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Zhou S, Zhang J, Meng X, Meng Y, Han X. Case Report: Bronchial artery embolization and chemoradiotherapy for central squamous cell lung carcinoma with rapid regression. Front Oncol 2022; 12:1026087. [PMID: 36591505 PMCID: PMC9795177 DOI: 10.3389/fonc.2022.1026087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022] Open
Abstract
Background Interventional embolization is a common treatment for hemoptysis, one of the complications of lung cancer. However, there are no official guidelines for the use of this method in antitumor therapy. Case Description Herein, we describe a case of a patient who was pathologically diagnosed as central squamous cell lung cancer. The patient received chemotherapy, interventional embolization and radiotherapy successively. The tumor regressed rapidly within 48 hours of receipt of interventional embolization. Furthermore, the tumor decreased by more than 50% in size within 7 days during radiotherapy. Unfortunately, the patient has since developed lymph node metastases and remains under treatment. Conclusions Thus, finding the suitable blood vessel embolized may be a suitable option to reduce the local tumor load and can be considered as antitumor therapy in combination with other treatments. The patient's theoretical hypoxia state after interventional therapy still produced a good tumor regression after radiotherapy. However, so far, no related studies have reported the changes of tumor immune microenvironment in human body after intervention and radiotherapy.
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Affiliation(s)
- Siqi Zhou
- Department of Oncology, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Jianxin Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Xue Meng
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Yingtao Meng
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China,*Correspondence: Xiao Han, ; Yingtao Meng,
| | - Xiao Han
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China,*Correspondence: Xiao Han, ; Yingtao Meng,
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Oshi MA, Haider A, Siddique MI, Zeb A, Jamal SB, Khalil AAK, Naeem M. Nanomaterials for chronic inflammatory diseases: the current status and future prospects. APPLIED NANOSCIENCE 2021. [DOI: 10.1007/s13204-021-02019-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Ruge A, Kumar N, Menezes C. The Effectiveness of Gelfoam as the Sole and Primary Embolization Agent in the Management of Hemoptysis: A Retrospective Study from a Tertiary Care Center. J Clin Imaging Sci 2021; 11:10. [PMID: 33767902 PMCID: PMC7981937 DOI: 10.25259/jcis_160_2020] [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: 09/09/2020] [Accepted: 01/30/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: The objective of this study was to evaluate the role of Gelfoam as an effective embolizing agent in patients with hemoptysis presenting to a tertiary care center in developing nations. Material and Methods: A retrospective analysis of data from 30 patients treated by Interventional radiologist at St. John’s Medical College, Bangalore, India, was performed. The study included 22 males (73.3%) and 8 (26.65%) female patients. Gelfoam was used as the sole embolizing agent and arteries with features of abnormal blush and hypertrophy were targeted. Analysis of the etiology, immediate, and short-term outcome and complications, when present, was performed. The median follow-up period was 45 days following an embolization procedure at this center. Results: A high short-term efficacy was noted following embolization procedures with Gelfoam as the sole agent. Twenty-eight out of 30 procedures were deemed successful, and post-tubercular changes were noted to be the cause for hemoptysis in 23 patients. The high short-term efficacy (93.3%), evidenced by a complete stoppage of hemoptysis, along with a relatively low rate of complications (spinal cord ischemia in only 2.3%), strengthens the position of Gelfoam as the sole embolizing agent in a resource-limited setting. Conclusion: In an economically constrained setting, Gelfoam proves to be a useful first choice single embolization agent, while polyvinyl alcohol particles coupled with microcatheter systems remain within reach of only those who can afford them.
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Affiliation(s)
- Abhinandan Ruge
- Department of Radio Diagnosis, St. John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Nidhi Kumar
- Department of Radio Diagnosis, St. John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Clyde Menezes
- Department of Radio Diagnosis, St. John's Medical College Hospital, Bengaluru, Karnataka, India
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Mattay RR, Shlansky-Goldberg R, Pukenas BA. Recurrent massive hemoptysis in a patient with cystic fibrosis: balloon assisted Onyx embolization after bronchial artery coil recanalization. CVIR Endovasc 2021; 4:4. [PMID: 33400002 PMCID: PMC7785756 DOI: 10.1186/s42155-020-00200-8] [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: 09/17/2020] [Accepted: 12/22/2020] [Indexed: 12/15/2022] