1
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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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2
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Guzelbey T, Arslan MF, Cingoz M, Erdim C, Altun O, Mutlu IN, Kilickesmez O. Efficacy and safety of particle embolization in bronchial arteries of hemoptysis patients with shunts. Clin Radiol 2024:S0009-9260(24)00291-5. [PMID: 38942705 DOI: 10.1016/j.crad.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/24/2024] [Accepted: 06/03/2024] [Indexed: 06/30/2024]
Abstract
AIM This study assesses the safety and efficacy of particle embolization during bronchial artery embolization (BAE) in patients with shunts between bronchial and non-bronchial systemic arteries and the pulmonary artery. METHODS In this retrospective, single-center study, we analyzed 312 BAE procedures performed from June 2020 to April 2023. The patient cohort had shunts between bronchial and non-bronchial systemic arteries and the pulmonary artery. We meticulously collected and examined comprehensive data, including clinical characteristics, computed tomography (CT) imaging, and embolization procedural details. RESULTS Vascular shunts were identified in 49 patients. The etiologies of hemoptysis included post-TB sequelae (42.8%), bronchiectasis (26.5%), active TB (12.2%), aspergilloma (8.1%), bacterial pneumonia (4.1%), lung cancer (4.1%), and non-tuberculous mycobacterial infection (2%). The technical success rate of the procedures was 98%, with 149 out of 152 identified vessels successfully embolized. All patients experienced cessation or significant reduction of hemoptysis within 24 hours following the procedure. The clinical success rates were 97.9% at one month, 93.9% at six months, and 89.8% at one year. No shunt-related complications were detected. CONCLUSION BAE with particle embolization is a safe and effective treatment for hemoptysis, particularly in cases with complex shunts between bronchial and non-bronchial systemic arteries and the pulmonary artery.
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Affiliation(s)
- T Guzelbey
- Department of Interventional Radiology, Basaksehir Cam and Sakura City Hospital, Istanbul, 34480, Turkey.
| | - M F Arslan
- Department of Interventional Radiology, Basaksehir Cam and Sakura City Hospital, Istanbul, 34480, Turkey.
| | - M Cingoz
- Department of Interventional Radiology, Basaksehir Cam and Sakura City Hospital, Istanbul, 34480, Turkey.
| | - C Erdim
- Department of Interventional Radiology, Basaksehir Cam and Sakura City Hospital, Istanbul, 34480, Turkey.
| | - O Altun
- Department of Interventional Radiology, Basaksehir Cam and Sakura City Hospital, Istanbul, 34480, Turkey.
| | - I N Mutlu
- Department of Interventional Radiology, Basaksehir Cam and Sakura City Hospital, Istanbul, 34480, Turkey.
| | - O Kilickesmez
- Department of Interventional Radiology, Basaksehir Cam and Sakura City Hospital, Istanbul, 34480, Turkey.
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3
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Hanotin C, Salvayre R, Lassalle L, Fartoukh M, Lehrer R, Gibelin A, Barral M. Predictive Factors for Recurrent Hemoptysis after Bronchial Artery Embolization in Patients with Lung Cancer. J Vasc Interv Radiol 2024:S1051-0443(24)00380-4. [PMID: 38844204 DOI: 10.1016/j.jvir.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/08/2024] [Accepted: 05/25/2024] [Indexed: 07/14/2024] Open
Abstract
PURPOSE To identify clinical, radiological, and angiographic characteristics associated with recurrent hemoptysis after bronchial artery embolization (BAE) in patients with lung cancer and severe hemoptysis admitted to the intensive care unit (ICU). MATERIALS AND METHODS A total of 144 consecutive patients with lung cancer who underwent BAE for life-threatening hemoptysis admitted in the ICU between 2014 and 2022 were retrospectively included. Demographics, laboratory values, clinical course, and radiological/angiographic features were compared between those with and without recurrent hemoptysis within 1 month after embolization. RESULTS Of the 144 patients (mean age, 60.2 years [SD ± 10.9]; females, 15.3%), 34.7% (50/144) experienced clinically relevant recurrent hemoptysis within 1 month; among them, 29 of 50 (58.0%) cases necessitated a second embolization. Massive hemoptysis was observed in 54.2%, with 16.7% receiving the vasopressin analog terlipressin. The mean volume of hemoptysis and simplified acute physiology score II (SAPS II) were 235 mL (SD ± 214.3) and 31.2 (SD ± 18.6), respectively. Computed tomography (CT) angiography revealed pulmonary artery (PA) injury (11.5%) and necrosis/cavitation (25.8%), and PA embolization was performed in 15.3% of cases. Technical success rate was 92%. SAPS II (P = .01), massive hemoptysis (P < .001), terlipressin use (P = .01), necrosis/cavitation (P = .01), and PA injury on CT angiography (P < .001) were associated with recurrent hemoptysis. Independent predictors on multivariate analysis were massive hemoptysis (P = .016) and PA injury on CT angiography (P = .001). CONCLUSIONS In patients with lung cancer and life-threatening hemoptysis treated by BAE, massive hemoptysis and PA injury identified on CT angiography are independent predictors of recurrent hemoptysis.
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Affiliation(s)
- Clement Hanotin
- Department of Radiology, Hôpital Tenon - Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Raphael Salvayre
- Department of Intensive Care Medicine, Hôpital Tenon - Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Louis Lassalle
- Réseau d'imagerie Sud Francilien, Evry, France; Ramsay Sante, Clinique du Mousseau, Evry, France
| | - Muriel Fartoukh
- Department of Radiology, Hôpital Tenon - Assistance Publique - Hôpitaux de Paris, Paris, France; Department of Intensive Care Medicine, Hôpital Tenon - Assistance Publique - Hôpitaux de Paris, Paris, France; Sorbonne Université, Paris, France
| | - Raphael Lehrer
- Department of Radiology, Hôpital Tenon - Assistance Publique - Hôpitaux de Paris, Paris, France; Department of Intensive Care Medicine, Hôpital Tenon - Assistance Publique - Hôpitaux de Paris, Paris, France; Réseau d'imagerie Sud Francilien, Evry, France
| | - Aude Gibelin
- Department of Intensive Care Medicine, Hôpital Tenon - Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Matthias Barral
- Department of Radiology, Hôpital Tenon - Assistance Publique - Hôpitaux de Paris, Paris, France; Sorbonne Université, Paris, France.
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4
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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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5
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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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6
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Seo W, Kim HW, Kim JS, Min J. Long term management of people with post-tuberculosis lung disease. Korean J Intern Med 2024; 39:7-24. [PMID: 38225822 PMCID: PMC10790047 DOI: 10.3904/kjim.2023.395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/24/2023] [Accepted: 11/08/2023] [Indexed: 01/17/2024] Open
Abstract
Post-tuberculosis lung disease (PTLD) is emerging as a significant area of global interest. As the number of patients surviving tuberculosis (TB) increases, the subsequent long-term repercussions have drawn increased attention due to their profound clinical and socioeconomic impacts. A primary obstacle to its comprehensive study has been its marked heterogeneity. The disease presents a spectrum of clinical manifestations which encompass tracheobronchial stenosis, bronchiectasis, granulomas with fibrosis, cavitation with associated aspergillosis, chronic pleural diseases, and small airway diseases-all persistent consequences of PTLD. The spectrum of symptoms a patient may experience varies based on the severity of the initial infection and the efficacy of the treatment received. As a result, the long-term management of PTLD necessitates a detailed and specific approach, addressing each manifestation individually-a tailored strategy. In the immediate aftermath (0-12 months after anti-TB chemotherapy), there should be an emphasis on monitoring for relapse, tracheobronchial stenosis, and smoking cessation. Subsequent management should focus on addressing hemoptysis, managing infection including aspergillosis, and TB-associated chronic obstructive pulmonary disease or restrictive lung function. There remains a vast expanse of knowledge to be discovered in PTLD. This review emphasizes the pressing need for comprehensive, consolidated guidelines for management of patients with PTLD.
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Affiliation(s)
- Wan Seo
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Hyung Woo Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Ju Sang Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Jinsoo Min
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
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7
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Notsuda H, Tomiyama F, Onodera K, Watanabe T, Watanabe Y, Oishi H, Niikawa H, Inoue C, Ota H, Noda M, Okada Y. Systemic-to-pulmonary artery shunt treated with transcatheter arterial embolization and subsequent lung segmentectomy. Egypt Heart J 2023; 75:103. [PMID: 38123754 PMCID: PMC10733262 DOI: 10.1186/s43044-023-00431-9] [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: 11/10/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Systemic-to-pulmonary artery shunt (SPAS) is a rare condition that can occur as a result of congenital heart disease or chronic pulmonary inflammation, occasionally leading to life-threatening hemoptysis. Computed tomography (CT) imaging is crucial in the diagnosis of SPAS, and the optimal management approach for SPAS remains uncertain. This case report presents a novel approach to the treatment of SPAS, consisting of transcatheter arterial embolization of the systemic artery followed by lung segmentectomy. CASE PRESENTATION A 42-year-old man with abnormal chest findings was referred to us and a diagnosis of SPAS was established based on the CT findings showing a blood flow regurgitation from the dilated left 4th intercostal artery to the Lt. A6. The patient was asymptomatic but we decided to treat him to prevent a risk of future hemoptysis. Transcatheter arterial embolization (TAE) of systemic arteries followed by S6 segmentectomy was successfully performed with minimal blood loss and complete removal of the dilated intra-pulmonary blood vessels. Histological analysis confirmed the diagnosis of SPAS. CONCLUSION We reported a case of SPAS, who was successfully treated with the combination of TAE and subsequent segmentectomy. The blood loss during surgery was minimal and this strategy appeared to minimize future recanalization and hemoptysis. Further studies and long-term follow-up of SPAS patients are required to establish standardized management guidelines for this rare condition.
