 0.523, and p = 0.879, respectively). Mean total iodine given was 49.2 g (SD = 31.9 g) for those without a CTA and 70.6 g (SD = 24.9 g) for those with a CTA (p = 0.001). Ongoing hemoptysis at last clinical follow up was 13/35 (37.1%) in those without CTA and 9/26 (34.6%) in those with CTA (p = 0.794). CONCLUSIONS Pre-procedure CTA did not improve radiation effective dose and symptom recurrence after BAE and is associated with significant increases in total iodine dose.
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Affiliation(s)
- Daniel Giraldo Herrera
- University of Virginia Health System, Department of Radiology and Medical Imaging, Division of Interventional Radiology, United States of America.
| | - Bahrom J Ostad
- University of Virginia Health System, Department of Radiology and Medical Imaging, Division of Interventional Radiology, United States of America
| | - Luke R Wilkins
- University of Virginia Health System, Department of Radiology and Medical Imaging, Division of Interventional Radiology, United States of America
| | - Daniel P Sheeran
- University of Virginia Health System, Department of Radiology and Medical Imaging, Division of Interventional Radiology, United States of America
| | - Auh Whan Park
- University of Virginia Health System, Department of Radiology and Medical Imaging, Division of Interventional Radiology, United States of America
| | - Allen R Goode
- University of Virginia Health System, Department of Radiology and Medical Imaging, Division of Diagnostic Medical Physics, United States of America
| | - James T Patrie
- University of Virginia School of Medicine, Department of Public Health Sciences, United States of America
| | - John F Angle
- University of Virginia Health System, Department of Radiology and Medical Imaging, Division of Interventional Radiology, United States of America
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11
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Onishi Y, Shimizu H, Ando S, Kawamura H, Onishi M, Taniguchi T, Isoda H, Nakamoto Y. Transcatheter arterial embolization of the subclavian and axillary artery branches for hemorrhage control. Br J Radiol 2023; 96:20221132. [PMID: 36745129 PMCID: PMC10161924 DOI: 10.1259/bjr.20221132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/16/2023] [Accepted: 01/24/2023] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To evaluate the effectiveness and safety of transcatheter arterial embolization (TAE) of the branches of the subclavian and axillary arteries for hemorrhage control. METHODS Between January 2015 and June 2022, 35 TAE procedures were performed for hemorrhage from the branches of the subclavian and axillary arteries in 34 patients (22 men, 12 women; 1 male underwent TAE twice; mean age = 76 years). Pre-TAE CT showed hematomas in the chest (n = 25) and abdominal walls (n = 3), shoulder (n = 2), and lower neck (n = 2). CT showed hemothorax in eight cases. Angiographic findings, embolization technique, and technical and clinical success of TAE were retrospectively assessed in all cases. RESULTS TAE was performed by transfemoral (n = 16), transradial (n = 12), and transbrachial (n = 7) approaches. Angiography revealed contrast media extravasation or pseudoaneurysms in 32 cases (91.4%). The most commonly embolized arteries were the internal thoracic (n = 12), lateral thoracic (n = 6), and thoracoacromial (n = 6) arteries. Technical and clinical success rates were 100 and 85.7%, respectively. A complication (skin necrosis after injection of the liquid embolic agent) developed in only one patient (2.9%) and was conservatively managed. CONCLUSION TAE is an effective and safe treatment for hemorrhage from the branches of the subclavian and axillary arteries. ADVANCES IN KNOWLEDGE Transfemoral approach has been used for TAE of the branches of the subclavian and axillary artery. Transradial and transbrachial approaches can also be considered.
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Affiliation(s)
- Yasuyuki Onishi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hironori Shimizu
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Saya Ando
- Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Hitomi Kawamura
- Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | | | | | - Hiroyoshi Isoda
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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12
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Yan HT, Lu GD, Zhang JX, Zhou CG, Liu J, Liu S, Shi HB, Zu QQ. Comparison of Bronchial Artery Embolisation Versus Conservative Treatment for Bronchiectasis-Related Nonmassive Haemoptysis: A Single-Centre Retrospective Study. Cardiovasc Intervent Radiol 2023; 46:369-376. [PMID: 36658375 DOI: 10.1007/s00270-023-03361-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To compare the safety and effectiveness between bronchial artery embolisation (BAE) and conservative treatment for bronchiectasis-related nonmassive haemoptysis patients. MATERIALS AND METHODS From January 2015 to December 2020, consecutive bronchiectasis-related nonmassive haemoptysis patients who underwent either BAE (n = 98) or conservative treatment (n = 118) were included. Treatment-related complications, length of hospital stays, clinical success rate, patient satisfaction, and recurrence-free survival rates were compared between groups. Prognostic factors related to recurrence were also analysed. RESULTS During a median follow-up time of 44.8 months (range, 2.4-83.6 months), 34 and 66 patients in the BAE and conservative treatment groups suffered relapse. The 1-year, 2-year, 3-year and 5-year haemoptysis-free survival rates in the BAE and conservative treatment groups were 79.2%, 68.1%, 62.8%, and 57.6% and 64.0%, 52.8%, 44.1%, and 37.0%, respectively (P = 0.007). The minor complication rate after BAE was higher than that after conservative treatment (23/98 vs. 12/118, P = 0.008). BAE was associated with shorter hospital stays (5.0 vs. 7.0 days, P = 0.042) and higher patient satisfaction (88.8% vs. 74.6%, P = 0.008) than those for conservative treatment and with comparable clinical success rates (95.9% vs. 91.5%, P = 0.192). Treatment type, haemoptysis duration, and bronchiectasis severity were independently significant predictors of recurrence for these patients. CONCLUSIONS BAE could be another option for bronchiectasis-related nonmassive haemoptysis patients. In the patients with longer duration and more severe bronchiectasis, BAE still appeared to have better long-term haemoptysis control than conservative therapy.
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Affiliation(s)
- Hai-Tao Yan
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, 210029, China
| | - Guang-Dong Lu
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, 210029, China
| | - Jin-Xing Zhang
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, 210029, China
| | - Chun-Gao Zhou
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, 210029, China
| | - Jin Liu
- Department of Clinical Medicine Research Institution, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Sheng Liu
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, 210029, China
| | - Hai-Bin Shi
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, 210029, China
| | - Qing-Quan Zu
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, 210029, China.
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13
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Zhou S, Zhang J, Meng X, Meng Y, Han X. Case Report: Bronchial artery embolization and chemoradiotherapy for central squamous cell lung carcinoma with rapid regression. Front Oncol 2022; 12:1026087. [PMID: 36591505 PMCID: PMC9795177 DOI: 10.3389/fonc.2022.1026087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022] Open
Abstract
Background Interventional embolization is a common treatment for hemoptysis, one of the complications of lung cancer. However, there are no official guidelines for the use of this method in antitumor therapy. Case Description Herein, we describe a case of a patient who was pathologically diagnosed as central squamous cell lung cancer. The patient received chemotherapy, interventional embolization and radiotherapy successively. The tumor regressed rapidly within 48 hours of receipt of interventional embolization. Furthermore, the tumor decreased by more than 50% in size within 7 days during radiotherapy. Unfortunately, the patient has since developed lymph node metastases and remains under treatment. Conclusions Thus, finding the suitable blood vessel embolized may be a suitable option to reduce the local tumor load and can be considered as antitumor therapy in combination with other treatments. The patient's theoretical hypoxia state after interventional therapy still produced a good tumor regression after radiotherapy. However, so far, no related studies have reported the changes of tumor immune microenvironment in human body after intervention and radiotherapy.
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Affiliation(s)
- Siqi Zhou
- Department of Oncology, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Jianxin Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Xue Meng
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Yingtao Meng
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China,*Correspondence: Xiao Han, ; Yingtao Meng,
| | - Xiao Han
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China,*Correspondence: Xiao Han, ; Yingtao Meng,
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14
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Barrot V, Pellerin O, Reverdito G, Sapoval M, Boeken T. Ruptured pulmonary artery pseudoaneurysm treated with stent graft: case report and literature review. CVIR Endovasc 2022; 5:59. [PMID: 36417019 PMCID: PMC9684381 DOI: 10.1186/s42155-022-00339-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 11/10/2022] [Indexed: 11/24/2022] Open
Abstract
Background Hemoptysis is a severe condition, associated with a high mortality rate from asphyxiation. Less than 5% of cases come from the pulmonary arterial circulation and large pseudoaneurysm are rarely treatable by stent graft. Case presentation We present the case of a 74-year-old man who suffered from a new onset of hemoptysis despite a prior bronchial artery embolization. He underwent a rescue endovascular stent graft placement for a massive hemoptysis caused by a ruptured proximal pulmonary artery pseudoaneurysm. A short review of similar situations is provided. Conclusion Salvage endovascular stent graft placement for a massive hemoptysis caused by a ruptured proximal pulmonary artery pseudoaneurysm is a viable salvage technique for life-threatening hemoptysis.
