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Lin Q, Chen J, Yu T, Gao B, Kuang K, Fan Y, Xu J, Li X, Lin X, Xu L. Risk factors for the recurrence in pulmonary tuberculosis patients with massive hemoptysis. THE CLINICAL RESPIRATORY JOURNAL 2023. [PMID: 37406999 PMCID: PMC10363826 DOI: 10.1111/crj.13653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/29/2023] [Accepted: 06/11/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVES To evaluate the outcomes of bronchial artery embolization (BAE) for the treatment of massive hemoptysis in patients with pulmonary tuberculosis and identify risk factors that influence recurrence. METHODS A total of 81 patients with massive hemoptysis who underwent BAE between January 2014 and December 2017 were retrospectively reviewed. All of the patients had either a history of pulmonary tuberculosis or a current diagnosis of pulmonary tuberculosis. Follow-up ranged from 18 to 66 months. RESULTS Hemoptysis was stopped or markedly decreased, with subsequent clinical improvement in 73 patients, while 11 patients experienced recurrence during the follow-up period. Systemic-pulmonary shunts and clinical failure showed a statistically significant correlation with the recurrence rate. The cumulative non-recurrence rate was 95.3% for 3 months and 81.9% for more than 24 months. Complications were common (12.5%), but self-limiting. CONCLUSIONS BAE is a safe and effective treatment option for the control of massive hemoptysis in pulmonary tuberculosis patients. Systemic-pulmonary shunts and clinical failure are the risk factors for recurrence.
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Affiliation(s)
- Qiong Lin
- Department of Respiratory Medicine, Fuzhou No.1 Hospital Affiliated with Fujian Medical University, Fuzhou, Fujian, China
| | - Jian Chen
- Department of Intervention Therapy, Fuzhou No.1 Hospital Affiliated with Fujian Medical University, Fuzhou, Fujian, China
| | - Tianxing Yu
- Department of Respiratory Medicine, Fuzhou No.1 Hospital Affiliated with Fujian Medical University, Fuzhou, Fujian, China
| | - Bing Gao
- Department of Medical Imaging, Fuzhou Second Hospital of Xiamen University (Fuzhou Second Hospital), Fuzhou, Fujian, China
| | - Kaijin Kuang
- School of Finance, Fujian Jiangxia University, Fuzhou, Fujian, China
| | - Yong Fan
- Cent Lab, Fuzhou No.1 Hospital Affiliated with Fujian Medical University, Fuzhou, Fujian, China
| | - Junping Xu
- Department of Respiratory Medicine, Fuzhou No.1 Hospital Affiliated with Fujian Medical University, Fuzhou, Fujian, China
| | - Xiaohua Li
- Department of Respiratory Medicine, Fuzhou No.1 Hospital Affiliated with Fujian Medical University, Fuzhou, Fujian, China
| | - Xin Lin
- Department of Respiratory Medicine, Fuzhou No.1 Hospital Affiliated with Fujian Medical University, Fuzhou, Fujian, China
| | - Liyu Xu
- Department of Respiratory Medicine, Fuzhou No.1 Hospital Affiliated with Fujian Medical University, Fuzhou, Fujian, China
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Olsen KM, Manouchehr-Pour S, Donnelly EF, Henry TS, Berry MF, Boiselle PM, Colletti PM, Harrison NE, Kuzniewski CT, Laroia AT, Maldonado F, Pinchot JW, Raptis CA, Shim K, Tong BC, Wu CC, Kanne JP. ACR Appropriateness Criteria® Hemoptysis. J Am Coll Radiol 2020; 17:S148-S159. [PMID: 32370959 DOI: 10.1016/j.jacr.2020.01.043] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 11/26/2022]
Abstract
Hemoptysis, the expectoration of blood, ranges in severity from nonmassive to massive. This publication reviews the literature on the imaging and treatment of hemoptysis. Based on the literature, the imaging recommendations for massive hemoptysis are both a chest radiograph and CT with contrast or CTA with contrast. Bronchial artery embolization is also recommended in the majority of cases. In nonmassive hemoptysis, both a chest radiograph and CT with contrast or CTA with contrast is recommended. Bronchial artery embolization is becoming more commonly utilized, typically in the setting of failed medical therapy. Recurrent hemoptysis, defined as hemoptysis that recurs following initially successful cessation of hemoptysis, is best reassessed with a chest radiograph and either CT with contrast or CTA with contrast. Bronchial artery embolization is increasingly becoming the treatment of choice in recurrent hemoptysis, with the exception of infectious causes such as in cystic fibrosis. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Edwin F Donnelly
- Panel Chair, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Travis S Henry