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Affiliation(s)
- Hirotsugu Notsuda
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University Hospital, Tohoku University, 4-1, Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
| | - Fumiko Tomiyama
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University Hospital, Tohoku University, 4-1, Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Ken Onodera
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University Hospital, Tohoku University, 4-1, Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Tatsuaki Watanabe
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University Hospital, Tohoku University, 4-1, Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Yui Watanabe
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University Hospital, Tohoku University, 4-1, Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Hisashi Oishi
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University Hospital, Tohoku University, 4-1, Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Hiromichi Niikawa
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University Hospital, Tohoku University, 4-1, Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Chihiro Inoue
- Department of Anatomic Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Masafumi Noda
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University Hospital, Tohoku University, 4-1, Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Yoshinori Okada
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University Hospital, Tohoku University, 4-1, Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
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8
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Wucherpfennig L, Triphan SMF, Wege S, Kauczor HU, Heussel CP, Sommerburg O, Stahl M, Mall MA, Eichinger M, Wielpütz MO. Elexacaftor/Tezacaftor/Ivacaftor Improves Bronchial Artery Dilatation Detected by Magnetic Resonance Imaging in Patients with Cystic Fibrosis. Ann Am Thorac Soc 2023; 20:1595-1604. [PMID: 37579262 DOI: 10.1513/annalsats.202302-168oc] [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: 02/21/2023] [Accepted: 08/14/2023] [Indexed: 08/16/2023] Open
Abstract
Rationale: Magnetic resonance imaging (MRI) detects improvements in mucus plugging and bronchial wall thickening, but not in lung perfusion in patients with cystic fibrosis (CF) treated with elexacaftor/tezacaftor/ivacaftor (ETI). Objectives: To determine whether bronchial artery dilatation (BAD), a key feature of advanced lung disease, indicates irreversibility of perfusion abnormalities and whether BAD could be reversed in CF patients treated with ETI. Methods: A total of 59 adults with CF underwent longitudinal chest MRI, including magnetic resonance angiography twice, comprising 35 patients with CF (mean age, 31 ± 7 yr) before (MRI1) and after (MRI2) at least 1 month (mean duration, 8 ± 4 mo) on ETI therapy and 24 control patients with CF (mean age, 31 ± 7 yr) without ETI. MRI was assessed using the validated chest MRI score, and the presence and total lumen area of BAD were assessed with commercial software. Results: The MRI global score was stable in the control group from MRI1 to MRI2 (mean difference, 1.1 [-0.3, 2.4]; P = 0.054), but it was reduced in the ETI group (-10.1 [-0.3, 2.4]; P < 0.001). In the control and ETI groups, BAD was present in almost all patients at baseline (95% and 94%, respectively), which did not change at MRI2. The BAD total lumen area did not change in the control group from MRI1 to MRI2 (1.0 mm2 [-0.2, 2.2]; P = 0.099) but decreased in the ETI group (-7.0 mm2 [-8.9, -5.0]; P < 0.001). This decrease correlated with improvements in the MRI global score (r = 0.540; P < 0.001). Conclusions: Our data show that BAD may be partially reversible under ETI therapy in adult patients with CF who have established disease.
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Affiliation(s)
- Lena Wucherpfennig
- Department of Diagnostic and Interventional Radiology
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, and
- Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
| | - Simon M F Triphan
- Department of Diagnostic and Interventional Radiology
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, and
- Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
| | - Sabine Wege
- Department of Pulmonology and Respiratory Medicine, Cystic Fibrosis Center, Thoracic Clinic, University Hospital Heidelberg, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, and
- Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
| | - Claus P Heussel
- Department of Diagnostic and Interventional Radiology
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, and
- Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
| | - Olaf Sommerburg
- Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
- Department of Translational Pulmonology and
| | - Mirjam Stahl
- Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
- Department of Translational Pulmonology and
- Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, University of Heidelberg, Heidelberg, Germany
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Center for Lung Research, Berlin, Germany; and
- Berlin Institute of Health at Charité - University Medicine Berlin, Berlin, Germany
| | - Marcus A Mall
- Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
- Department of Translational Pulmonology and
- Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, University of Heidelberg, Heidelberg, Germany
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Center for Lung Research, Berlin, Germany; and
- Berlin Institute of Health at Charité - University Medicine Berlin, Berlin, Germany
| | - Monika Eichinger
- Department of Diagnostic and Interventional Radiology
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, and
- Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
| | - Mark O Wielpütz
- Department of Diagnostic and Interventional Radiology
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, and
- Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
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9
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Benjamin SR, Nair AA, Joel RK, Gnanamuthu BR, Rao VM, Andugala SS. An overview on the principles of management of haemoptysis. Indian J Thorac Cardiovasc Surg 2023; 39:505-515. [PMID: 37609603 PMCID: PMC10442015 DOI: 10.1007/s12055-023-01547-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: 02/25/2023] [Revised: 04/19/2023] [Accepted: 05/24/2023] [Indexed: 08/24/2023] Open
Abstract
Haemoptysis is a frequently encountered presentation in thoracic surgery practice. Most of the patients present with chronic haemoptysis while 5% of them will present with life-threatening acute haemoptysis. Emergency surgery used to be the first-line management in acute life-threatening haemoptysis which resulted in significant morbidity and mortality. With advancements in interventional procedures, most of these acute presentations are now being managed conservatively by interventionists. In a country like India with a high incidence of tuberculosis and other infectious diseases of the lungs, haemoptysis is even more common. While interventional procedures help to tide over the crisis and earn valuable time to stabilise a haemorrhaging patient, surgical resection is the definitive management most of the time. This review will endeavour to establish the definition, aetiology, emergency, and definitive management of a patient who presents with haemoptysis.
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Affiliation(s)
- Santhosh Regini Benjamin
- Department of Cardiothoracic Surgery, The Christian Medical College (CMC Hospital), Vellore, 632004 Tamil Nadu India
| | - Avinash Anil Nair
- Department of Respiratory Medicine, The Christian Medical College, Vellore, 632004 Tamil Nadu India
| | - Raj Kumar Joel
- Department of Cardiothoracic Surgery, The Christian Medical College (CMC Hospital), Vellore, 632004 Tamil Nadu India
| | - Birla Roy Gnanamuthu
- Department of Cardiothoracic Surgery, The Christian Medical College (CMC Hospital), Vellore, 632004 Tamil Nadu India
| | - Vinay Murahari Rao
- Department of Cardiothoracic Surgery, The Christian Medical College (CMC Hospital), Vellore, 632004 Tamil Nadu India
| | - Shalom Sylvester Andugala
- Department of Cardiothoracic Surgery, The Christian Medical College (CMC Hospital), Vellore, 632004 Tamil Nadu India
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10
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Marak JR, Kumar T, Gara H, Dwivedi S. Rasmussen aneurysm: Case series of a rare complication of Pulmonary Tuberculosis. Respir Med Case Rep 2023; 45:101897. [PMID: 37577119 PMCID: PMC10413191 DOI: 10.1016/j.rmcr.2023.101897] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/15/2023] [Accepted: 07/18/2023] [Indexed: 08/15/2023] Open
Abstract
Rasmussen aneurysm refers specifically to a pseudoaneursysmal dilatation of a branch of the pulmonary artery adjacent or within a tuberculous cavity. The incidence of pulmonary vascular complication secondary to tuberculosis is very rare hence underdiagnosed by many clinicians. It can present with life threatening haemoptysis and CT angiography plays an important role in localizing the lesion and guiding treatment. On contrary the most common cause of massive haemoptysis is of bronchial artery origin. Early diagnosis and proper interventions are essential as it is associated with high mortality. Herein we report three cases of Rasmussen aneurysm in patients with haemoptysis. Only one patient underwent emergency trans-arterial embolization of the involved pulmonary artery.
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Affiliation(s)
- James R. Marak
- Department of Radiodiagnosis, Dr RMLIMS, Gomti Nagar, Lucknow, Uttar Pradesh, 226010, India
| | - Tushant Kumar
- Department of Radiodiagnosis, Dr RMLIMS, Gomti Nagar, Lucknow, Uttar Pradesh, 226010, India
| | - Harsha Gara
- Department of Radiodiagnosis, Dr RMLIMS, Gomti Nagar, Lucknow, Uttar Pradesh, 226010, India
| | - Shivam Dwivedi
- Department of Radiodiagnosis, Dr RMLIMS, Gomti Nagar, Lucknow, Uttar Pradesh, 226010, India
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11
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Ruwisch J, Welte T, Prasse A. [An outline of pulmonary hemorrhage - A pulmonologists perspective]. Dtsch Med Wochenschr 2023; 148:845-857. [PMID: 37364579 DOI: 10.1055/a-1817-7887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Hemoptysis resembles a clinical emergency and necessitates a fast and well-coordinated diagnostic and therapeutic approach. While up to 50% of the underlying causes remain unidentified, the majority of cases in the western world can be attributed to respiratory infections and pulmonary neoplasm. While 10% of the patients present with massive, life-threatening hemoptysis, which require a timely airway protection in order to secure a sustained pulmonary gas-exchange, the vast majority presents with non-critical pulmonary bleeding events. Most critical pulmonary bleeding events arise from the bronchial circulation. An early chest imaging is key for identifying the bleeding cause and localization. While chest x-rays are widely implemented in the clinical work-flow and rapidly applicable, computed tomography and computed tomography angiography exhibit the highest diagnostic yield. Bronchoscopy can add diagnostic information especially in pathologies of the central airways, while offering multiple therapeutic options to maintain pulmonary gas exchange. The initial therapeutic regimen comprises early supportive care, but treatment of the underlying etiology is of prognostic relevance and avoids recurrent bleeding events. Bronchial arterial embolization usually is the therapy of choice in patients with massive hemoptysis, while definitive surgery is reserved for patients with refractory bleeding and complex pathologies.
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12
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Singhal R, K.B SB, Naranje P, Kazimi J, Garg PK, Chandra D, Popat BA, Shetty NS, Gorsi U, Vimala LR, Khera PS, Irodi A, Kulkarni S, Keshava SN, Bhalla AS. Society of Chest Imaging and Interventions Consensus Guidelines for the Interventional Radiology Management of Hemoptysis. Indian J Radiol Imaging 2023; 33:361-372. [PMID: 37362365 PMCID: PMC10289864 DOI: 10.1055/s-0043-1762552] [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: 06/28/2023] Open
Abstract
The recommendations from the Society of Chest Imaging and Interventions expert group comprehensively cover all the aspects of management of hemoptysis, highlighting the role of diagnostic and interventional radiology. The diversity existing in etiopathology, imaging findings, and management of hemoptysis has been addressed. The management algorithm recommends the options for effective treatment while minimizing the chances of recurrence, based on the best evidence available and opinion from the experts.