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15
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Lu GD, Yan HT, Zhang JX, Liu S, Shi HB, Zu QQ. Bronchial artery embolization for the management of frequent hemoptysis caused by bronchiectasis. BMC Pulm Med 2022; 22:394. [PMID: 36319977 PMCID: PMC9624090 DOI: 10.1186/s12890-022-02198-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022] Open
Abstract
Background To retrospectively evaluate the effectiveness of bronchial artery embolization (BAE) compared with conservative therapy for the treatment of frequent hemoptysis caused by bronchiectasis. Methods From January 2015 to December 2019, consecutive patients who were admitted due to frequent (more than three times per year) bronchiectasis-related hemoptysis were retrospectively reviewed. Those who were treated with either BAE (n = 69) or conservative therapy (n = 47) were enrolled for analysis. The technical success, clinical success, and complications of the BAE procedure were evaluated. Long-term hemoptysis-free survival rates and clinical success were compared between patients in the BAE group and patients in the conservative group. A Cox proportional hazard regression model was used to identify the predictors of recurrent hemoptysis. Results The technical success rate was 100% for the BAE procedure, and clinical success was achieved in 92.8% (64 of 69) of cases. No major procedure-related complications occurred, and minor complications were observed in 16 cases (23.2%). The 1-, 2-, and 3-year hemoptysis-free survival rates were 88.3, 71.3, and 66.2%, respectively, for the BAE group and 31.9, 17.6, and 2.5%, respectively, for the conservative treatment group (P < 0.001). Multivariate analysis showed that BAE was a protective factor against recurrent hemoptysis in treated patients. In addition, the presence of cystic bronchiectasis was the only independent risk factor for rebleeding in the whole population and in the BAE group. Conclusions BAE may provide an effective option for patients with frequent bronchiectasis-related hemoptysis, especially for those without cystic bronchiectasis. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-02198-2.
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Affiliation(s)
- Guang-Dong Lu
- grid.412676.00000 0004 1799 0784Department of Interventional Radiology, the First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029 Jiangsu China
| | - Hai-Tao Yan
- grid.412676.00000 0004 1799 0784Department of Interventional Radiology, the First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029 Jiangsu China
| | - Jin-Xing Zhang
- grid.412676.00000 0004 1799 0784Department of Interventional Radiology, the First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029 Jiangsu China
| | - Sheng Liu
- grid.412676.00000 0004 1799 0784Department of Interventional Radiology, the First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029 Jiangsu China
| | - Hai-Bin Shi
- grid.412676.00000 0004 1799 0784Department of Interventional Radiology, the First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029 Jiangsu China
| | - Qing-Quan Zu
- grid.412676.00000 0004 1799 0784Department of Interventional Radiology, the First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029 Jiangsu China
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16
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Kaur H, Pandhi N, Kajal NC. A prospective study of the clinical profile of hemoptysis and its correlation with radiological and microbiological findings. Int J Mycobacteriol 2022; 11:394-399. [PMID: 36510924 DOI: 10.4103/ijmy.ijmy_137_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background The etiological pattern of hemoptysis has evolved, with pulmonary tuberculosis (PTB) becoming less prevalent as a cause. There is a paucity of literature regarding the spectrum of diseases that present as hemoptysis and the data related to detailed clinical profile are lacking. Hence, this study is taken up to determine the clinical profile of hemoptysis and its correlation with radiological and microbiological findings. Methods This was a 3-year observational prospective study of a total of 50 patients who presented with active hemoptysis. Data were recorded from these patients for assessing the clinical characteristics, radiological, and microbiological correlation. Results The most common etiologies of hemoptysis identified in this study were PTB in 60% of the patients, aspergilloma in 14%, followed by bronchiectasis in 8%, pneumonia in 8%, carcinoma lung in 4%, and lung abscess in 1 (2%). Mild hemoptysis was present in 8% of patients, whereas 42% had moderate hemoptysis, 18% of patients had severe, and 32% had massive hemoptysis. Sixty percent of patients had recurrent hemoptysis, and the majority of the patients, i.e., 68% tested negative on sputum smear examination for acid-fast bacillus. In 60% of patients, no growth was obtained in the sputum cultures. The most common organisms isolated from sputum cultures of the rest of the patients were Pseudomonas in 14%, Klebsiella in 10%, Escherichia coli in 4%, Staphylococci in 4%, and Streptococcus pneumoniae in 4% of the cases. The majority of the patients were having consolidation and cavitary disease. A highly significant correlation was noted between the radiological findings of consolidation, mycetoma, cystic shadows, lung mass, and lung abscess and the etiology of hemoptysis (P = 0.000). Conclusion Hemoptysis of any volume implies a life-threatening process, which mandates immediate evaluation and treatment. It is evident that the etiological spectrum of hemoptysis is continuously changing, and more sophisticated investigations, better imaging techniques, bronchoscopic tools, availability of newer techniques in the developing world, and changing patterns of diseases, all contribute to these changes. Identification of the etiology, and localization of the bleeding site, is essential for the efficient management of hemoptysis.
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Affiliation(s)
- Harveen Kaur
- Department of Pulmonary Medicine, Government Medical College, Amritsar, Punjab, India
| | - Naveen Pandhi
- Department of Pulmonary Medicine, Government Medical College, Amritsar, Punjab, India
| | - N C Kajal
- Department of Pulmonary Medicine, Government Medical College, Amritsar, Punjab, India
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17
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Kim S, Kim JH, Ko GY, Gwon DI, Shin JH, Yoon HK. Bronchial artery embolization for hemoptysis caused by metastatic hepatocellular carcinoma. Sci Rep 2022; 12:6906. [PMID: 35484185 PMCID: PMC9050675 DOI: 10.1038/s41598-022-10972-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/12/2022] [Indexed: 12/21/2022] Open
Abstract
Because of its extremely rare incidence, the safety and efficacy of bronchial artery embolization (BAE) for the treatment of hemoptysis caused by pulmonary metastasis from HCC are not well known. We therefore evaluated the safety and efficacy of BAE in these patients. Data from 18 patients with hepatocellular carcinoma (HCC) and pulmonary metastasis who received BAE for the treatment of hemoptysis between 2003 and 2021 were retrospectively reviewed. Technical and clinical success were achieved in 100% and 94% of patients, respectively. Of the 18 embolization procedures, six were performed using polyvinyl alcohol (PVA) particles only, five were performed using gelfoam only, three were performed using gelfoam plus microcoils, one was performed using PVA plus microcoils, one was performed using embospheres, one was performed using lipiodol plus PVA and gelfoam, and one was performed using hystoacryl with microballoon protection. In eight patients for whom CT just before BAE and at follow-up were available, the mean size of the largest metastatic tumor decreased from 5.1 to 3.7 cm (P = 0.035). Hemoptysis recurred in three patients (17%) during follow-up. The median overall and hemoptysis-free survival periods were 149 days and 132 days, respectively. BAE is an effective and safe option for the treatment of hemoptysis in patients with pulmonary metastasis from HCC, with a favorable clinical success rate and a low rate of hemoptysis recurrence. In addition, we also observed BAE to have a positive antitumor effect on pulmonary metastases from HCC, but this requires confirmation in a future study.
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Affiliation(s)
- Sungwon Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Jin Hyoung Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea.
| | - Gi-Young Ko
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Dong Il Gwon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Hyun-Ki Yoon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
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18
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Kettenbach J, Ittrich H, Gaubert JY, Gebauer B, Vos JA. CIRSE Standards of Practice on Bronchial Artery Embolisation. Cardiovasc Intervent Radiol 2022; 45:721-732. [PMID: 35396612 PMCID: PMC9117352 DOI: 10.1007/s00270-022-03127-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 01/24/2022] [Indexed: 01/21/2023]
Abstract
This CIRSE Standards of Practice document is aimed at interventional radiologists and provides best practices for performing bronchial artery embolisation to effectively treat haemoptysis. It has been developed by an expert writing group established by the CIRSE Standards of Practice Committee.