- Panel Vice-Chair, University of California San Francisco, San Francisco, California
| | - Mark F Berry
- Stanford University Medical Center, Stanford, California; The Society of Thoracic Surgeons
| | - Phillip M Boiselle
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | | | - Nicholas E Harrison
- Beaumont Health System, Royal Oak, Michigan; American College of Emergency Physicians
| | | | | | - Fabien Maldonado
- Vanderbilt University Medical Center, Nashville, Tennessee; American College of Chest Physicians
| | | | | | - Kyungran Shim
- John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois; American College of Physicians
| | - Betty C Tong
- Duke University School of Medicine, Durham, North Carolina; The Society of Thoracic Surgeons
| | - Carol C Wu
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey P Kanne
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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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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Gagnon S, Quigley N, Dutau H, Delage A, Fortin M. Approach to Hemoptysis in the Modern Era. Can Respir J 2017; 2017:1565030. [PMID: 29430203 PMCID: PMC5752991 DOI: 10.1155/2017/1565030] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 11/14/2017] [Indexed: 11/26/2022] Open
Abstract
Hemoptysis is a frequent manifestation of a wide variety of diseases, with mild to life-threatening presentations. The diagnostic workup and the management of severe hemoptysis are often challenging. Advances in endoscopic techniques have led to different new therapeutic approaches. Cold saline, vasoconstrictive and antifibrinolytic agents, oxidized regenerated cellulose, biocompatible glue, laser photocoagulation, argon plasma coagulation, and endobronchial stents and valves are amongst the tools available to the bronchoscopist. In this article, we review the evidence regarding the definition, etiology, diagnostic modalities, and treatment of severe hemoptysis in the modern era with emphasis on bronchoscopic techniques.
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Affiliation(s)
- Sébastien Gagnon
- Institut Universitaire de Pneumologie et de Cardiologie de Québec, 2725 Ch Ste-Foy, Quebec City, QC, Canada G1V 4G5
| | - Nicholas Quigley
- Institut Universitaire de Pneumologie et de Cardiologie de Québec, 2725 Ch Ste-Foy, Quebec City, QC, Canada G1V 4G5
| | - Hervé Dutau
- Hôpital Nord Marseille, Assistance Publique des Hôpitaux de Marseille, 13915 Chemin des Bourrely, Marseille, France
| | - Antoine Delage
- Institut Universitaire de Pneumologie et de Cardiologie de Québec, 2725 Ch Ste-Foy, Quebec City, QC, Canada G1V 4G5
| | - Marc Fortin
- Institut Universitaire de Pneumologie et de Cardiologie de Québec, 2725 Ch Ste-Foy, Quebec City, QC, Canada G1V 4G5
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Rasciti E, Sverzellati N, Silva M, Casadei A, Attinà D, Palazzini M, Galiè N, Zompatori M. Bronchial artery embolization for the treatment of haemoptysis in pulmonary hypertension. Radiol Med 2016; 122:257-264. [PMID: 28025781 DOI: 10.1007/s11547-016-0714-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 11/27/2016] [Indexed: 01/10/2023]
Abstract
PURPOSE To test the efficacy of bronchial artery embolization (BAE) to treat haemoptysis in pulmonary hypertension (PH). METHODS 33 patients were treated by BAE for haemoptysis associated with PH (PH group = 21) or non-associated with PH (control group = 12). The details of procedure, outcome, and rate of relapse were compared between the two groups. Within the PH group, the comparison was operated between subjects with congenital heart disease-associated pulmonary artery hypertension (CHD-APAH subgroup = 12) and non-CHD (non-CHD-APAH subgroup = 9). RESULTS The rate of relapse at 30 and 90-days was similar between the PH group and control group. BAE in the PH group was more challenging (median 2 arteries embolized per procedure) compared to the control group (median 1 artery embolized per procedure; p = 0.001). Bleeding arteries were more heterogeneous in the PH group, while a single right bronchial artery was the only clinical finding in 66.7% of controls (p = 0.001). Within the PH group, the CHD subgroup showed higher survival rate compared to the non-CHD-APAH group (p = 0.007). CONCLUSION BAE is effective and safe for the treatment of haemoptysis in PH, yet more challenging than other conditions. In PH-associated haemoptysis, BAE provides higher survival rate for subjects with PH associated with CHD.