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Affiliation(s)
- Rajat Singhal
- Department of Interventional Radiology, Division of Clinical Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Santhosh Babu K.B
- Department of Interventional Radiology, Division of Clinical Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Priyanka Naranje
- Department of Radio-Diagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Junaid Kazimi
- Department of Radio-Diagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Pawan K. Garg
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Jodhpur, Rajasthan, India
| | - Daksh Chandra
- Interventional Radiology Department, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Bhavesh A. Popat
- Department of Interventional Radiology, Hinduja Hospital, Mumbai, Maharashtra, India
- Department of Interventional Radiology, Breach Candy Hospital, Mumbai, Maharashtra, India
- Department of Interventional Radiology, Saifee Hospital, Mumbai, Maharashtra, India
| | - Nitin S. Shetty
- Interventional Radiology Department, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Ujjwal Gorsi
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Leena Robinson Vimala
- Department of Radiodiagnosis, Division of Clinical Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Pushpinder S. Khera
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Jodhpur, Rajasthan, India
| | - Aparna Irodi
- Department of Radiodiagnosis, Division of Clinical Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Suyash Kulkarni
- Interventional Radiology Department, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shyamkumar N. Keshava
- Department of Interventional Radiology, Division of Clinical Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ashu S. Bhalla
- Department of Radio-Diagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
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13
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Yan HT, Lu GD, Liu J, Liu S, Shi HB, Zhou CG, Zu QQ. Does the presence of systemic artery-pulmonary circulation shunt during bronchial arterial embolization increase the recurrence of noncancer-related hemoptysis? A retrospective cohort study. Respir Res 2023; 24:119. [PMID: 37131263 PMCID: PMC10152774 DOI: 10.1186/s12931-023-02427-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 04/19/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND The presence of systemic artery-pulmonary circulation shunt (SPS) during the bronchial arterial embolization (BAE) procedure, has been inferred to be a potential risk factor for recurrence. The aim of this study is to reveal the impact of SPS on the recurrence of noncancer-related hemoptysis after BAE. METHODS In this study, 134 patients with SPS (SPS-present group) and 192 patients without SPS (SPS-absent group) who underwent BAE for noncancer-related hemoptysis from January 2015 to December 2020 were compared. Four different Cox proportional hazards regression models were used to clarify the impact of SPSs on hemoptysis recurrence after BAE. RESULTS During the median follow-up time of 39.8 months, recurrence occurred in 75 (23.0%) patients, including 51 (38.1%) in the SPS-present group and 24 (12.5%) in the SPS-absent group. The 1-month, 1-year, 2-year, 3-year and 5-year hemoptysis-free survival rates in the SPS-present and SPS-absent groups were 91.8%, 79.7%, 70.6%, 62.3%, and 52.6% and 97.9%, 94.7%, 89.0%, 87.1%, and 82.3%, respectively (P < 0.001). The adjusted hazard ratios of SPSs in the four models were 3.37 [95% confidence intervals (CI), 2.07-5.47, P < 0.001 in model 1], 1.96 (95% CI, 1.11-3.49, P = 0.021 in model 2), 2.29 (95% CI, 1.34-3.92, P = 0.002 in model 3), and 2.39 (95% CI, 1.44-3.97, P = 0.001 in model 4). CONCLUSIONS The presence of SPS during BAE increases the recurrence probability of noncancer-related hemoptysis after BAE.
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Affiliation(s)
- Hai-Tao Yan
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Guang-Dong Lu
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Jin Liu
- Department of Clinical Medicine Research Institution, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - Sheng Liu
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Hai-Bin Shi
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China.
| | - Chun-Gao Zhou
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China.
| | - Qing-Quan Zu
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China.
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14
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Toupchiani S, Hegab S, Rana DES, Ainley A. A systemic arterial-pulmonary arterial shunt mimicking a pulmonary embolism on CT pulmonary angiogram. Radiol Case Rep 2023; 18:1905-1908. [PMID: 36942004 PMCID: PMC10023907 DOI: 10.1016/j.radcr.2023.02.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/04/2023] [Accepted: 02/08/2023] [Indexed: 03/14/2023] Open
Abstract
We report the case of a middle-aged woman on a background of severe respiratory disease who presented with hemoptysis. Investigations with CT pulmonary angiogram showed evidence of a large pulmonary arterial filling defect which was initially treated as a pulmonary embolism. However, despite being anticoagulated, she experienced ongoing hemoptysis. Further imaging several days later using aortic phase CT confirmed that the filling defect was a false positive; the artifact was due to retrograde filling from a systemic arterial-pulmonary arterial shunt and anticoagulation was stopped. Although PE is the most common cause of filling defects, this case suggests that in the setting of patients with chronic inflammatory parenchymal pulmonary disease, clinicians should consider alternative causes such as systemic arterial-pulmonary arterial shunts.
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Affiliation(s)
- Saeideh Toupchiani
- Department of Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK
- Corresponding author.
| | - Shady Hegab
- Department of Radiology, Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK
| | - Dur-E-Sameen Rana
- Department of Radiology, Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK
| | - Adam Ainley
- Department of Respiratory Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK
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15
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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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16
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Garg P, Khandelwal A, Bhardwaj K, Ish P, Khurana R, Malik A. Bronchial Artery Embolization in Management of Hemoptysis in a Developing Country: An Initial Experience. THE ARAB JOURNAL OF INTERVENTIONAL RADIOLOGY 2023. [DOI: 10.1055/s-0043-1763496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
Abstract
Purpose This article evaluates the immediate success, recurrence rate, complications, and the culprit vessel of bronchial artery embolization (BAE) in patients presenting with hemoptysis.
Methods and Materials All patients who underwent BAE from July 1, 2018 to August 31, 2021 were included. BAE was done for moderate to severe hemoptysis or for mild hemoptysis which was recurrent and not controlled by medical management. Patients referred for surgical intervention and hemoptysis controlled on medical management were excluded.
Results One hundred and thirty patients underwent BAE in the study period. Mean age was 41.5 years and majority (73.1%) was male. Forty-three (33.1%) patients had mild, 46 (35.4%) had moderate, and 41 (31.5%) with the duration of symptoms ranging from 3 days to 25 years. Most common culprit vessel was posterior intercostal artery closely followed by the intercostobronchial artery. Hypervascularity was the most common angiographic abnormality encountered. On an average, 2.75 vessels were embolized per BAE with a wide range of 1 to 8 vessels. Hemoptysis control was seen in 96.1% patients immediately, 90.7 % at 1 month, 82.3 % at 3 months, and 66.9 % at 6 months. Overall recurrence was seen in 43 patients (33.1%). Chest pain was the most common minor side effect occurring in 77.1% cases.
Conclusion BAE is a safe and effective procedure that can be performed routinely in patients presenting with moderate to massive hemoptysis or with mild hemoptysis refractory to medical management.
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Affiliation(s)
- Puneet Garg
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Ayush Khandelwal
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Krishna Bhardwaj
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Pranav Ish
- Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Rajat Khurana
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Amita Malik
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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17
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Al Saadi W, Al Khalili H, Al Hajriy M. Superior vena cava syndrome-induced hemoptysis. Am J Med Sci 2023; 365:205-211. [PMID: 36152811 DOI: 10.1016/j.amjms.2022.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 04/26/2022] [Accepted: 07/28/2022] [Indexed: 01/11/2023]
Abstract
Superior vena cava (SVC) syndrome resulting from obstruction of the blood flow to the superior vena cava is rarely reported to present with life-threatening hemoptysis. The pathogenesis and the underlying mechanism are still not well described in the literature. We report a unique case of a 27-year-old man known to have end-stage kidney disease (ESKD) on hemodialysis that presented with shortness of breath and life-threatening hemoptysis that developed during the dialysis session. Computerized tomography with contrast (CTPA) confirmed the presence of a large, calcified thrombus within the SVC along with the formation of multiple collaterals which was diagnostic for SVC syndrome. Attempts for revascularization and stenting failed, and the patient had a prolonged and stormy course while admitted, including difficult alternative dialysis access that unfortunately resulted in death eventually. Here we are highlighting the importance of recognition of hemoptysis as a presentation of SVC syndrome by explaining the underlying pathogenesis and possible management options.
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Affiliation(s)
- Waleed Al Saadi
- Internal Medicine Department, Oman Medical Specialty Board, Muscat, Oman.
| | - Huda Al Khalili
- Internal Medicine Department, Oman Medical Specialty Board, Muscat, Oman; Anaesthesia and Critical Care Department, The Royal Hospital, Muscat, Oman
| | - Mahmood Al Hajriy
- Interventional Radiology, Radiology Department, The Royal Hospital, Muscat, Oman
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18
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Mansur A, Garg T, Camacho JC, Habibollahi P, Edward Boas F, Khorshidi F, Buethe J, Nezami N. Image-Guided Percutaneous and Transarterial Therapies for Primary and Metastatic Lung Cancer. Technol Cancer Res Treat 2023; 22:15330338231164193. [PMID: 36942407 PMCID: PMC10034348 DOI: 10.1177/15330338231164193] [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: 03/23/2023] Open
Abstract
Lung cancer is the leading cause of cancer mortality in the world. A significant proportion of patients with lung cancer are not candidates for surgery and must resort to other treatment alternatives. Rapid technological advancements in fields like interventional radiology have paved the way for valid treatment modalities like image-guided percutaneous and transarterial therapies for treatment of both primary and metastatic lung cancer. The rationale of ablative therapies relies on the fact that focused delivery of energy induces tumor destruction and pathological necrosis. Image-guided percutaneous thermal ablation therapies are established techniques in the local treatment of hepatic, renal, bone, thyroid, or uterine lesions. In the lung, the 3 main indications for lung ablation include local curative intent, a strategy to achieve a chemoholiday in oligometastatic disease, and recently, oligoprogressive disease. Transarterial therapies include a set of catheter-based treatments that involve delivering embolic and/or chemotherapeutic agents directed into the target tumor via the supplying arteries. This article provides a comprehensive review of the various techniques available and discusses their applications and associated complications in primary and metastatic lung cancer.
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Affiliation(s)
| | - Tushar Garg
- Division of Vascular and Interventional Radiology, Russell H Morgan Department of Radiology and Radiological Science, The 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Juan C Camacho
- Vascular and Interventional Radiology, Radiology Associates of Florida, Sarasota, FL, USA
| | - Peiman Habibollahi
- Department of Interventional Radiology, 4002University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - F Edward Boas
- Department of Radiology, 20220City of Hope Cancer Center, Duarte, CA, USA
| | - Fereshteh Khorshidi
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, 12264University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ji Buethe
- Division of Vascular and Interventional Radiology, Russell H Morgan Department of Radiology and Radiological Science, The 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nariman Nezami
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, 12264University of Maryland School of Medicine, Baltimore, MD, USA
- Experimental Therapeutics Program, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
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19
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Nagano N, Suzuki M, Yamamoto S, Kobayashi K, Iikura M, Izumi S, Hojo M, Sugiyama H. Short- and long-term efficacy of bronchial artery embolization using a gelatin sponge for the treatment of cryptogenic hemoptysis. Glob Health Med 2022; 4:315-321. [PMID: 36589217 PMCID: PMC9773223 DOI: 10.35772/ghm.2022.01057] [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: 08/21/2022] [Revised: 11/01/2022] [Accepted: 11/14/2022] [Indexed: 11/20/2022]
Abstract
Bronchial artery embolization (BAE) is the first choice treatment for hemoptysis. With advances in endovascular treatment, various embolic materials have become available. However, the optimal embolic material for the treatment of cryptogenic hemoptysis has not been determined. This study aimed to investigate the short-and long-term efficacy of BAE using a gelatin sponge in the treatment of patients with cryptogenic hemoptysis. The clinical characteristics, angiographic findings, and short- and long-term outcomes of BAE were retrospectively analyzed in 22 consecutive patients who underwent BAE for control of cryptogenic hemoptysis between January 2010 and September 2018. Selective angiography and super-selective BAE were successfully performed for all patients. A gelatin sponge was used in all patients. Further, polyvinyl alcohol was mixed with the gelatin sponge in 11 patients (50%). Angiography showed that the bronchial artery was responsible for hemoptysis in all patients, along with the intercostal artery in one patient (4.5%) and the inferior phrenic artery in one patient (4.5%). Immediate hemostasis was achieved in all patients. The recurrence-free rate was 100% for 1 month, 94.1% for 3 months, 94.1% for 12 months, and 87.4% for 24 months. Of two patients with recurrent hemoptysis, one underwent bronchoscopic hemoptysis and the other received intravenous hemostatic agents. No patient underwent BAE for recurrence. No severe complications occurred. In conclusion, BAE using a gelatin sponge has short- and long-term hemostatic efficacy for treating cryptogenic hemoptysis without any severe complications. A gelatin sponge is a suitable embolic material for patients with cryptogenic hemoptysis.