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Affiliation(s)
- Joachim Kettenbach
- Landesklinikum Wiener Neustadt, Institute of Diagnostics, Interventional Radiology and Nuclear Medicine, Wiener Neustadt, Austria.
| | - Harald Ittrich
- Department of Diagnostic and Interventional Radiology, Schoen Clinic Hamburg Eilbek, Hamburg, Germany
| | - Jean Yves Gaubert
- Department of Radiology, Timone University Hospital, Marseille, France.,Laboratory of Experimental Interventional Imaging, Aix-Marseille University, Marseille, France
| | - Bernhard Gebauer
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Albert Vos
- Department of Interventional Radiology, St Antonius Hospital, Nieuwegein, Utrecht, The Netherlands
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19
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Morimura F, Hamamoto K, Edo H, Ishida O, Tsustsumi K, Tamada S, Kuwamura H, Enjoji Y, Suyama Y, Sugiura H, Watanabe S, Ozaki I, Shinmoto H. Treatment of massive hemoptysis after thoracic aortic aneurysm repair. CVIR Endovasc 2022; 5:17. [PMID: 35290529 PMCID: PMC8924344 DOI: 10.1186/s42155-022-00293-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background Massive hemoptysis after thoracic aortic aneurysm (TAA) repair is a rare but potentially lethal condition. Endovascular management is a challenging treatment option due to the complexity of culprit vessel access. Case presentation An 81-year-old woman was referred to our hospital with massive hemoptysis. She had a history of graft replacement and thoracic endovascular aortic repair (TEVAR) for dissecting TAA. Computed tomography (CT) showed massive atelectasis with hematoma in the left lower lung lobe adjacent to the descending aortic aneurysm treated with TEVAR. Contrast-enhanced CT revealed a pseudoaneurysm and proliferation of abnormal vessels at the peripheral side of the left pulmonary ligament artery (PLA) in the atelectasis. The PLA continued to the right subscapular artery via a complex collateral pathway. Diagnostic angiography of the right subcapsular artery revealed a pseudoaneurysm and abnormal vessels at the peripheral side of the left PLA with a systemic-pulmonary artery shunt. Transcatheter arterial embolization (TAE) for the left PLA via the collateral pathway with N-butyl cyanoacrylate achieved complete embolization. The patient’s hemoptysis was controlled and she was discharged. Conclusions Here we presented a case of massive hemoptysis due to PLA disruption that occurred after TAA repair. TAE via a complex collateral pathway is a feasible and effective treatment for hemoptysis, even in patients who have undergone surgical or endovascular TAA repair.
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Affiliation(s)
- Fumio Morimura
- Department of Radiology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Kohei Hamamoto
- Department of Radiology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan.
| | - Hiromi Edo
- Department of Radiology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Osamu Ishida
- Department of Cardiovascular Surgery, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Koji Tsustsumi
- Department of Cardiovascular Surgery, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Soichiro Tamada
- Department of Radiology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Hiroshi Kuwamura
- Department of Radiology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Yasuhiro Enjoji
- Department of Radiology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Yohsuke Suyama
- Department of Radiology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Hiroaki Sugiura
- Department of Radiology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Sadahiro Watanabe
- Department of Radiology, Japan Self-Defense Forces Central Hospital, 1-2-24, Ikejiri, Setagaya-ku, 154-0001, Tokyo, Japan
| | - Ippei Ozaki
- Department of Radiology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
| | - Hiroshi Shinmoto
- Department of Radiology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan
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Haemoptysis in Pulmonary Arterial Hypertension Associated with Congenital Heart Disease: Insights on Pathophysiology, Diagnosis and Management. J Clin Med 2022; 11:jcm11030633. [PMID: 35160084 PMCID: PMC8836348 DOI: 10.3390/jcm11030633] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 12/12/2022] Open
Abstract
Haemoptysis represents one of the most severe major bleeding manifestations in the clinical course of pulmonary arterial hypertension (PAH) associated with congenital heart disease (CHD). Accumulating evidence indicates that dysfunction of the pulmonary vascular bed in the setting of PAH predisposes patients to increased hemorrhagic diathesis, resulting in mild to massive and life-threatening episodes of haemoptysis. Despite major advances in PAH targeted treatment strategies, haemoptysis is still correlated with substantial morbidity and impaired quality of life, requiring a multidisciplinary approach by adult CHD experts in tertiary centres. Technological innovations in the field of diagnostic and interventional radiology enabled the application of bronchial artery embolization (BAE), a valuable tool to efficiently control haemoptysis in modern clinical practice. However, bleeding recurrences are still prevalent, implying that the optimum management of haemoptysis and its implications remain obscure. Moreover, regarding the use of oral anticoagulation in patients with haemoptysis, current guidelines do not provide a clear therapeutic strategy due to the lack of evidence. This review aims to discuss the main pathophysiological mechanisms of haemoptysis in PAH-CHD, present the clinical spectrum and the available diagnostic tools, summarize current therapeutic challenges, and propose directions for future research in this group of patients.
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Bronchial artery embolization for hemoptysis: A systematic review and meta-analysis. J Interv Med 2021; 4:172-180. [PMID: 35586385 PMCID: PMC8947981 DOI: 10.1016/j.jimed.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/04/2021] [Accepted: 08/10/2021] [Indexed: 11/20/2022] Open
Abstract
Objective To assess the safety and efficacy of bronchial artery embolization (BAE) for hemoptysis. Methods and materials Databases with articles published in English, including Pubmed, Embase, Web of science and Chochrane library, were comprehensively searched to get accurate, up-to-date and sufficient literature about BAE for hemoptysis until March 2020. The technical success rates, immediate control rates, recurrence rates, mortality rates, and total complication rates (minor and major complication rates) extracted from the articles were pooled to estimate and assess the efficacy and safety of BAE using random-effect and fixed-effect models. Results 21 articles published between 2008 and 2019, which include a total of 2511 patients, were studied to evaluate the safety and efficacy of BAE. The technical success and immediate control rates are 99.9% (95%CI: 99%–100%) and 99.5% (95%CI: 97.8%–99.2%), respectively. This study showed hemoptysis recurrence in 23.7% (95%CI: 18.5%–28.9%) with a mortality rate of 2% (95%CI: 0–3%). Additionally, the assessment of complications revealed a total complication rate of 13.4% (95% CI: 7.6–19.2%), in which 0.2% (95% CI: 0.2–0.4%) were major complications and 10% (95% CI: 4.7–9.6%) were minor complications. Conclusion BAE is an effective, safe, and feasible procedure with a low complication rate for hemoptysis patients. However, recurrence of hemoptysis is still at high risk after BAE due to different underlying diseases.
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Swanson EM, Dickey B, Murray J, Ruiz S. Proximal pulmonary artery embolization for recurrent hemoptysis after bronchial artery embolization. Proc AMIA Symp 2021; 34:588-589. [PMID: 34456479 DOI: 10.1080/08998280.2021.1930842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Proximal pulmonary artery (PA) embolization is a dramatic interventional radiology procedure performed to control recurrent, life-threatening hemoptysis. Distal PA embolization procedures are commonly performed, and preoperative proximal PA embolization procedures have been reported, but to the best of our knowledge there has not been a reported case of a proximal PA embolization to treat hemoptysis. Here, we present a case of a complete proximal PA embolization that effectively resolved recurrent hemoptysis in a patient with a lung tumor following a failed bronchial artery embolization.
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Affiliation(s)
- Eric M Swanson
- College of Medicine, Texas A&M University Health Sciences Center, Bryan, Texas
| | - Brandon Dickey
- College of Medicine, Texas A&M University Health Sciences Center, Bryan, Texas
| | - James Murray
- Department of Interventional Radiology, Baylor Scott and White Medical Center, Temple, Texas
| | - Steven Ruiz
- Department of Interventional Radiology, Baylor Scott and White Medical Center, Temple, Texas
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Abstract
OBJECTIVES Hemoptysis is uncommon in children, even among the critically ill, with a paucity of epidemiological data to inform clinical decision-making. We describe hemoptysis-associated ICU admissions, including those who were critically ill at hemoptysis onset or who became critically ill as a result of hemoptysis, and identify predictors of mortality. DESIGN Retrospective cohort study. Demographics, hemoptysis location, and management were collected. Pediatric Logistic Organ Dysfunction-2 score within 24 hours of hemoptysis described illness severity. Primary outcome was inhospital mortality. SETTING Quaternary pediatric referral center between July 1, 2010, and June 30, 2017. PATIENTS Medical/surgical (PICU), cardiac ICU, and term neonatal ICU admissions with hemoptysis during or within 24 hours of ICU admission. INTERVENTIONS No intervention. MEASUREMENTS AND MAIN RESULTS There were 326 hemoptysis-associated ICU admissions in 300 patients. Most common diagnoses were cardiac (46%), infection (15%), bronchiectasis (10%), and neoplasm (7%). Demographics, interventions, and outcomes differed by diagnostic category. Overall, 79 patients (26%) died inhospital and 109 (36%) had died during follow-up (survivor mean 2.8 ± 1.9 yr). Neoplasm, bronchiectasis, renal dysfunction, inhospital hemoptysis onset, and higher Pediatric Logistic Organ Dysfunction-2 score were independent risk factors for inhospital mortality (p < 0.02). Pharmacotherapy (32%), blood products (29%), computerized tomography angiography (26%), bronchoscopy (44%), and cardiac catheterization (36%) were common. Targeted surgical interventions were rare. Of survivors, 15% were discharged with new respiratory support. Of the deaths, 93 (85%) occurred within 12 months of admission. For patients surviving 12 months, 5-year survival was 87% (95% CI, 78-92) and mortality risk remained only for those with neoplasm (log-rank p = 0.001). CONCLUSIONS We observed high inhospital mortality from hemoptysis-associated ICU admissions. Mortality was independently associated with hemoptysis onset location, underlying diagnosis, and severity of critical illness at event. Additional mortality was observed in the 12-month posthospital discharge. Future directions include further characterization of this vulnerable population and management recommendations for life-threatening pediatric hemoptysis incorporating underlying disease pathophysiology.