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Affiliation(s)
- Edoardo Rasciti
- Division of Radiology, Department of Surgical Sciences, University of Parma, Parma, Italy.
| | - Nicola Sverzellati
- Division of Radiology, Department of Surgical Sciences, University of Parma, Parma, Italy
| | - Mario Silva
- Division of Radiology, Department of Surgical Sciences, University of Parma, Parma, Italy
| | - Andrea Casadei
- Cardiothoracic Radiology Unit, Cardio-Thoracic-Vascular Department, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Domenico Attinà
- Cardiothoracic Radiology Unit, Cardio-Thoracic-Vascular Department, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Massimiliano Palazzini
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Nazzareno Galiè
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Maurizio Zompatori
- Cardiothoracic Radiology Unit, Cardio-Thoracic-Vascular Department, University Hospital S.Orsola-Malpighi, Bologna, Italy
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Dohan A, Darnige L, Sapoval M, Pellerin O. Spontaneous soft tissue hematomas. Diagn Interv Imaging 2015; 96:789-96. [PMID: 26066549 DOI: 10.1016/j.diii.2015.03.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 03/26/2015] [Indexed: 10/23/2022]
Abstract
Spontaneous muscle hematomas are a common and serious complication of anticoagulant treatment. The incidence of this event has increased along with the rise in the number of patients receiving anticoagulants. Radiological management is both diagnostic and interventional. Computed tomography angiography (CTA) is the main tool for the detection of hemorrhage to obtain a positive, topographic diagnosis and determine the severity. Detection of an active leak of contrast material during the arterial or venous phase is an indication for the use of arterial embolization. In addition, the interventional radiological procedure can be planned with CTA. Arterial embolization of the pedicles that are the source of the bleeding is an effective technique. The rate of technical and clinical success is 90% and 86%, respectively.
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Affiliation(s)
- A Dohan
- Université Paris-Diderot, 10, rue de Verdun, 75010 Paris, France; Inserm U965, French National Institute for Health and Medical Research Unit 965, France; Assistance publique-Hôpitaux de Paris, Hôpital Lariboisière, Visceral and Vascular Radiology Department, 2, rue Ambroise-Paré, 75475 Paris, France
| | - L Darnige
- Faculté de médecine, Université Paris Descartes Sorbonne Paris Cité Assistance Public Hôpitaux de Paris, Hôpital Européen Georges Pompidou Hematology Department, 20, rue Leblanc, 75015 Paris, France
| | - M Sapoval
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, 15, rue de l'École de Médecine, 75006 Paris, France; INSERM U970, Faculté de médecine, Université Paris Descartes Sorbonne Paris Cité Assistance Public Hôpitaux de Paris, Hôpital Européen Georges Pompidou Vascular and Oncological Interventional Radiology Department, 20, rue Leblanc, 75015 Paris, France; Assistance publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Vascular and Oncological Interventional Radiology Department, 20, rue Leblanc, 75015 Paris, France
| | - O Pellerin
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, 15, rue de l'École de Médecine, 75006 Paris, France; INSERM U970, Faculté de médecine, Université Paris Descartes Sorbonne Paris Cité Assistance Public Hôpitaux de Paris, Hôpital Européen Georges Pompidou Vascular and Oncological Interventional Radiology Department, 20, rue Leblanc, 75015 Paris, France; Assistance publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Vascular and Oncological Interventional Radiology Department, 20, rue Leblanc, 75015 Paris, France.