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Affiliation(s)
- Naoko Nagano
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan;,Department of Respiratory Medicine, The University of Tokyo, Tokyo, Japan
| | - Manabu Suzuki
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan;,Address correspondence to:Manabu Suzuki, Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan. E-mail:
| | - Shota Yamamoto
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan;,Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, Tokyo, Japan
| | - Konomi Kobayashi
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Motoyasu Iikura
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shinyu Izumi
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masayuki Hojo
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Haruhito Sugiyama
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
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20
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Tashi S, Tan Z, Gogna A. Use of the triple coaxial (triaxial) microcatheter system in superselective arterial embolisation for complex interventional cases: an initial experience with the system. CVIR Endovasc 2022; 5:67. [PMID: 36562878 PMCID: PMC9789256 DOI: 10.1186/s42155-022-00340-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/16/2022] [Indexed: 12/24/2022] Open
Abstract
LEARNING OBJECTIVE To share our experience in utilising the triple coaxial (triaxial) system in superselective cannulation of arteries for complex embolisation procedures. BACKGROUND Percutaneous transcatheter selective embolisation is widely performed for a myriad of oncologic (e.g., trans-arterial chemo- or radio-embolisation) and non-oncologic (e.g., for embolisation of bleeding and benign conditions such as uterine fibroid and benign prostate hyperplasia) purposes. The cornerstone of such embolisation procedures is to achieve superselective cannulation of the arterial supply to the tumour/organ, preventing the complication of non-target embolisation. However, a multitude of factors, such as complex vascular anatomy, can pose challenges to achieving this goal. CLINICAL FINDINGS/PROCEDURAL DETAILS The triaxial system utilises two smaller microcatheters telescoped through each other over a microwire. We have adopted the triaxial system for specific cases due to its perceived superior torquability and trackability compared to the conventional coaxial system, in which superselective cannulation is anticipated to be challenging. The triaxial system is also favourable in situations where the inner microcatheter needs to be "sacrificed" after administering the embolics (e.g., after administering radioisotopes in radioembolisation, N-butyl cyanoacrylate [NBCA] glue or ethylene-vinyl alcohol copolymer [EvOH] Onyx). Through a case series with procedural details such as fluoroscopic time, contrast administered, etc., we hope to illustrate the utility and efficacy of the triaxial system as well as present pitfalls in its usage. CONCLUSION The triaxial system appears to be a valuable system for certain complex embolisation procedures and could be better suited than the conventional coaxial systems in these specific circumstances.
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Affiliation(s)
- Sonam Tashi
- grid.163555.10000 0000 9486 5048Department of Vascular and Interventional Radiology, Singapore General Hospital, 31 Third Hospital Ave, Singapore, 168753 Singapore
| | - Zehao Tan
- grid.163555.10000 0000 9486 5048Department of Vascular and Interventional Radiology, Singapore General Hospital, 31 Third Hospital Ave, Singapore, 168753 Singapore
| | - Apoorva Gogna
- grid.163555.10000 0000 9486 5048Department of Vascular and Interventional Radiology, Singapore General Hospital, 31 Third Hospital Ave, Singapore, 168753 Singapore
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Prevalence of non-bronchial systemic culprit arteries in patients with hemoptysis with bronchiectasis and chronic pulmonary infection who underwent de novo bronchial artery embolization. Eur Radiol 2022; 33:4198-4204. [PMID: 36472693 DOI: 10.1007/s00330-022-09310-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 10/01/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To identify the prevalence of non-bronchial systemic culprit arteries and their relationship to bleeding lobes in patients with hemoptysis with bronchiectasis and chronic pulmonary infection who underwent de novo bronchial artery embolization (BAE). METHODS Data of 83 consecutive patients with bronchiectasis and chronic pulmonary infection (non-tuberculous mycobacteriosis, aspergillosis, and tuberculosis) who underwent de novo BAE between January 2019 and December 2020 were retrospectively reviewed. The prevalence of culprit arteries was investigated. RESULTS Fifty-five patients (66%) had 172 non-bronchial systemic culprit arteries. The bleeding lobes were the right upper, right middle, right lower, left upper, and left lower lobes in 14 (17%), 20 (24%), 7 (8%), 31 (37%), and 11 (13%) patients, respectively. The internal thoracic (49%; n = 41), intercostal (28%; n = 23), and inferior phrenic (28%; n = 23) arteries were the top three non-bronchial systemic culprit arteries, which were involved in all five types of bleeding lobes. The costocervical trunk and thoracoacromial and lateral thoracic arteries were predominant in patients with upper lobe bleeding. Ligament arteries were predominant in patients with left lower lobe bleeding. CONCLUSIONS These findings will better ensure the identification of non-bronchial systemic culprit arteries in patients with hemoptysis with bronchiectasis and chronic pulmonary infection. All systemic arteries, especially those which are adjacent to the lung lesions, should be evaluated carefully using MDCT; the internal thoracic, intercostal, and inferior phrenic arteries should be proactively assessed using angiography. KEY POINTS • Non-bronchial systemic culprit arteries were identified in 66% of patients with hemoptysis with bronchiectasis and chronic pulmonary infection who underwent de novo bronchial artery embolization. • The internal thoracic (49%), intercostal (28%), and inferior phrenic (28%) arteries were the top three arteries, which were involved in all five types of bleeding lobes. • The costocervical trunk and thoracoacromial and lateral thoracic arteries were prominent in patients with upper lobe bleeding, and the ligament artery was prominent in patients with left lower lobe bleeding.
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22
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Önür ST, Altın S, Akyıl FT, Kara K, Sökücü SN, Özdemir C, Özgül MA, Metin M, Cansever L, Ölçmen A, Kılıçkesmez NÖ. Management of recurrent hemoptysis: a single-center experience. Turk J Med Sci 2022; 52:1872-1880. [PMID: 36945984 PMCID: PMC10390104 DOI: 10.55730/1300-0144.5534] [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: 01/01/2022] [Accepted: 07/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND A successful planning methodology for patients with hemoptysis promises overall improvement in patient care. Conducted in a reference center for chest diseases, the present study aims to analyze characteristics and predictors of interventional methods in patients with recurrent hemoptysis. METHODS The present study is a single-center, retrospective observational study. Between 2015 and 2018, 5973 patients with follow-up data until 2021 requiring more than one hospitalization due to recurrent hemoptysis were investigated. Patient characteristics, the amount of hemoptysis, baseline admission parameters, interventional procedures of bronchial artery embolization (BAE), fiberoptic bronchoscopy, rigid bronchoscopy, and surgical resections applied were analyzed according to number of hospitalizations and outcome. RESULTS : Hospital admission numbers were higher in patients with sequela of tuberculosis, bronchiectasis and lung cancer. While lung cancer was the most frequent underlying reason in recurrent admissions, it was determined that as the amount of bleeding increased, the number of admissions also increased to the hospital, and BAE and rigid bronchoscopy were performed more frequently in the groups with less frequent admissions. There was no statistically significance between the amount of bleeding, and the interventional procedure alone or in combination with another procedure (p > 0.05). DISCUSSION In conclusion, patients with certain diseases may experience frequent hospital admissions due to hemoptysis. Recurrent admissions may get better results with BAE and rigid bronchoscopy. We think that these procedures should be preferred in the foreground of suitable patient selection in line with available facilities and experience.
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Affiliation(s)
- Seda Tural Önür
- Department of Pulmonology, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Sedat Altın
- Department of Pulmonology, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Fatma Tokgöz Akyıl
- Department of Pulmonology, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Kaan Kara
- Department of Pulmonology, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Sinem Nedime Sökücü
- Department of Pulmonology, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Cengiz Özdemir
- Department of Pulmonology, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Mehmet Akif Özgül
- Department of Pulmonology, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Muzaffer Metin
- Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Levent Cansever
- Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Aysun Ölçmen
- Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Nuri Özgür Kılıçkesmez
- Department of Interventional Radiodiagnostic, İstanbul Education and Research Hospital, University of Health Sciences, İstanbul, Turkey
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Varghese JK, Agarwal V, Batra A. Endovascular management of hemoptysis in a known case of tetralogy of fallot and tuberculosis complicated with aspergilloma: a case report. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00816-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Hemoptysis is a life-threatening complication due to bleeding either from hypertrophied bronchial arteries or enlarged non-bronchial systemic collaterals, having multiple etiologies. Bronchial artery embolization (BAE) is a minimally invasive modality of management that can effectively manage moderate-to-severe hemoptysis.
Case presentation
We report the case of a 25-year-old female with moderate-to-severe hemoptysis. There was prior history of tuberculosis and treatment with anti-tubercular therapy 6 months back. There was also a background of tetralogy of Fallot(TOF) with symptoms of chronic breathlessness and palpitations. Imaging evaluation with X-ray and HRCT thorax revealed a cavity in the left upper lobe with dependent soft tissue, implying a diagnosis of aspergilloma in an old tubercular cavity. TOF and right-sided aortic arch were noted. CT bronchial angiography showed dilated and tortuous left bronchial artery, as well as non-bronchial systemic collaterals from the ipsilateral internal mammary artery. Endovascular management was achieved by super-selective catheterization and embolization of the involved branch of the left bronchial artery and selective embolization of non-bronchial systemic collaterals from the ipsilateral internal mammary artery.
Conclusions
BAE has a high clinical success rate and is recommended as first-line therapy in the management of massive hemoptysis. The CT pulmonary angiography, as well as the pre-embolization angiogram, is very important to detect the source of hemoptysis from the non-bronchial systemic circulation, increasing the success rate and decreasing the incidence of recurrence. BAE is effective even in presence of underlying vascular anomalies such as Fallot of Tetralogy.