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Hwang JH, Kim JH, Park S, Lee KH, Park SH. Feasibility and outcomes of bronchial artery embolization in patients with non-massive hemoptysis. Respir Res 2021; 22:221. [PMID: 34362373 PMCID: PMC8344225 DOI: 10.1186/s12931-021-01820-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 08/02/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose To evaluate the safety, efficacy, and long-term outcome of bronchial artery embolization (BAE) in the treatment of non-massive hemoptysis and the prognostic factors associated with recurrent bleeding. Materials and methods From March 2005 to September 2014, BAE was performed in 233 patients with non-massive hemoptysis. All patients had a history of persistent or recurrent hemoptysis despite conservative medical treatment. We assessed the technical and clinical success, recurrence, prognostic factors related to recurrent bleeding, recurrence-free survival rate, additional treatment, and major complications in all the patients. Results Technical success was achieved in 224 patients (96.1%), and clinical success was obtained in 219 (94.0%) of the 233 patients. In addition, 64 patients (27.5%) presented hemoptysis recurrence with median time of 197 days after embolization. Tuberculosis sequelae and presence of aberrant bronchial artery or non-bronchial systemic collaterals were significantly related to recurrent bleeding (p < 0.05). The use of Histoacryl-based embolic materials significantly reduced the recurrent bleeding rate (p < 0.05). Patient who had a tuberculosis sequelae showed a significantly lower recurrence-free survival rate (p = 0.013). Presence of aberrant bronchial artery or non-bronchial systemic collaterals showed a statistically significant correlation with recurrence-free survival rate (p = 0.021). No patients had major complications during follow-up. Conclusions BAE is a safe and effective treatment to manage non-massive hemoptysis. The procedure may offer a better long-term control of recurrent hemoptysis and quality of life than conservative therapy alone.
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Affiliation(s)
- Jung Han Hwang
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, 21, Namdong-daero 774beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - Jeong Ho Kim
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, 21, Namdong-daero 774beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea.
| | - Suyoung Park
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, 21, Namdong-daero 774beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - Ki Hyun Lee
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, 21, Namdong-daero 774beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - So Hyun Park
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, 21, Namdong-daero 774beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
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Loiudice G, Catelli A, Corvino A, Quarantelli M, Venetucci P. Endovascular treatment of chronic hemoptysis in patients with pulmonary tuberculosis. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021201. [PMID: 34212920 PMCID: PMC8343743 DOI: 10.23750/abm.v92i3.10648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/01/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND We aimed to demonstrate the safety and efficacy of bronchial artery embolization (BAE) in patients with pulmonary tuberculosis in the planned management of "mild" hemoptysis. This treatment, already widely documented and used as a life-saving therapy in an emergency regimen, if properly planned in poorly controlled patients through medical therapy alone, can provide a valid opportunity by reducing the frequency and extent of non-fatal bleeding, but which still worsen the quality of life of these already significantly traumatized patients. METHODS All procedures were conducted through a right common femoral access with a 5 Fr catheter and a 2.7 Fr super-selective catheter coaxial technique of the branches of the bronchial arteries with suspected bleeding sources. Embolizations were performed with 500-700 micron Terumo PVA plastic microparticles. We decided to adopt the following inclusion criteria for the selection of patients to be enrolled: documented diagnosis of pulmonary TB, the presence of at least one bleeding episode that required at least two blood transfusions, evaluation with bronchoscopic examination to ascertain the bronchial origin of bleeding and the affected lobar site, execution of an angio-ct radiological study for the evaluation of the bronchial systemic anatomy as well as the patency of the pulmonary arterial circulation, general hemodynamic compensation and an age of enrollment between 25 and 65 years. RESULTS All selective embolization interventions demonstrated a technical success of 100% of the total number of patients. 11 out of 12 patients did not show any signs of relapse or complications related to the interventional procedure at a first check-up carried out at 48 hours, instead a fatal massive hemoptysis occurred in only one patient. At the next three-month follow-up, no relapses were documented in all selected patients. Only one patient required a second embolization four months after the first procedure. CONCLUSIONS Radiological-interventional approach in the elective regimen of super-selective embolization of the bronchial arteries (BAE) in the management and control of "mild" hemoptysis in patients with pulmonary tuberculosis not controlled exclusively by medical therapy, according to a strategy systematic of planned intervention and respecting clear and standardized inclusion criteria, represented in our experience a safe and effective procedure, free from significant short and long term complications, especially in well selected patients, which, although not always allows a definitive and stable control of hemoptysis, can in any case significantly limit the risks, also allowing a better planning of the most appropriate therapeutic intervention strategy.
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Affiliation(s)
- Giovanni Loiudice
- Advanced Biomedical Sciences Department, University Federico II of Naples (UNINA), via S. Pansini 5, I-80131.
| | - Antonio Catelli
- Advanced Biomedical Sciences Department, University Federico II of Naples (UNINA), via S. Pansini 5, I-80131.
| | - Antonio Corvino
- Motor Science and Wellness Department, University of Naples "Parthenope", via F. Acton 38, I-80133 Naples, Italy .
| | - Mario Quarantelli
- Advanced Biomedical Sciences Department, University Federico II of Naples (UNINA), via S. Pansini 5, I-80131.
| | - Pietro Venetucci
- Advanced Biomedical Sciences Department, University Federico II of Naples (UNINA), via S. Pansini 5, I-80131.
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Gupta A, Hadziomerovic A. Embolotherapy in Bronchial Hemorrhage. Thorac Surg Clin 2021; 31:323-332. [PMID: 34304841 DOI: 10.1016/j.thorsurg.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Hemoptysis, defined as bleeding into the tracheobronchial tree, is a serious symptom that can cause asphyxiation if inadequately treated. Massive hemoptysis carries a very high mortality risk, and therefore, a prompt multidisciplinary approach to hemoptysis is highly encouraged. Bronchial artery embolization has evolved as the mainstay of treatment in control of hemoptysis. It is a low-risk procedure that carries high initial clinical success rates. Despite relatively high recurrence rates, it can be repeated until the underlying disease process can be definitively treated.
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Affiliation(s)
- Ashish Gupta
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, University of Ottawa, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario K1H8L6, Canada.
| | - Adnan Hadziomerovic
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, University of Ottawa, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario K1H8L6, Canada
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Fukaya T, Kasai H, Nagata J, Sugiura T. Haemoptysis due to an atypical right bronchial artery branching from the left subclavian artery evaluated by four-dimensional CT and bronchial arteriography. BMJ Case Rep 2021; 14:14/3/e239754. [PMID: 33692054 PMCID: PMC7949430 DOI: 10.1136/bcr-2020-239754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Haemoptysis can be a life-threatening condition, and bronchial artery embolisation (BAE) is the most effective treatment. A 19-year-old man who had been followed up for neutrophil migration failure and bronchiectasis since birth was admitted to our department with repeated haemoptysis. Contrast-enhanced CT revealed hyperplasia and tortuosity of the bronchial artery; however, it could not reveal the origin and running by the axial views. Three-dimensional (3D) and four-dimensional (4D) CT revealed branching of the right bronchial artery from the left subclavian artery and a bronchial artery–pulmonary artery shunt. Bronchial angiography confirmed these findings. Based on these findings, BAE was successfully performed. 3D and 4D CT can be useful for determining the cause of haemoptysis. Furthermore, evaluating the anatomy of bronchial arteries prior to BAE may be useful for performing safer procedures.