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Bhalla A, Kandasamy D, Veedu P, Mohan A, Gamanagatti S. A retrospective analysis of 334 cases of hemoptysis treated by bronchial artery embolization. Oman Med J 2015; 30:119-28. [PMID: 25960838 PMCID: PMC4412455 DOI: 10.5001/omj.2015.26] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 03/08/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To analyze the safety and efficacy of bronchial artery embolization (BAE) in the management of hemoptysis. METHODS We conducted a retrospective study of 334 patients who had undergone BAE for hemoptysis from January 2007 to July 2013. Our study included 255 (76.3%) males and 79 (23.7%) females with an age range from five to 81 years old. All relevant arteries were evaluated but only those arteries that showed hypertrophy and significant blush were targeted. Polyvinyl alcohol (PVA) was used in all patients and gel foam was used in combination with PVA where there was significant shunting. RESULTS Mild hemoptysis was seen in 70 patients, moderate in 195 patients, and severe in 69 patients. On imaging, right side disease was seen in 101 patients, left side involvement in 59 patients, and bilateral involvement in 174 patients. Post-tubercular changes were the predominant pathology seen in 248 patients. Among 334 patients (386 procedures), 42 patients underwent the procedure twice and five patients underwent the procedure thrice. A total of 485 arteries were attempted of which 440 arteries were successfully embolized. Right intercosto-bronchial was the most common culprit artery present in 157 patients, followed by common bronchial (n=97), left bronchial (n=55), and right bronchial (n=45). We embolized a maximum of four arteries in one session. Immediate complications such as dissection and rupture occurred in only nine sessions (2.3%). Twenty-five procedures (6.5%) were repeated within two months, which were due to technical or clinical failure and 27 procedures (7%) were repeated after two months. CONCLUSIONS BAE is a safe and effective procedure with a negligible complication rate. Our approach of targeting hypertrophied arteries was effective.
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Affiliation(s)
- Ashu Bhalla
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Prasad Veedu
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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Fruchter O, Schneer S, Rusanov V, Belenky A, Kramer MR. Bronchial artery embolization for massive hemoptysis: Long-term follow-up. Asian Cardiovasc Thorac Ann 2014; 23:55-60. [DOI: 10.1177/0218492314544310] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim Bronchial artery angiography with embolization has become a mainstay in the treatment of massive hemoptysis. Whereas the immediate success rate is high, the reported long-term success rate varies widely among different groups. We aimed to explore the long-term outcome and clinical predictors associated with recurrent bleeding following bronchial artery embolization. Methods We reviewed the clinical characteristics, underlying etiologies, procedure details, and outcome of bronchial artery embolization performed for massive hemoptysis between 1999 and 2012. Results All 52 consecutive patients treated by bronchial artery embolization during the study period were included. The major etiologies of massive hemoptysis were bronchiectasis (mostly post-infectious) in 53.8%, and primary and metastatic lung cancer in 30.8%. The immediate success rate was high (48/52; 92%). Of 45 patients who survived more than 24 hours following bronchial artery embolization, recurrent bleeding did not occur in 19 (42.2%) during a median follow-up period of 60 months (range 6–130 months). Bleeding recurred in 26 (57.7%); within 30 days in 15 (33.3%) and after 1 month in the other 11 (24.4%). The average time to onset of early and late repeat bleeding was 2 and 506 days, respectively. Idiopathic bronchiectasis and lung cancer were associated with a high likelihood of late bleeding recurrence. Conclusions Bronchial artery embolization is an effective immediate treatment for massive hemoptysis. Because the bleeding recurrence rate is high in patients with lung cancer or idiopathic bronchiectasis, surgery should be considered in these patients following initial stabilization by bronchial artery embolization. For other underlying etiologies, the long-term outcome is excellent.
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Affiliation(s)
- Oren Fruchter
- The Pulmonary Institute, Rabin Medical Center, Petah Tiqwa, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sonia Schneer
- The Pulmonary Institute, Rabin Medical Center, Petah Tiqwa, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Victoria Rusanov
- The Pulmonary Institute, Rabin Medical Center, Petah Tiqwa, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Belenky
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Interventional Radiology, Rabin Medical Center, Petah Tiqwa, Israel
| | - Mordechai R Kramer
- The Pulmonary Institute, Rabin Medical Center, Petah Tiqwa, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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