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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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Role of Bronchial Artery Embolization as Early Treatment Option in Stable Cystic Fibrosis Patients with Sub-Massive Hemoptysis: Personal Experience and Literature Review. J Clin Med 2022; 11:jcm11216432. [PMID: 36362659 PMCID: PMC9657817 DOI: 10.3390/jcm11216432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/19/2022] [Accepted: 10/27/2022] [Indexed: 11/22/2022] Open
Abstract
(1) Background: We describe our experience with cystic fibrosis (CF) patients treated with bronchial artery embolization (BAE) for sub-massive hemoptysis to understand if early treatment of sub-massive hemoptysis can reduce the volume of any subsequent bleedings. (2) Materials: We performed a retrospective study including CF patients who underwent angiographic procedures for BAE following sub-massive hemoptysis, from March 2016 to December 2021. All patients underwent an initial chest angio-CT study. BAE was realized with microspheres or coils. (3) Results: Thirteen patients were included, subjected to at least one BAE after sub-massive hemoptysis, for a total of 19 procedures. Technical success was 94.7%; in a single case, the catheterization of the bronchial arterial feeder was not achievable and the procedure was repeated. Primary clinical success was 92.3%; secondary clinical success was 69.2%. Relative clinical success was 85%. A higher incidence of recurrent hemoptysis following treatment with coils was observed (100% of cases) compared to treatment with microspheres (54.5% of cases) χ2 = 5.43 (p < 0.05). (4) Conclusions: BAE is a safe and effective method for the treatment of hemoptysis in CF patients; it should be practiced not only after massive or recurrent hemoptysis but also in patients with sub-massive bleeding to improve their life expectancy and quality of life.
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Lo EYW, Viiala N, Catt J, French B. Bronchial artery pseudoaneurysm presenting with hoarseness: Diagnosis and endovascular management. Radiol Case Rep 2022; 17:4018-4020. [PMID: 36039083 PMCID: PMC9418193 DOI: 10.1016/j.radcr.2022.07.087] [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: 05/05/2022] [Revised: 07/17/2022] [Accepted: 07/23/2022] [Indexed: 11/17/2022] Open
Abstract
Bronchial artery pseudoaneurysm is a rare entity which is diagnosed radiologically; with or without symptoms. Symptoms of phonation changes with bronchial artery pseudoaneurysm are yet to be reported. This article describes the case of a 56-year-old man who presented with a history of a hoarse voice. This was investigated with computed tomography of his chest which diagnosed a bronchial artery pseudoaneurysm under the arch of the aorta. He was subsequently treated with coil embolization. The original symptoms improved with this intervention. This case highlights the rare presentation of hoarseness of voice in this rare condition.
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Affiliation(s)
- Eric Yu Wei Lo
- Department of Cardiothoracic Surgery, Liverpool Hospital, Elizabeth Street, Liverpool, NSW, 2170, Australia
- Corresponding author.
| | - Nicholas Viiala
- Department of Haematology, Liverpool Hospital, Elizabeth Street, Liverpool, NSW, 2170, Australia
- South Western Sydney Clinical School, University of NSW, Kensington, Australia
| | - Jules Catt
- Department of Interventional Radiology, Liverpool Hospital, Elizabeth Street, Liverpool, NSW, 2170, Australia
| | - Bruce French
- Department of Cardiothoracic Surgery, Liverpool Hospital, Elizabeth Street, Liverpool, NSW, 2170, Australia
- University of Western Sydney, Liverpool, NSW, 2170 Australia
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Mora-Soize C, Carsin-Vu A, Caby GM, Belkessa N, Marcus C, Soize S. Recurrent massive hemoptysis from distal pulmonary pseudoaneurysms complicating invasive aspergillosis in a teenager. Radiol Case Rep 2022; 17:3897-3902. [PMID: 35996719 PMCID: PMC9391511 DOI: 10.1016/j.radcr.2022.07.095] [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: 07/10/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 12/05/2022] Open
Abstract
Invasive pulmonary aspergillosis in children rarely complicates life-threatening massive hemoptysis. Here, we report the case of a 15-year-old girl with acute lymphoblastic leukemia who was hospitalized for fever and medullary aplasia 1 month after beginning chemotherapy for invasive pulmonary aspergillosis. Despite voriconazole and caspofungine treatment, excavation of some lesions caused a unilateral small pneumothorax and bilateral pleural effusion, justifying intensive care management. The massive hemoptysis that occurred on day 23 was complicated with heart failure, and the patient was promptly resuscitated. Fibroscopy and computed tomography angiography (CTA) did not reveal the origin or cause of the bleeding. A second massive bleeding event occurred on day 32, and heart failure resolved after 10min of low flow. A new CTA showed 2 pseudoaneurysms of the subsegmental pulmonary arteries that were treated with embolization. Sedation was gradually decreased owing to improvement in respiratory status, but the patient did not regain consciousness because of deep brain sequelae. A limitation of care was decided upon, and the patient died in the following weeks. Massive hemoptysis is a rare life-threatening complication of invasive pulmonary aspergillosis, especially in children. Pulmonary artery pseudoaneurysms are unusual and should be detected as soon as possible to guide therapy. Intensive care management should be followed by embolization if the patient is stable; otherwise, surgery is indicated, ideally after identifying the source of bleeding by CTA or bronchoscopy. Early CTA follow-up can be proposed if the source of bleeding is still unknown as pseudoaneurysms can appear or grow rapidly.
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Affiliation(s)
- Caroline Mora-Soize
- Department of Pediatric Radiology, American Memorial Hospital, CHU de Reims, Université de Reims Champagne-Ardenne, 47 rue Cognacq-Jay, 51092, Reims, France
- Department of Diagnostic and Interventional Radiology, Hôpital Robert Debré, CHU de Reims, 51 avenue du Général Koening, Université de Reims Champagne-Ardenne, 51092, Reims, France
- Corresponding author.
| | - Aline Carsin-Vu
- Department of Pediatric Radiology, American Memorial Hospital, CHU de Reims, Université de Reims Champagne-Ardenne, 47 rue Cognacq-Jay, 51092, Reims, France
| | - Gratiela Mac Caby
- Department of Pediatric Radiology, American Memorial Hospital, CHU de Reims, Université de Reims Champagne-Ardenne, 47 rue Cognacq-Jay, 51092, Reims, France
| | - Nasredine Belkessa
- Department of Pediatric Radiology, American Memorial Hospital, CHU de Reims, Université de Reims Champagne-Ardenne, 47 rue Cognacq-Jay, 51092, Reims, France
- Department of Diagnostic and Interventional Radiology, Hôpital Robert Debré, CHU de Reims, 51 avenue du Général Koening, Université de Reims Champagne-Ardenne, 51092, Reims, France
| | - Claude Marcus
- Department of Pediatric Radiology, American Memorial Hospital, CHU de Reims, Université de Reims Champagne-Ardenne, 47 rue Cognacq-Jay, 51092, Reims, France
- Department of Diagnostic and Interventional Radiology, Hôpital Robert Debré, CHU de Reims, 51 avenue du Général Koening, Université de Reims Champagne-Ardenne, 51092, Reims, France
| | - Sebastien Soize
- Department of Radiology, Hôpital Maison Blanche, CHU de Reims, Université de Reims Champagne-Ardenne, 45 rue Cognacq-Jay, 51092, Reims, France
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Park SJ, Lee S, Lee HN, Cho Y. Early versus delayed bronchial artery embolization for non-massive hemoptysis. Eur Radiol 2022; 33:116-124. [DOI: 10.1007/s00330-022-08993-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/05/2022] [Accepted: 06/29/2022] [Indexed: 11/27/2022]
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Westrych K, Ruzik K, Zielinska N, Paulsen F, Georgiev GP, Olewnik Ł, Łabętowicz P. Common trunk of the internal thoracic artery, inferior thyroid artery and thyrocervical trunk from the subclavian artery: a rare arterial variant. SURGICAL AND RADIOLOGIC ANATOMY : SRA 2022; 44:983-986. [PMID: 35792911 DOI: 10.1007/s00276-022-02977-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/16/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE In this article, we describe a complex and rare variant of the common trunk arising as a branch of the subclavian artery. This description highlights the clinical relevance of such a variation for medical practice. METHODS A routine dissection was carried out on an adult 74-year-old female cadaver. After identification and preparation of the common trunk, measurements and photographs were taken. RESULTS The dissection revealed a common trunk arising from the first part of the left subclavian artery. It divided into the left internal thoracic artery, the inferior thyroid artery, and the thyrocervical trunk. Further on, the branches of the thyrocervical trunk supplied blood to the trapezius muscle, the longus colli muscle and the supraspinatus muscle. CONCLUSION For the first time, we report the specific appearance of a common trunk from the left subclavian artery that includes the origin of the left internal thoracic artery, inferior thyroid artery, and thyrocervical trunk. Knowledge of the different variations of subclavian branches is essential because of the high frequency with which this region is involved in diagnostic and surgical procedures. LEVEL OF EVIDENCE II Basic Science Research.
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Affiliation(s)
- Karolina Westrych
- Department of Anatomical Dissection and Donation, Medical University of Lodz, ul. Żeligowskiego 7/9, 90-410, Łódź, Poland
| | - Kacper Ruzik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, ul. Żeligowskiego 7/9, 90-410, Łódź, Poland.
| | - Nicol Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, ul. Żeligowskiego 7/9, 90-410, Łódź, Poland
| | - Friedrich Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany.,Department of Operative Surgery and Topographic Anatomy, Sechenov University, Moscow, Russia
| | - Georgi P Georgiev
- Department of Orthopedics and Traumatology, University Hospital Queen Giovanna-ISUL, Medical University of Sofia, Sofia, Bulgaria
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, ul. Żeligowskiego 7/9, 90-410, Łódź, Poland
| | - Piotr Łabętowicz
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Łódź, Poland
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Chen Y, Lin L, Deng Q, Li N, Wang Z, Liu J, Sun H. Coronary artery-bronchial artery fistula imaging characteristics and its correlation with pulmonary disease severity. Heart Vessels 2022; 37:2101-2106. [PMID: 35729428 DOI: 10.1007/s00380-022-02106-y] [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: 12/20/2021] [Accepted: 05/19/2022] [Indexed: 11/28/2022]
Abstract
Hemoptysis is a common clinical emergency, bronchial arterial embolization is considered to be an effective treatment. The presence of coronary artery-bronchial artery fistula (CBF) may lead to recurrence of hemoptysis after treatment. It is necessary to investigate the imaging characteristics of a CBF and its correlation with the severity of pulmonary disease. With the development of multi-detector computed tomography, our study used the 320-slice CT bronchial artery angiography technology to observe and visualize blood vessels. The image and clinical data of 2015 hemoptysis patients with 320-slice CT bronchial artery angiography were retrospectively reviewed from January 2015 to December 2019. The axial and three-dimensional CT images were analyzed. The incidence, anatomical characteristics of CBF and pulmonary disease severity score were evaluated. A total of 12 CBF vessels were detected in 11 patients. We found that the incidence of CBF in this group was 0.55% (11/2015). Mean CBF diameter was 1.9 mm (1.2-2.5 mm). The course of CBF usually was relatively fixed. The proportions of CBF originated from the left circumflex artery, right coronary artery, and left anterior descending artery were 75%, 16.7% and 8.3%, respectively. Preliminarily analysis of the correlation between the trend of CBF and the pulmonary diseases severity score showed that CBF was more likely to communicate with a bronchial artery on the side with a higher severity score. CBF may occur in patients with chronic pulmonary disease and hemoptysis, and its origin, course and trend are characteristic. Detailed and comprehensive computed tomography angiography image analysis is helpful to improve the clinical treatment of hemoptysis with CBF.
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Affiliation(s)
- Yonghua Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Liaoyi Lin
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Qingshan Deng
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Na Li
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Zhenzhang Wang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Jinjin Liu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.
| | - Houzhang Sun
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.
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Jadhav SS, Dhok A, Chaudhari SV, Khandaitkar S, Ambhore AN. Rasmussen's Aneurysm: A Rare Case. Cureus 2022; 14:e25740. [PMID: 35812556 PMCID: PMC9270097 DOI: 10.7759/cureus.25740] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2022] [Indexed: 12/02/2022] Open
Abstract
Rasmussen’s aneurysm is a very uncommon condition occurring in post-pulmonary tuberculosis patients. We are presenting a case of a young male patient with the chief complaints of hemoptysis, breathlessness on exertion, cough with expectoration and fever, and weight loss. A thorough radiological examination revealed multiple cavitary lesions, bronchiectasis, tree-in-bud appearance and pulmonary nodules, and areas of air-spaced opacities, indicating a likely diagnosis of post-primary pulmonary tuberculosis with stages of active infection and healed infection. The post-contrast study revealed a well-defined dilated vascular channel arising from a branch of the right pulmonary artery indicating pseudo-aneurysm formation, i.e., Rasmussen’s aneurysm, within a large cavity in the right middle lobe. The patient underwent emergency trans-arterial embolization successfully and he was stable postoperatively.
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García Jurado PB, Pérez Montilla ME, Lombardo Galera MS, Entrenas Castillo M, García-Revillo J, Espejo Herrero JJ. Embolization of bronchial arteries and nonbronchial systemic arteries with n-butyl-cyanoacrylate in patients with hemoptysis: A retrospective single-center study. RADIOLOGIA 2022; 65:99-105. [PMID: 37059585 DOI: 10.1016/j.rxeng.2020.12.003] [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: 08/07/2020] [Accepted: 12/01/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate the safety and efficacy of the embolization of bronchial arteries and nonbronchial systemic arteries with n-butyl-cyanoacrylate (NBCA) in patients with hemoptysis. METHODS We analyzed a total of 55 consecutive patients with hemoptysis (14 mild, 31 moderate, and 10 massive) treated with the embolization of bronchial arteries and nonbronchial systemic arteries with n-butyl-cyanoacrylate between November 2013 and January 2020. The main variables analyzed were the rates of technical success, of clinical success, of recurrence, and of complications. Statistics included a descriptive analysis and Kaplan-Meier survival curves. RESULTS Embolization was a technical success in 55 (100%) and a clinical success in 54 (98.2%). During follow-up (mean, 23.8 months; interquartile range, 9.7-38.2 months), hemoptysis recurred in 5 (9.3%) patients. The nonrecurrence rate was 91.9% one year after the initial procedure and 88.7% two years and four years after the initial procedure. Minor complications related with the procedure occurred in 6 (10.9%); no major complications occurred. CONCLUSIONS The embolization of bronchial arteries and nonbronchial systemic arteries with n-butyl-cyanoacrylate is safe and efficacious for controlling hemoptysis, resulting in low recurrence rates.
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Affiliation(s)
- P B García Jurado
- Unidad de Gestión Clínica de Radiodiagnóstico y Cáncer de Mama, Sección de Radiología Vascular Intervencionista, Hospital Universitario Reina Sofía, Córdoba, Spain.
| | - M E Pérez Montilla
- Unidad de Gestión Clínica de Radiodiagnóstico y Cáncer de Mama, Sección de Radiología Vascular Intervencionista, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - M S Lombardo Galera
- Unidad de Gestión Clínica de Radiodiagnóstico y Cáncer de Mama, Sección de Radiología Vascular Intervencionista, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - M Entrenas Castillo
- Unidad de Gestión Clínica de Neumología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - J García-Revillo
- Unidad de Gestión Clínica de Radiodiagnóstico y Cáncer de Mama, Sección de Radiología Vascular Intervencionista, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - J J Espejo Herrero
- Unidad de Gestión Clínica de Radiodiagnóstico y Cáncer de Mama, Sección de Radiología Vascular Intervencionista, Hospital Universitario Reina Sofía, Córdoba, Spain
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Abstract
Massive hemoptysis is a highly morbid medical condition with up to 75% mortality with conservative treatment. Bronchial artery embolization has emerged as the common treatment for both acute massive hemoptysis and chronic hemoptysis. This article will review the clinical presentation, bronchial artery anatomy, embolization procedure, complications, and expected outcomes.
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Affiliation(s)
- Claire S. Kaufman
- Dotter Department of Interventional Radiology, Oregon Health & Sciences University, Portland, Oregon
| | - Sharon W. Kwan
- Dotter Department of Interventional Radiology, Oregon Health & Sciences University, Portland, Oregon
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Higgins MC, Shi J, Bader M, Kohanteb PA, Brahmbhatt TS. Role of Interventional Radiology in the Management of Non-aortic Thoracic Trauma. Semin Intervent Radiol 2022; 39:312-328. [PMID: 36062226 PMCID: PMC9433159 DOI: 10.1055/s-0042-1753482] [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: 10/14/2022]
Abstract
Trauma remains a leading cause of death for all age groups, and nearly two-thirds of these individuals suffer thoracic trauma. Due to the various types of injuries, including vascular and nonvascular, interventional radiology plays a major role in the acute and chronic management of the thoracic trauma patient. Interventional radiologists are critical members in the multidisciplinary team focusing on treatment of the patient with thoracic injury. Through case presentations, this article will review the role of interventional radiology in the management of trauma patients suffering thoracic injuries.
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Affiliation(s)
- Mikhail C.S.S. Higgins
- Department of Radiology, Boston Medical Center, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Jessica Shi
- Boston University School of Medicine, Boston, Massachusetts
| | - Mohammad Bader
- Department of Radiology, Boston Medical Center, Boston, Massachusetts
| | - Paul A. Kohanteb
- Department of Radiology, Boston Medical Center, Boston, Massachusetts
| | - Tejal S. Brahmbhatt
- Boston University School of Medicine, Boston, Massachusetts
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care; Boston Medical Center, Boston, Massachusetts
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35
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Angiographic and histopathological study on bronchial-to-pulmonary vascular anastomoses on explants from patients with cystic fibrosis after bronchial artery embolisation. J Cyst Fibros 2022; 21:1042-1047. [DOI: 10.1016/j.jcf.2022.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/19/2022] [Accepted: 04/19/2022] [Indexed: 11/21/2022]
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36
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Liu MY, Rose SC, Loh A, Taddonio M, Redmond JW, Meisinger QC, Minocha J, Berman ZT. Utility of Cone-Beam CT for Bronchial Artery Embolization and Chemoinfusion: A Single-Institution Retrospective Case Series. Cardiovasc Intervent Radiol 2022; 45:834-840. [PMID: 35441243 PMCID: PMC9117382 DOI: 10.1007/s00270-022-03148-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/31/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To describe the technique and document utility of adjunctive cone-beam CT (CBCT) in patients undergoing bronchial artery embolization (BAE) or chemoinfusion (BAC). MATERIALS AND METHODS Between August 2010 and February 2021, 26 patients (62 bronchial arteries) were evaluated with CBCT in addition to the usual digital subtraction angiography (DSA) during BAE or BAC. 19 patients (43 arteries) underwent BAE for hemoptysis; 7 patients (19 arteries) had BAC for palliation of lung malignancy. Retrospective review of procedural reports and the archived DSA and CBCT images was assessed for (1) whether CBCT findings added unique diagnostic information prior to treatment of target arteries compared to DSA alone; and (2) whether these unique CBCT findings led to modification of embolization or chemoinfusion technique. RESULTS In 61 of 62 (98%) interrogated bronchial arteries, CBCT provided additional unique diagnostic information over planar DSA, primarily cross-sectional assessment of the spinal canal for spinal arteries. In 46/62 (74%) of the bronchial arteries the unique information did not lead to a change in therapeutic technique. In 15 bronchial arteries (24%), the added information from CBCT led to change in embolization and/or chemoinfusion technique. Embolization of one small unrecognized spinal artery branch (1.6%), which was missed intra-procedurally but retrospectively seen on CBCT led to transient spinal cord ischemia. CONCLUSIONS These results suggest that adjunctive use of CBCT technique may improve diagnostic confidence from information provided by DSA in nearly all cases of BAE and BAC leading to improved therapeutic targeting or change in technique of embolization or chemoinfusion.
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Affiliation(s)
- Michael Y Liu
- Department of Radiology, University of California San Diego Medical Center, 200 West Arbor Drive, San Diego, CA, 92103, USA.
| | - Steven C Rose
- Department of Radiology, University of California San Diego Medical Center, 200 West Arbor Drive, San Diego, CA, 92103, USA
| | - Alexander Loh
- San Diego School of Medicine, University of California, San Diego, CA, USA
| | - Michael Taddonio
- Department of Radiology, University of California San Diego Medical Center, 200 West Arbor Drive, San Diego, CA, 92103, USA
| | - Jonas W Redmond
- Department of Radiology, University of California San Diego Medical Center, 200 West Arbor Drive, San Diego, CA, 92103, USA
| | - Quinn C Meisinger
- Department of Radiology, University of California San Diego Medical Center, 200 West Arbor Drive, San Diego, CA, 92103, USA
| | - Jeet Minocha
- Department of Radiology, University of California San Diego Medical Center, 200 West Arbor Drive, San Diego, CA, 92103, USA
| | - Zachary T Berman
- Department of Radiology, University of California San Diego Medical Center, 200 West Arbor Drive, San Diego, CA, 92103, USA
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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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Massive hemoptysis treated with embolization of an ectopic bronchial artery arising from the right thyrocervical trunk: a case report. CVIR Endovasc 2022; 5:6. [PMID: 35041120 PMCID: PMC8766613 DOI: 10.1186/s42155-022-00285-3] [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: 10/07/2021] [Accepted: 01/10/2022] [Indexed: 11/30/2022] Open
Abstract
Background Ectopic bronchial artery and non-bronchial systemic arteries may be the culprit vessels of hemoptysis. The main cause of clinical failure of bronchial artery embolization is incomplete embolization caused by the misidentification of the culprit arteries by conventional angiography. Multidetector computed tomography angiography is useful for visualizing the culprit arteries. Case presentation An 82-year-old man was admitted with hemoptysis. Preprocedural multidetector computed tomography angiography revealed an ectopic bronchial artery branching from the right thyrocervical trunk. Superselective embolization of the ectopic bronchial artery was performed using gelatin sponge particles and metallic coils. Hemoptysis was controlled by this procedure without any associated complications. Conclusions Ectopic bronchial arteries originating from the thyrocervical trunk are rare. Preprocedural multidetector computed tomography angiography is useful for visualizing the culprit arteries of hemoptysis, especially if a patient has an ectopic bronchial artery or an ectopic non-bronchial systemic artery.