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Affiliation(s)
- Takumi Fukaya
- Medicine, School of Medicine, Chiba University, Chiba, Japan
| | - Hajime Kasai
- Department of Respirology, Chiba University Hospital, Chiba, Japan
| | - Jun Nagata
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Toshihiko Sugiura
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Spiliopoulos S, Katsanos K, Paraskevopoulos I, Mariappan M, Festas G, Kitrou P, Papageorgiou C, Reppas L, Palialexis K, Karnabatidis D, Brountzos E. Multicenter retrospective study of transcatheter arterial embolisation for life-threatening haemorrhage in patients with uncorrected bleeding diathesis. CVIR Endovasc 2020; 3:95. [PMID: 33301058 PMCID: PMC7728894 DOI: 10.1186/s42155-020-00186-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/29/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND We retrospectively investigated outcomes of emergency TAE for the management of life-threatening haemorrhage in patients with uncorrected bleeding diathesis. MATERIALS AND METHODS This multicenter, retrospective, study, was designed to investigate the safety and efficacy of percutaneous TAE for the management of life-threatening haemorrhage in patients with uncorrected bleeding disorder at the time of embolization. All consecutive patients with uncorrected coagulation who underwent TAE for the treatment of haemorrhage, between January 1st and December 31th 2019 in three European centers were included. Inclusion criteria were thrombocytopenia (platelet count < 50,000/mL) and/or International Normalized Ratio (INR) ≥2.0, and/or activated partial thromboplastin time (aPTT) > 45 s, and/or a pre-existing underlying blood-clotting disorder such as factor VIII, Von Willebrand disease, hepatic cirrhosis with abnormal liver function tests. Primary outcome measures were technical success, rebleeding rate and clinical success. Secondary outcome measures included patients' 30-day survival rate, and procedure-related complications. RESULTS In total, 134 patients underwent TAE for bleeding control. A subgroup of 17 patients with 18 procedures [11 female, mean age 70.5 ± 15 years] which represent 12.7% of the total number of patients, presented with pathological coagulation parameters at the time of TAE (haemophilia n = 3, thrombocytopenia n = 1, cirrhosis n = 5, anticoagulants n = 7, secondary to bleeding n = 1) and were analyzed. Technical success was 100%, as in all procedures the bleeding site was detected and successfully embolised. Clinical success was 100%, as none of the patients died of bleeding during hospitalization, nor was surgically treated for bleeding relapse. Only one rebleeding case was noted (5.9%) that was successfully treated with a second TAE. No procedure-related complications were noted. According to Kaplan-Meier analysis the estimated 30-day survival rate was 84.2%. CONCLUSION TAE in selected patients with uncorrected bleeding diathesis should be considered as a suitable individualized management approach. Emergency TAE for life threatening haemorrhage in patients with coagulation cascade disorders should be used as an aid in realistic clinical decision making.
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Affiliation(s)
- Stavros Spiliopoulos
- grid.5216.00000 0001 2155 08002nd Department of Radiology, Interventional Radiology Unit, Medical School, National and Kapodistrian University of Athens, “Attikon” University Hospital, Athens, Greece
- grid.417581.e0000 0000 8678 4766Department of Clinical Radiology, Interventional Radiology Unit, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, AB25 2ZN UK
| | - Konstantinos Katsanos
- grid.412458.eDepartment of Interventional Radiology, School of Medicine, Patras University Hospital, Rion, Greece
| | - Ioannis Paraskevopoulos
- grid.417581.e0000 0000 8678 4766Department of Clinical Radiology, Interventional Radiology Unit, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, AB25 2ZN UK
| | - Martin Mariappan
- grid.417581.e0000 0000 8678 4766Department of Clinical Radiology, Interventional Radiology Unit, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, AB25 2ZN UK
| | - Georgios Festas
- grid.5216.00000 0001 2155 08002nd Department of Radiology, Interventional Radiology Unit, Medical School, National and Kapodistrian University of Athens, “Attikon” University Hospital, Athens, Greece
| | - Panagiotis Kitrou
- grid.412458.eDepartment of Interventional Radiology, School of Medicine, Patras University Hospital, Rion, Greece
| | - Christos Papageorgiou
- grid.412458.eDepartment of Interventional Radiology, School of Medicine, Patras University Hospital, Rion, Greece
| | - Lazaros Reppas
- grid.5216.00000 0001 2155 08002nd Department of Radiology, Interventional Radiology Unit, Medical School, National and Kapodistrian University of Athens, “Attikon” University Hospital, Athens, Greece
| | - Konstantinos Palialexis
- grid.5216.00000 0001 2155 08002nd Department of Radiology, Interventional Radiology Unit, Medical School, National and Kapodistrian University of Athens, “Attikon” University Hospital, Athens, Greece
| | - Dimitrios Karnabatidis
- grid.412458.eDepartment of Interventional Radiology, School of Medicine, Patras University Hospital, Rion, Greece
| | - Elias Brountzos
- grid.5216.00000 0001 2155 08002nd Department of Radiology, Interventional Radiology Unit, Medical School, National and Kapodistrian University of Athens, “Attikon” University Hospital, Athens, Greece
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Recurrent Hemoptysis After Bronchial Artery Embolization: Prediction Using a Nomogram and Artificial Neural Network Model. AJR Am J Roentgenol 2020; 215:1490-1498. [PMID: 33052741 DOI: 10.2214/ajr.20.22775] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Detection of Shunting Into Pulmonary Artery on Multidetector Row Computed Tomography Arteriography Before Bronchial Arterial Embolization: A Preliminary Study. J Comput Assist Tomogr 2020; 44:852-856. [PMID: 32976258 DOI: 10.1097/rct.0000000000001099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the diagnostic performance of detecting systemic arterial pulmonary circulation shunts on multidetector row computed tomography arteriography (MDCTA). METHODS Thirty-five consecutive bronchial artery embolization sessions with preprocedural MDCTA were performed for 32 patients and 35 sessions. The MDCTA studies with computed tomography value of pulmonary trunk visually lower than that of ascending aorta were defined as "diagnostic MDCTA." Angiographic studies and "diagnostic MDCTA" were evaluated, respectively, for shunting into pulmonary artery. Based on the results of angiographic studies, diagnostic performance of "diagnostic MDCTA" was evaluated. RESULTS The rate of diagnostic MDCTA was 63% (23 of 35). On "diagnostic MDCTA," sensitivity, specificity, and positive and negative predictive values for detecting shunts were 83% 100%, 100%, 94%, respectively. CONCLUSIONS Systemic arterial pulmonary circulation shunts were detected on "diagnostic MDCTA" with high sensitivity and specificity.
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Le HY, Le VN, Pham NH, Phung AT, Nguyen TT, Do Q. Value of multidetector computed tomography angiography before bronchial artery embolization in hemoptysis management and early recurrence prediction: a prospective study. BMC Pulm Med 2020; 20:231. [PMID: 32867748 PMCID: PMC7457514 DOI: 10.1186/s12890-020-01271-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 08/19/2020] [Indexed: 12/19/2022] Open
Abstract
Background Multidetector computed tomography (MDCT) angiography is a useful examination to detect the source of the bleeding in patients with hemoptysis. The aim of the study was to prospectively evaluate the role and clinical efficacy of MDCT angiography before bronchial artery embolization (BAE) for the management of hemoptysis, and to investigate the predictors of early recurrence. Methods It is a double-center study which included 57 hemoptysis patients undergoing MDCT angiography prior to BAE from August 2019 to July 2020. A prospective analysis of culprit arteries detected by MDCT angiography allowed an evaluation of the role of this technique. A follow-up was done to assess the efficacy of BAE with preprocedural MDCT angiography and to explore the risk factors of early recurrent hemoptysis. Results The accuracy of MDCT angiography in the identification of culprit arteries was as high as 97.5%. The average number of total culprit arteries per patient was 2.75 ± 1.73. Among which, the average numbers of culprit ectopic bronchial arteries (BAs) and non-bronchial systemic arteries (NBSAs) per patient were 0.21 ± 0.41 and 1.04 ± 1.57, respectively. The immediate clinical success rate, total hemoptysis recurrence rate, and early hemoptysis recurrence rate of BAE following MDCT angiography were 94.7, 18.5, 16.7%, respectively. Aspergilloma (HR = 6.63, 95% CI: 1.31–33.60, p = 0.022) was associated with an increase in the risk of early recurrence. Conclusions MDCT angiography should be performed before BAE for the management of hemoptysis. Aspergilloma was an independent predictor for early recurrence.
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Affiliation(s)
- Huu Y Le
- Department of Respiratory Diseases, Military Hospital 103, Hanoi, Vietnam.,Division of Interventional Radiology, Military Hospital 103, Hanoi, Vietnam
| | - Van Nam Le
- Department of Infectious Diseases, Military Hospital 103, Hanoi, Vietnam
| | - Ngoc Hung Pham
- Department of Epidemiology, Vietnam Military Medical University, Hanoi, Vietnam
| | - Anh Tuan Phung
- Division of Interventional Radiology, Military Hospital 103, Hanoi, Vietnam.,Department of Diagnostic Radiology, Military Hospital 103, Hanoi, Vietnam
| | - Thanh Tung Nguyen
- Department of Respiratory Diseases, Military Hospital 103, Hanoi, Vietnam.,Division of Interventional Radiology, Military Hospital 103, Hanoi, Vietnam
| | - Quyet Do
- Department of Respiratory Diseases, Military Hospital 103, Hanoi, Vietnam. .,Department of Medicine, Vietnam Military Medical University, Hanoi, Vietnam.