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Mahmoud N, Moussa C, Attia M, Rouis H, Khattab A, Khouaja I, Zendah I, Hantous S, Maȃlej S. Rasmussen aneurysm: A forgotten complication of tuberculosis in the COVID-19 era. Respir Med Case Rep 2022; 39:101714. [PMID: 35937613 PMCID: PMC9339016 DOI: 10.1016/j.rmcr.2022.101714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 07/12/2022] [Accepted: 07/21/2022] [Indexed: 10/27/2022] Open
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40
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Taoka M, Makimoto G, Umakoshi N, Ninomiya K, Higo H, Kato Y, Fujii M, Kubo T, Ichihara E, Ohashi K, Hotta K, Tabata M, Maeda Y, Kiura K. Massive hemoptysis in a post-operative patient with recurrent lung cancer successfully treated by the combination therapy of Endobronchial Watanabe Spigot and bronchial artery embolization. Respir Med Case Rep 2022; 38:101669. [PMID: 35646587 PMCID: PMC9136182 DOI: 10.1016/j.rmcr.2022.101669] [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: 03/06/2022] [Revised: 04/13/2022] [Accepted: 05/17/2022] [Indexed: 12/01/2022] Open
Abstract
A 76-year-old woman who was treated with lorlatinib for postoperative recurrent anaplastic lymphoma kinase-positive lung adenocarcinoma visited our hospital with massive hemoptysis. Chest computed tomography showed massive bleeding from the right upper lobe; however, the cause of bleeding was unclear. After bronchial artery embolization (BAE), bronchial occlusion was performed using an Endobronchial Watanabe Spigot (EWS) that was easily placed because BAE had reduced the bleeding volume. Treatment with BAE alone was inadequate; however, additional therapy with EWS after BAE successfully controlled the massive hemoptysis, especially in this patient who underwent lobectomy to prevent respiratory dysfunction.
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Omachi N, Ishikawa H, Nishihara T, Yamaguchi Y, Kitaoka A, Kitaguchi K, Hattori T, Kawaguchi T. Bronchial artery aneurysm: Prevalence, clinical characteristics, and long-term prognosis following bronchial artery embolization. J Vasc Interv Radiol 2021; 33:121-129. [PMID: 34752932 DOI: 10.1016/j.jvir.2021.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/20/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To investigate the prevalence, clinical characteristics, and long-term prognosis of bronchial artery aneurysm (BAA) following bronchial artery embolization (BAE). MATERIALS AND METHODS The medical records of consecutive patients who underwent bronchial artery angiography between August 2013 to December 2019 were reviewed retrospectively. Patients who were diagnosed with BAA during this period were enrolled in this study. The prevalence, patients' characteristics, symptoms, comorbidities, angiographic findings, and long-term prognosis following BAE were investigated. RESULTS BAA was observed in 20 out of 508 patients who underwent bronchial artery angiography (3.9%). The patients' median age was 69 years (range 44-91). The main causes of BAA were cryptogenic, bronchiectasis/cystic fibrosis, and pulmonary aspergillosis. The median diameter of the ruptured BAAs was significantly smaller than that of the unruptured BAAs [5.4 mm (4.8-7.3 mm) versus 9.0 mm (7.2-13.9 mm), p = 0.009]. All patients were successfully treated with BAE without major adverse events. The median follow-up period after BAE was 970 (quartiles: 561-1796) days. The BAA-related survival rate was 100% at 2 and 3 years after BAE, and the overall survival rate after BAE was 89.2% (95% CI: 89.0-89.3) at 2 years and 74.3% (95% CI, 74.0-74.5) at 3 years. BAA related adverse events and mortality did not occur during the follow up period. CONCLUSION BAA was observed in 3.9 % (20/508) of patients who underwent bronchial artery angiography. All patients with BAA were successfully treated by BAE. BAA rupture and consequent mortality did not occur during follow up period.
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Affiliation(s)
- Naoki Omachi
- Hemoptysis and Pulmonary-Circulation Center, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Japan; Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan.
| | - Hideo Ishikawa
- Hemoptysis and Pulmonary-Circulation Center, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Japan; Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Takashi Nishihara
- Hemoptysis and Pulmonary-Circulation Center, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Japan; Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Yu Yamaguchi
- Hemoptysis and Pulmonary-Circulation Center, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Japan; Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Aya Kitaoka
- Hemoptysis and Pulmonary-Circulation Center, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Japan; Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Kazushi Kitaguchi
- Hemoptysis and Pulmonary-Circulation Center, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Japan; Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Tomoaki Hattori
- Hemoptysis and Pulmonary-Circulation Center, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Japan; Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Tomoya Kawaguchi
- Hemoptysis and Pulmonary-Circulation Center, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Japan; Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
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Piacentino F, Fontana F, Curti M, Coppola A, Venturini M. Bronchial artery embolization with an ethylene vinyl alcohol copolymer agent (Squid) and polyvinyl alcohol particles for treatment of hemoptysis. Diagn Interv Radiol 2021; 27:786-788. [PMID: 34792034 PMCID: PMC8621634 DOI: 10.5152/dir.2021.20601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Bronchial artery embolization (BAE) is considered the first choice treatment for hemoptysis. To our knowledge no cases of BAE using a recent ethylene vinyl alcohol copolymer agent (Squid) have been previously mentioned. Two cases of BAE for remitting hemoptysis using Squid and polyvinyl alcohol particles are reported in this technical note. The final angiographic control confirmed full exclusion of the target territory in both cases. Both patients felt some chest pain immediately after the embolization, not requiring any medications. No more episodes of hemoptysis occurred in the following 3 months after the procedure.
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Affiliation(s)
- Filippo Piacentino
- From the Department of Radiology (C.M. ), Insubria University, Varese, Italy
| | - Federico Fontana
- From the Department of Radiology (C.M. ), Insubria University, Varese, Italy
| | - Marco Curti
- From the Department of Radiology (C.M. ), Insubria University, Varese, Italy
| | - Andrea Coppola
- From the Department of Radiology (C.M. ), Insubria University, Varese, Italy
| | - Massimo Venturini
- From the Department of Radiology (C.M. ), Insubria University, Varese, Italy
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43
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Xiaobing L, Meipan Y, Pengfei X, Yue Z, Ying L, Xiangnan L, Yu Q, Yaozhen M, Chunxia L, Gang W. Bronchial Artery Chemoembolization for Hemoptysis in Advanced Primary Lung Cancer. Clin Lung Cancer 2021; 23:e203-e209. [PMID: 34824012 DOI: 10.1016/j.cllc.2021.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 10/06/2021] [Accepted: 10/10/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND To evaluate the safety and effectiveness of bronchial arterial infusion chemoembolization (BAICE) for lung cancer with hemoptysis. PATIENTS AND METHODS Retrospectively analyze clinical data of patients undergoing BAICE for the treatment of lung cancer with hemoptysis, evaluate the clinical efficacy of this approach, observe postoperative adverse reactions, and analyze hemoptysis-free survival (HFS) and overall survival (OS). RESULTS All 187 patients underwent BAICE with technical success rate of 100%, clinical success rate of 86.6%, clinical failure rate of 13.4%. After BAICE, the tumor curative effect was evaluated as complete remission in 56 cases, partial remission in 82 cases, stable disease in 26 cases, and progressive disease in 6 cases. The objective response rate was 73.8%, and the disease control rate was 87.7%. Median HFS of the 154 clinically successful cases was 10.5 months (95% confidence interval [CI]: 8.11-11.89). The degree of hemoptysis (massive hemoptysis hazard ratio [HR] = 5.9, 95% CI: 3.43-10.16, P = .00) and cavitary lung mass (HR = 2.39, 95% CI: 1.44-3.99, P = .001), were significantly related to a reduction in HFS after BAICE. The 6-month and 12-month survival rates were 66.5% and 45.6%, respectively. The median OS of clinically successful cases was 13.0 months (95% CI: 11.22-14.77). The median OS of 16 clinically failed cases was 2.0 months (95% CI: 0.41-2.45) (P < .001). All adverse events were grade 1. CONCLUSION BAICE for advanced lung cancer with hemoptysis is safe, effective, and tolerable.
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Affiliation(s)
- Li Xiaobing
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yin Meipan
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xie Pengfei
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Zhao Yue
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Liu Ying
- Department of Respiratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Li Xiangnan
- Departments of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Qi Yu
- Departments of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Ma Yaozhen
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Li Chunxia
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Wu Gang
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
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Fukaya T, Kasai H, Sugiura T, Nagata J, Suzuki K, Ohashi K, Tanaka N, Abe M, Suga M, Sakao S, Suzuki T. Six Cases of Hemoptysis with Angiogenesis from Non-Bronchial Systemic Arteries. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e933187. [PMID: 34610006 PMCID: PMC8503798 DOI: 10.12659/ajcr.933187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although bronchial arteries are the most common cause of hemoptysis, other systemic arteries can cause hemoptysis and are potential pitfalls for successful embolization. CASE REPORT We present 6 cases of hemoptysis showing vascularization from systemic arteries other than bronchial arteries that presented to our department between 2013 and 2020. Chronic inflammatory diseases such as tuberculosis and pulmonary aspergillosis were the underlying diseases in 4 of the 6 cases. In all 6 cases, the lesions were close to the pleura. The abnormal non-bronchial systemic arteries were the internal thoracic artery in 4 cases, intercostal artery in 2 cases, lateral thoracic artery in 2 cases, and the subclavian, thyrocervical, and inferior phrenic arteries in 1 case each, all of which formed a shunt with the pulmonary artery. Additionally, depending on the location of the lesion, the non-bronchial systemic arteries near the lesion proliferated into the lung parenchyma through the adherent pleura. CONCLUSIONS When lesions are in contact with the pleura, various non-bronchial systemic arteries near the lesion can develop in the pulmonary parenchyma via the adherent pleura, which can cause hemoptysis. In patients with hemoptysis, it may be useful to evaluate chest contrast-enhanced computed tomography and angiography, while always accounting for the potential involvement of non-bronchial systemic arteries to ensure a safer and more reliable treatment.
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Affiliation(s)
- Takumi Fukaya
- Department of Medicine, School of Medicine, Chiba University, Chiba, Japan
| | - Hajime Kasai
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan.,Health Professional Development Center, Chiba University, Chiba, Japan
| | - Toshihiko Sugiura
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Jun Nagata
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kenichi Suzuki
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kana Ohashi
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Nozomi Tanaka
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Mitsuhiro Abe
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masaki Suga
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Seiichiro Sakao
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takuji Suzuki
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Behçet's disease presenting with massive hemoptysis related to bronchovascular fistula: A case report. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 29:408-411. [PMID: 34589263 PMCID: PMC8462114 DOI: 10.5606/tgkdc.dergisi.2021.19487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/10/2020] [Indexed: 11/21/2022]
Abstract
A 37-year-old male patient was admitted to our hospital with recurrent hemoptysis, 50 mL per day. Thoracic computed tomography showed no pathology responsible for hemoptysis. Bronchoscopy revealed mucosal infiltrations and 2 to 3-mm blotch in the lateral wall of the right lower lobe. After punch biopsy of the suspected area, massive bleeding occurred. Right lower bilobectomy was performed urgently. A bronchovascular fistula was noticed at the specimen. Pathological examination result was compatible with clinically suspected Behçet"s disease. The patient was given high-dose steroid and cyclophosphamide treatment and received azathioprine maintenance treatment for 18 months. He has been symptom-free for three-year follow-up.