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Abstract
Life-threatening hemoptysis (LTH) is any amount of hemoptysis that causes significant hemodynamic decompensation or respiratory distress which may lead to death if left untreated. While the amount of hemoptysis that qualifies as massive hemoptysis has continued to be debated, any amount between 100 to 1,000 mL/day is considered significant. Up to 15% cases of hemoptysis are LTH and need urgent life-saving intervention. Understanding of pulmonary vascular anatomy is of paramount importance to manage LTH. The goal of treatment lies in airway protection, appropriate oxygenation, and prevention of exsanguination. Once the airway is stabilized, a quick diagnosis and control of bleeding site is targeted. This chapter highlights current practices and approach to LTH including medical management, bronchoscopic approach, and advanced therapies such as bronchial artery embolization and surgical resection. We review situations, such as bronchiectasis, vascular malformation, diffuse alveolar hemorrhage, and tracheostomy bleed and specific approach to management of these conditions in a systematic and evidence-based manner.
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Placement of a Double-Lumen Endotracheal Tube Using a Combined Bronchoscopy and Fluoroscopy Technique: A Case Report. A A Pract 2020; 14:e01198. [PMID: 32784316 DOI: 10.1213/xaa.0000000000001198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Bronchial artery embolization (BAE) is a well-established intervention for hemoptysis that requires airway management by a trained anesthesiologist. The use of fluoroscopic guidance for positioning a double-lumen endotracheal tube (DLT) has been described in previous studies. The case presented illustrates a combined fluoroscopic- and bronchoscopic-guided approach for positioning a DLT in a patient with active pulmonary hemorrhage causing obstruction of views on bronchoscopy. This combined technique proved valuable in a situation marked by high clinical urgency.
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Sarioglu O, Capar AE, Yavuz MY, Belet U. Angiographic Findings and Outcomes of Bronchial Artery Embolization in Patients with Pulmonary Tuberculosis. Eurasian J Med 2020; 52:126-131. [PMID: 32612418 DOI: 10.5152/eurasianjmed.2020.19221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/24/2019] [Indexed: 11/22/2022] Open
Abstract
Objective We aimed to evaluate the angiographic findings and outcomes of bronchial artery embolization in tuberculosis patients and to compare them with those of non-tuberculosis patients. Materials and Methods Patients who underwent bronchial artery embolization in a single interventional radiology department with hemoptysis were reviewed. A total of 89 patients (66 males and 23 females; mean age 52.71±15.37) were incorporated in the study. The patients were divided into two groups: tuberculosis group (n=36) and non-tuberculosis group (16 malignancy, 22 bronchiectasis, 6 pulmonary infection, 5 chronic obstructive pulmonary disease, 4 idiopathic; n=53). Angiography and embolization procedure were performed by interventional radiologists with 5, 10, and 20 years of experience. Angiographic findings were classified as tortuosity, hypertrophy, hypervascularity, aneurysm, bronchopulmonary shunt, extravasation, and normal bronchial artery. Chi-square test was used to compare angiographic findings between tuberculosis and non-tuberculosis patient groups. Results Bronchopulmonary shunt was found to be significantly higher in the tuberculosis group as compared to that in the non-tuberculosis group (p=0.002). Neither of the groups showed a statistically significant difference with respect to recurrence (p=0.436). Conclusion Bronchial artery embolization is a useful and effective treatment method of hemoptysis in tuberculosis. Evaluation of bronchopulmonary shunts in patients with tuberculosis is critical for the reduction of catastrophic complications.
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Affiliation(s)
- Orkun Sarioglu
- Department of Radiology, Health Sciences University, Tepecik Educational and Research Hospital, Izmir, Turkey
| | - Ahmet Ergin Capar
- Department of Radiology, Health Sciences University, Tepecik Educational and Research Hospital, Izmir, Turkey
| | - Melike Yuksel Yavuz
- Department of Chest Diseases, Izmir Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Umit Belet
- Department of Radiology, Health Sciences University, Tepecik Educational and Research Hospital, Izmir, Turkey
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Esophageal Bronchial Artery Fistulaization: A Complication of an Endobronchial Ultrasound. ACG Case Rep J 2020; 7:e00355. [PMID: 32548187 PMCID: PMC7224716 DOI: 10.14309/crj.0000000000000355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 02/03/2020] [Indexed: 12/17/2022] Open
Abstract
Bronchial artery pseudoaneurysms are an extremely rare cause of upper gastrointestinal bleeding. The presence of a bronchial artery pseudoaneurysm resulting in an esophageal fistula is an entity that, to our knowledge, has yet to be described. Successful management requires an interdisciplinary approach to guide closure of the defects. We present a novel case of an esophageal fistula and bronchial artery pseudoaneurysm resulting from an endobronchial ultrasound-guided transbronchial needle aspiration successfully managed by endoscopic therapy and coil embolization.
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Al Bshabshe A, Assiri A, Somaily M. Massive hemoptysis secondary to Behçet's aneurysm controlled with endobronchial balloon lung isolation: Case report and review of literature. Respir Med Case Rep 2020; 30:101105. [PMID: 32518747 PMCID: PMC7270600 DOI: 10.1016/j.rmcr.2020.101105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 05/22/2020] [Accepted: 05/22/2020] [Indexed: 11/12/2022] Open
Abstract
Behçet's disease (BD) is a multisystem disorder with various clinical presentations. Herein, we present a lethal complication associated with pulmonary artery aneurysm due to BD, resulting in massive hemoptysis that was controlled using endobronchial balloon lung isolation.
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Affiliation(s)
- Ali Al Bshabshe
- Department of Internal Medicine, Critical Care Division, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Amer Assiri
- Department of Medicine Division of Critical Care, King Khalid University Medical City, Abha, Saudi Arabia
| | - Mansour Somaily
- Department of Medicine Rheumatology Division, King Khalid University Medical City, Abha, Saudi Arabia
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Rivilla MB, Barroso KAM, Moreno EM, Garrido AMR, Reguera IR, Mazariegos Rubí MA, Hernández BB, Morales AP, Rodríguez CÁ, Cabellos RÁ. Bronchial artery aneurysms arising from antiangiogenic therapy. Curr Probl Cancer 2020; 44:100569. [PMID: 32279892 DOI: 10.1016/j.currproblcancer.2020.100569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 03/01/2020] [Accepted: 03/04/2020] [Indexed: 11/25/2022]
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Chen Y, Wang KF, Wang ZW, Liu CZ, Jin ZY. Value of CT-Angiography in the Emergency Management of Severe Hemoptysis. ACTA ACUST UNITED AC 2020; 34:194-198. [PMID: 31601302 DOI: 10.24920/003482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective To depict imaging anatomy of bronchial artery (BA) using multidetector CT-angiography (MDCTA) and evaluate the value of MDCTA for management of hemoptysis patients requiring admission to emergency room. Methods We retrospectively studied the clinical and radiological data of patients with severe hemoptysis (≥100 ml of expectorated blood in a 24-hour period) requiring admission to emergency room from Jan 1, 2013 to Dec 31, 2015. Patients' images of MDCTA, treatment modalities, and outcome were discussed. Results A total of 108 patients underwent MDCTA scans. Etiology of hemoptysis was mainly bronchiectasis (44%), tuberculosis sequelae (26%) and tumor (18%). MDCTA visualized 197 traceable BAs and also suggested the involvement of 35 nonbronchial systemic arteries. The mean diameter of BAs, measured at the level of the bronchial bifurcation in the mediastinum, was 2.8±1.2 mm. The mean diameter of BAs, for 52 patients who only received conservative treatment, was 2.9±1.1 mm, and was not significantly larger than that of BAs for 56 patients who underwent bronchial artery embolization (BAE) for continued bleeding which did not resolve after conservative treatment (2.7±1.1 mm, P = 0.94). The technical success rate of embolization was 95% (53/56). Clinical success rate during follow-up was achieved in 50 (94%) of 53 patients who had undergone embolization. Conclusions MDCTA provides useful information for identifying the anatomical characteristics of bleeding-related BAs and nonbronchial systemic arteries for the management of patients with severe hemoptysis. However, MDCTA could not determine the individuals who need BAE through measuring diameter of BAs.
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Affiliation(s)
- Ying Chen
- Department of Radiology, Peking the 6th Hospital, Beijing 100007, China
| | - Ke-Fei Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China
| | - Zhi-Wei Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China
| | - Chang-Zhu Liu
- Department of Radiology, Peking the 6th Hospital, Beijing 100007, China
| | - Zheng-Yu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China
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Efficacy and Safety of Bronchial Artery Embolization on Hemoptysis in Chronic Thromboembolic Pulmonary Hypertension: A Pilot Prospective Cohort Study. Crit Care Med 2020; 47:e182-e189. [PMID: 30531186 PMCID: PMC6407824 DOI: 10.1097/ccm.0000000000003578] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Supplemental Digital Content is available in the text. Objectives: Managing hemoptysis in chronic thromboembolic pulmonary hypertension can be challenging due to the difficulties in maintaining coagulation homeostasis in affected patients. In this study, we evaluated the efficacy and safety of bronchial artery embolization in treating hemoptysis in chronic thromboembolic pulmonary hypertension patients. Design: Pilot, prospective cohort study. Setting: A large respiratory medical institute. Patients: From January 1, 2012, to December 31, 2017, hospitalized chronic thromboembolic pulmonary hypertension patients were eligible for inclusion. Patients with pulmonary hypertension caused by other conditions, or who failed to participate in the follow-up were excluded. Interventions: Hemoptysis in chronic thromboembolic pulmonary hypertension patients was treated with or without bronchial artery embolization based on whether the bleeding could be stopped with medication alone and patient willingness for bronchial artery embolization treatment. Measurements and Main Results: A total of 328 patients diagnosed with chronic thromboembolic pulmonary hypertension were consecutively collected, 317 patients were completed the follow-up. There were 15 chronic thromboembolic pulmonary hypertension patients with hemoptysis in total, and the occurrence rate of hemoptysis in chronic thromboembolic pulmonary hypertension patients was 4.7%. Among the hemoptysis chronic thromboembolic pulmonary hypertension patients, 10 (67%) underwent bronchial artery embolization, and five (33%) were treated with medication only. The median follow-up period for hemoptysis patients was 7.6 months. In patients underwent bronchial artery embolization treatment, oxygenation index and right heart function showed no significant difference between pre bronchial artery embolization and post bronchial artery embolization. Hemoptysis relapse (20% vs 80%; p = 0.025) and hemoptysis-related mortality (0% vs 40%; p = 0.032) were significantly lower, whereas the overall survival (90% vs 40%; p = 0.040) was higher in patients treated with bronchial artery embolization than in patients treated without bronchial artery embolization. Conclusions: Bronchial artery embolization procedure demonstrated effectiveness and safety to treat hemoptysis in chronic thromboembolic pulmonary hypertension patients at our center, but further controlled studies are needed before it can be considered as an effective therapy for these patients.
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Davidson K, Shojaee S. Managing Massive Hemoptysis. Chest 2020; 157:77-88. [DOI: 10.1016/j.chest.2019.07.012] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/02/2019] [Accepted: 07/11/2019] [Indexed: 12/26/2022] Open
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Narechania S, Renapurkar R, Heresi GA. Mimickers of chronic thromboembolic pulmonary hypertension on imaging tests: a review. Pulm Circ 2020; 10:2045894019882620. [PMID: 32257112 PMCID: PMC7103595 DOI: 10.1177/2045894019882620] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 09/21/2019] [Indexed: 12/20/2022] Open
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is caused by mechanical obstruction of large pulmonary arteries secondary to one or more episodes of pulmonary embolism. Ventilation perfusion scan is the recommended initial screening test for this condition and typically shows multiple large mismatched perfusion defects. However, not all patients with an abnormal ventilation perfusion scan have CTEPH since there are other conditions that be associated with a positive ventilation perfusion scan. These conditions include in situ thrombosis, pulmonary artery sarcoma, fibrosing mediastinitis, pulmonary vasculitis and sarcoidosis, among others. Although these conditions cannot be distinguished from CTEPH using a ventilation perfusion scan, they have certain characteristic radiological features that can be demonstrated on other imaging techniques such as computed tomography scan and can help in differentiation of these conditions. In this review, we have summarized some key clinical and radiological features that can help differentiate CTEPH from the CTEPH mimics.
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Affiliation(s)
| | - Rahul Renapurkar
- Department of Diagnostic Radiology,
Cleveland
Clinic, Cleveland, OH, USA
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Martin LN, Higgins L, Mohabir P, Sze DY, Hofmann LV. Bronchial Artery Embolization for Hemoptysis in Cystic Fibrosis Patients: A 17-Year Review. J Vasc Interv Radiol 2019; 31:331-335. [PMID: 31899109 DOI: 10.1016/j.jvir.2019.08.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 08/21/2019] [Accepted: 08/28/2019] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To review safety and efficacy of bronchial artery embolization (BAE) for treatment of hemoptysis in adult patients with cystic fibrosis (CF) and to report 30-day, 1-year, and 3-year outcomes. MATERIALS AND METHODS Between January 2001 and April 2018, 242 patients with CF were evaluated for hemoptysis. Thirty-eight BAEs were performed in 28 patients with hemoptysis. Technical success was defined as freedom from repeat embolization and hemoptysis-related mortality. Clinical success was defined as freedom from repeat embolization and mortality from any cause. Technical and clinical success were examined at 30 days, 1 year, and 3 years after initial BAE. Mean patient age was 32 years, and median follow-up was 4.8 years (range, 10 mo to 16.7 y). RESULTS Technical and clinical success rates at 30 days were 89% (25/28) and 82% (23/28), respectively. Success rates at 1 year were 86% (24/28) and 79% (22/28), respectively, and at 3 years were 82% (23/28) and 75% (21/28), respectively. The 30-day overall complication rate was 7.9% (3/38) with 2.6% (1/38) major complication rate and 5.2% (2/38) minor complication rate. Overall 3-year mortality rate was 25% (7/28). CONCLUSIONS BAE is safe and effective in patients with CF presenting with life-threatening hemoptysis. BAE results in high rates of long-term technical and clinical success in this patient population despite progressive chronic disease. Repeat embolization is necessary only in a minority of patients.
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Affiliation(s)
- Lynne N Martin
- Division of Interventional Radiology, Stanford Medicine, 300 Pasteur Drive, H3630, Stanford, CA 94305.
| | - Luke Higgins
- Division of Interventional Radiology, Stanford Medicine, 300 Pasteur Drive, H3630, Stanford, CA 94305
| | - Paul Mohabir
- Division of Pulmonary and Critical Care Medicine, Stanford Medicine, 300 Pasteur Drive, H3630, Stanford, CA 94305
| | - Daniel Y Sze
- Division of Interventional Radiology, Stanford Medicine, 300 Pasteur Drive, H3630, Stanford, CA 94305
| | - Lawrence V Hofmann
- Division of Interventional Radiology, Stanford Medicine, 300 Pasteur Drive, H3630, Stanford, CA 94305
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Wang BR, Bongers KS, Cardenas-Garcia J. Hemoptysis: Rethinking Management. CURRENT PULMONOLOGY REPORTS 2019. [DOI: 10.1007/s13665-019-00234-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Shah JH, Whitmore MJ. Interventional Radiology's Role in the Treatment of Pediatric Thoracic Disease. Semin Roentgenol 2019; 54:395-406. [PMID: 31706372 DOI: 10.1053/j.ro.2019.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jay H Shah
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, GA; Department of Radiology and Imaging Sciences, Division of Pediatric Radiology, Emory University School of Medicine, Emory + Children's Pediatric Institute, Children's Healthcare of Atlanta at Egleston, Atlanta, GA.
| | - Morgan J Whitmore
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, GA
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Yu D, Jie B, Li LL, Jiang S. Bilateral pulmonary vein stenting for treatment of massive hemoptysis caused by pulmonary vein stenosis following catheter ablation for atrial fibrillation. BMC Cardiovasc Disord 2019; 19:162. [PMID: 31272384 PMCID: PMC6610941 DOI: 10.1186/s12872-019-1141-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 06/25/2019] [Indexed: 11/10/2022] Open
Abstract
Background Massive hemoptysis is a life-threatening condition. Massive hemoptysis caused by pulmonary vein stenosis (PVS) after radiofrequency catheter ablation for atrial fibrillation (AF) is rare. However, bilateral lung hemorrhage following bilateral PVS is extremely rare. Case presentation We herein describe a 62-year-old man with refractory massive hemoptysis after radiofrequency catheter ablation for AF, which was successfully controlled by surgical lobectomy and endovascular bilateral PV stenting. The hemorrhage was derived from the bilateral lungs following PV obstruction and bilateral PVS, which was definitively diagnosed by bronchoscopic examination. The patient had no recurrence of hemoptysis during a follow-up period of 30 months, and the PV stents had not narrowed as shown by computed tomography 30 months after stent placement. Conclusions Massive hemoptysis can be caused by bilateral PVS after radiofrequency catheter ablation for AF, and hemorrhage from the bilateral lungs in such patients is extremely rare. Nevertheless, cardiologists, interventional radiologists, and pulmonologists should consider the potential for massive hemoptysis caused by PVS. Electronic supplementary material The online version of this article (10.1186/s12872-019-1141-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dong Yu
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200433, China
| | - Bing Jie
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200433, China
| | - Ling-Ling Li
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200433, China
| | - Sen Jiang
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200433, China.