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Semasinghe Bandaralage SP, Tay G, Hay K, Megram E, Smith D, Gadowski T, Wright E, France M, Bell S, Reid D. Outcomes of artery embolisation for cystic fibrosis patients with haemoptysis: a 20-year experience at a major Australian tertiary centre. Intern Med J 2021; 51:1526-1529. [PMID: 34541776 DOI: 10.1111/imj.15483] [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: 10/09/2020] [Revised: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 11/30/2022]
Abstract
There are no published data on Australian adult cystic fibrosis (CF) patient outcomes post bronchial arterial embolisation (BAE). We report 20 years of experience of BAE at a major Australian tertiary adult CF centre, where 46 patients underwent 100 BAE during this period. Mortality rate was comparable to previous studies (4% per year) and most who died had repeat BAE requirements. A higher proportion (9 out of 45) of patients were transplanted compared to previous publications. Repeat BAE was common and significantly higher in patients already on tranexamic acid.
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Affiliation(s)
- Sahan P Semasinghe Bandaralage
- Respiratory Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - George Tay
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Karen Hay
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Emma Megram
- Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Daniel Smith
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Tahlia Gadowski
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Eimear Wright
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Megan France
- Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Scott Bell
- Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia.,Lung Bacteria Group, Child Health Research Centre - University of Queensland, Brisbane, Queensland, Australia
| | - David Reid
- Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
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47
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Charya AV, Holden VK, Pickering EM. Management of life-threatening hemoptysis in the ICU. J Thorac Dis 2021; 13:5139-5158. [PMID: 34527355 PMCID: PMC8411133 DOI: 10.21037/jtd-19-3991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/24/2020] [Indexed: 12/12/2022]
Abstract
Life-threatening hemoptysis is commonly encountered in the ICU and its management can be challenging even for experienced clinicians. Depending on the etiology and severity, one can tailor the treatment modality and therapeutic intervention(s). The grading of severity of hemoptysis varies greatly in the literature; however, unlike hemorrhage in other scenarios, small amounts of blood can significantly impair oxygenation and ventilation leading to cardiovascular collapse. Importantly, the initial evaluation and management should focus on airway and hemodynamic stabilization along with maintenance of oxygenation and ventilation. In this review, we discuss commonly encountered etiologies, vascular anatomy, diagnostic evaluation, and therapeutic interventions. We examine the evolving trends in etiologies of life-threating hemoptysis over the years. The role of flexible and rigid bronchoscopy as both a diagnostic and therapeutic modality is explored, as well as the use and indications of several bronchoscopic techniques, such as topical hemostatic agents, endobronchial tamponade, and tranexamic acid (TXA). In addition, we assess the use of multi-row detector computed tomography as the initial rapid diagnostic method of choice and its use in planning for definitive treatment. The efficacy and long-term results of bronchial artery embolization (BAE) are evaluated, as well as indications for surgical intervention. Furthermore, the importance of a multidisciplinary approach is emphasized. The necessary interplay between intensivists, consultative services, and radiologists is described in detail and an algorithmic management strategy incorporating the above is outlined. Given the complexity in management of life-threatening hemoptysis, this paper aims to summarize the available diagnostic and therapeutic methods and provide a standardized approach for the management of patients with this often difficult to treat condition.
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Affiliation(s)
- Ananth V Charya
- Division of Pulmonary and Critical Care Medicine, University of Maryland Medical Center, Baltimore, MD, USA
| | - Van K Holden
- Division of Pulmonary and Critical Care Medicine, Section of Interventional Pulmonology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Edward M Pickering
- Division of Pulmonary and Critical Care Medicine, Section of Interventional Pulmonology, University of Maryland School of Medicine, Baltimore, MD, USA
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Jajodia S, Goenka U, Jash D, Tiwary I, Goenka MK. Endovascular management of massive hemoptysis due to covid-19 related pulmonary artery pseudoaneurysm: A rare entity. Radiol Case Rep 2021; 16:3597-3601. [PMID: 34466180 PMCID: PMC8390365 DOI: 10.1016/j.radcr.2021.08.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 12/12/2022] Open
Abstract
Pulmonary artery pseudoaneurysms are rare causes of massive hemoptysis, even less common in setting of COVID-19 pneumonia. We describe and discuss an index case of cavitating COVID-19 pneumonia complicated by a pulmonary artery pseudoaneurysm without concomitant pulmonary thromboembolism. The patient presented with severe hemoptysis and was managed by endovascular coil embolization. Good technical and clinical success was achieved with complete resolution of hemoptysis.
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Affiliation(s)
- Surabhi Jajodia
- Department of Clinical imaging and Interventional Radiology, Apollo Multi Speciality Hospitals, 58, Canal circular road, Kolkata 700054, India
- Corresponding author. S. Jajodia.
| | - Usha Goenka
- Department of Clinical imaging and Interventional Radiology, Apollo Multi Speciality Hospitals, 58, Canal circular road, Kolkata 700054, India
| | - Debraj Jash
- Department of Pulmonary Medicine, Apollo Multi Speciality Hospitals, Kolkata, India
| | - Indrajeet Tiwary
- Institute of Gastro-sciences, Apollo Multi Speciality Hospitals, Kolkata, India
| | - Mahesh Kumar Goenka
- Institute of Gastro-sciences, Apollo Multi Speciality Hospitals, Kolkata, India
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Dohna M, Renz DM, Stehling F, Dohna-Schwake C, Sutharsan S, Neurohr C, Wirtz H, Eickmeier O, Grosse-Onnebrink J, Sauerbrey A, Soditt V, Poplawska K, Wacker F, Montag MJ. Coil embolisation for massive haemoptysis in cystic fibrosis. BMJ Open Respir Res 2021; 8:8/1/e000985. [PMID: 34385150 PMCID: PMC8362706 DOI: 10.1136/bmjresp-2021-000985] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 07/26/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction Massive haemoptysis is a life-threatening event in advanced cystic fibrosis (CF) lung disease with bronchial artery embolisation (BAE) as standard of care treatment. The aim of our study was to scrutinise short-term and long-term outcomes of patients with CF and haemoptysis after BAE using coils. Methods We carried out a retrospective cohort study of 34 adult patients treated for massive haemoptysis with super selective bronchial artery coil embolisation (ssBACE) between January 2008 and February 2015. Embolisation protocol was restricted to the culprit vessel(s) and three lobes maximum. Demographic data, functional end-expiratory volume in 1 s in % predicted (FEV1% pred.) and body mass index before and after ssBACE, sputum colonisation, procedural data, time to transplant and time to death were documented. Results Patients treated with ssBACE showed significant improvement of FEV1% pred. after embolisation (p=0.004) with 72.8% alive 5 years post-ssBACE. Mean age of the patients was 29.9 years (±7.7). Mean FEV1% pred. was 45.7% (±20.1). Median survival to follow-up was 75 months (0–125). Severe complication rate was 0%, recanalisation rate 8.8% and 5-year-reintervention rate 58.8%. Chronic infection with Pseudomonas aeruginosa was found in 79.4%, Staphylococcus areus in 50% and Aspergillus fumigatus in 47.1%. Discussion ssBACE is a safe and effective treatment for massive haemoptysis in patients with CF with good results for controlling haemostasis and excellent short-term and long-term survival, especially in severely affected patients with FEV<40% pred. We think the data of our study support the use of coils and a protocol of careful and prudent embolisation.
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Affiliation(s)
- Martha Dohna
- Pediatric Radiology, Hannover Medical School, Hannover, Germany
| | | | - Florian Stehling
- Department of Pediatric Pulmonology and Sleep Medicine, University Hospital Essen, Essen, Germany
| | | | | | - Claus Neurohr
- Robert-Bosch-Krankenhaus Klinik Schillerhohe, Gerlingen, Germany
| | - Hubert Wirtz
- Department of Respiratory Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Olaf Eickmeier
- Department of Pneumology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | | | | | - Volker Soditt
- Pediatrics, Stadtisches Klinikum Solingen, Solingen, Germany
| | - Krystyna Poplawska
- Pediatrics, Johannes Gutenberg University Hospital Mainz, Mainz, Germany
| | - Frank Wacker
- Radiology, Hannover Medical School, Hannover, Germany
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50
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Arif A, Bhinder KK, Sarfraz A, Sarfraz Z, Felix M, Chérrez-Ojeda I. The radiological presentation of Rasmussen aneurysm secondary to pulmonary tuberculosis and COVID-19: A case report. Radiol Case Rep 2021; 16:3350-3353. [PMID: 34377220 PMCID: PMC8343381 DOI: 10.1016/j.radcr.2021.07.088] [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: 07/16/2021] [Revised: 07/29/2021] [Accepted: 07/31/2021] [Indexed: 11/19/2022] Open
Abstract
Rasmussen aneurysm is rare diagnosis occurring in patients with long-standing tuberculosis. TB-COVID-19 co-infection in the context of Rasmussen aneurysm is a rare occurrence, yet new cases are emerging. An elderly male was recently diagnosed with TB-COVID-19 co-infection and presented with sudden onset massive hemoptysis. The patient was diagnosed with Rasmussen aneurysm after being evaluated by computed tomography pulmonary angiogram due to a suggestive clinical presentation. Interventional radiologists planned for embolization of pulmonary artery, with an unidentifiable source. It was suspected that the patient's source of bleeding was hampered due to local tamponade effect or thrombosis of the aneurysm. The patient remained stable after 24 hours on computed tomography pulmonary angiogram. Our case emphasizes the importance of Rasmussen aneurysm as a differential diagnosis when presented with a TB-COVID-19 co-infection and sudden onset of hemoptysis symptomatically and radiologically. The timely diagnosis and management are key to improve mortality.
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Affiliation(s)
- Adnan Arif
- Shifa International Hospital, Islamabad, Pakistan
| | | | | | - Zouina Sarfraz
- Fatima Jinnah Medical University, Lahore, Pakistan
- Corresponding author.
| | - Miguel Felix
- Universidad Espíritu Santo, Samborondón, Ecuador
- Respiralab Research Center, Guayaquil, Ecuador
| | - Ivan Chérrez-Ojeda
- Universidad Espíritu Santo, Samborondón, Ecuador
- Respiralab Research Center, Guayaquil, Ecuador
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