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Lu GD, Zhang JX, Zhou CG, Xia JG, Liu S, Zu QQ, Shi HB. Arterial embolization for hemoptysis in patients with chronic pulmonary tuberculosis and in patients with bronchiectasis. Acta Radiol 2019; 60:866-872. [PMID: 30282481 DOI: 10.1177/0284185118805258] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Guang-Dong Lu
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Jin-Xing Zhang
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Chun-Gao Zhou
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Jin-Guo Xia
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Sheng Liu
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Qing-Quan Zu
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Hai-Bin Shi
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
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Bronchial arterial embolization using a gelatin sponge for hemoptysis from pulmonary aspergilloma: comparison with other pulmonary diseases. Emerg Radiol 2019; 26:501-506. [PMID: 31129737 DOI: 10.1007/s10140-019-01695-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/07/2019] [Accepted: 05/13/2019] [Indexed: 01/20/2023]
Abstract
PURPOSE To evaluate the clinical outcomes of bronchial artery embolization (BAE) using a gelatin sponge for hemoptysis from pulmonary aspergilloma and compare them with treatment outcomes for hemoptysis from other diseases. METHODS Fifty-two patients underwent BAE using a gelatin sponge. The etiology of hemoptysis was pulmonary aspergilloma in 8 (PA group) and other diseases in 44 (control group). The technical success rate, clinical success rate, hemoptysis-free rate, and complication rate were compared between the PA group and control group. Technical success was defined as the complete cessation of the targeted feeding artery as confirmed by digital subtraction angiography, and clinical success as the cessation of hemoptysis within 24 h of BAE. Recurrent hemoptysis was defined as a single or multiple episodes of hemoptysis causing > 30 ml of bleeding per day. RESULTS Technical and clinical success rates were 100% in both groups. Hemoptysis-free rates were 85% at 6 months and 72% at 12-60 months in the control group, and 38% at 6-12 months and 25% thereafter in the PA group (P = 0.0009). No complications were observed following BAE in any case in the two groups. CONCLUSION BAE using a gelatin sponge may not be effective for hemoptysis from pulmonary aspergilloma.
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Han K, Yoon KW, Kim JH, Kim GM. Bronchial Artery Embolization for Hemoptysis in Primary Lung Cancer: A Retrospective Review of 84 Patients. J Vasc Interv Radiol 2019; 30:428-434. [PMID: 30819488 DOI: 10.1016/j.jvir.2018.08.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/04/2018] [Accepted: 08/19/2018] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of bronchial artery embolization (BAE) in patients with primary lung cancer-related hemoptysis and to identify factors associated with hemoptysis-free survival. METHODS Data from 84 patients with primary lung cancer (non-small cell [n = 74] and small cell [n = 10]) who underwent BAE from 1997 to 2018 for the management of hemoptysis were retrospectively reviewed. Of these, 53 patients had stage IV lung cancer. The hemoptysis volume prior to initial BAE was trivial (blood-tinged sputum) in 21 patients, moderate (< 300 mL per 24 hours) in 34 patients, and massive (> 300 mL per 24 hours) in 29 patients. RESULTS Technical success, defined as the ability to selectively embolize the abnormal vessel, was achieved in 83 patients (98.8%), and clinical success was achieved in 69 (82.1%) patients. Polyvinyl alcohol particles were used to embolize in 51 patients, gelfoam in 15 patients, and gelfoam plus microcoils in 17 patients. Hemoptysis recurred in 20 patients (23.8%) during follow-up. The median hemoptysis-free survival and overall survival periods were both 61 days. In the clinical-success and clinical-failure groups, the median overall survival period was 99 and 9 days, respectively (P < .001). In multivariable analysis, massive hemoptysis (P = .012) and cavitary lung mass (P = .019) were predictive factors for shortened hemoptysis-free survival. CONCLUSIONS BAE is a safe and effective approach to control hemoptysis, although the prognosis in primary lung cancer patients presenting with hemoptysis is generally poor. Massive hemoptysis and cavitary lung mass are significant predictors of shortened hemoptysis-free survival.
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Affiliation(s)
- Kichang Han
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Woong Yoon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Korea
| | - Jin Hyoung Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Korea.
| | - Gyoung Min Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
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Ittrich H, Bockhorn M, Klose H, Simon M. The Diagnosis and Treatment of Hemoptysis. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018. [PMID: 28625277 DOI: 10.3238/arztebl.2017.0371] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hemoptysis, i.e., the expectoration of blood from the lower airways, has an annual incidence of approximately 0.1% in ambulatory patients and 0.2% in inpatients. It is a potentially life-threatening medical emergency and carries a high mortality. METHODS This review article is based on pertinent publications retrieved by a selective search in PubMed. RESULTS Hemoptysis can be a sign of many different diseases. Its cause remains unknown in about half of all cases. Its more common recognized causes include infectious and inflammatory airway diseases (25.8%) and cancer (17.4%). Mild hemoptysis is self-limited in 90% of cases; massive hemoptysis carries a worse prognosis. In patients whose life is threatened by massive hemoptysis, adequate oxygenation must be achieved through the administration of oxygen, positioning of the patient with the bleeding side down (if known), and temporary intubation if necessary. A thorough diagnostic evaluation is needed to identify the underlying pathology, site of bleeding, and vascular anatomy, so that the appropriate treatment can be planned. The evaluation should include conventional chest x-rays in two planes, contrastenhanced multislice computerized tomography, and bronchoscopy. Hemostasis can be achieved at bronchoscopically accessible bleeding sites with interventionalbronchoscopic local treatment. Bronchial artery embolization is the first line of treatment for hemorrhage from the pulmonary periphery; it is performed to treat massive or recurrent hemoptysis or as a presurgical measure and provides successful hemostasis in 75-98% of cases. Surgery is indicated if bronchial artery embolization alone is not successful, or for special indications (traumatic or iatrogenic pulmonary/vascular injury, refractory asper gilloma). CONCLUSION The successful treatment of hemoptysis requires thorough diagnostic evaluation and close interdisciplinary collaboration among pulmonologists, radiologists, and thoracic surgeons.
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Affiliation(s)
- Harald Ittrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg; Department of General, Visceral and Thoracic Surgery, Center for Surgical Sciences, University Medical Center Hamburg-Eppendorf, Hamburg; Department of Pulmonology, II. Medical Clinic, University Medical Center Hamburg-Eppendorf, Hamburg
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Zaidi SJ, Schweig L, Patel D, Javois A, Akhter J. A novel approach to the diagnosis and treatment of hemoptysis in infants: A case series. Pediatr Pulmonol 2018; 53:1504-1509. [PMID: 30226294 PMCID: PMC7168067 DOI: 10.1002/ppul.24160] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/19/2018] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Hemoptysis in children is an uncommon presenting symptom but can be life-threatening if massive. Cardiac catheterization and coil embolization of aorto-pulmonary collateral vessels (APCs) is uncommon in pediatric hemoptysis patients without congenital heart disease. METHODS We present a series of seven infants (≤12 months of age) with hemoptysis, all of whom underwent cardiac catheterization to look for and intervene upon APCs, if found. Only those patients who underwent both bronchoscopy as well as cardiac catheterization from January 1995 to January 2015 were included in this retrospective review. RESULTS Seven patients met inclusion criteria, and three had a history of recurrent hemoptysis. The mean age was 3 months. Four had evidence of bleeding on bronchoscopy. All seven had respiratory distress which necessitated ICU admission; five required mechanical ventilation. Cardiac catheterization showed significant APCs (>2 mm) in six of the seven studied patients, all of which were coil embolized. One patient had no significant APCs and therefore, no embolization. All patients had complete resolution with no recurrences during the 10-20-year outpatient follow-up period. Chest CT scans were not helpful in delineating the site or etiology of bleeding in any patient. CONCLUSIONS APCs should be considered as a differential diagnosis for pulmonary hemorrhage in infants after more common causes have been ruled out.
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Affiliation(s)
- S Javed Zaidi
- Department of Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, Illinois
| | - Lorene Schweig
- Department of Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, Illinois
| | - Dhaval Patel
- Department of Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, Illinois
| | - Alexander Javois
- Department of Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, Illinois
| | - Javeed Akhter
- Department of Pediatric Pulmonology, Advocate Children's Hospital, Oak Lawn, Illinois
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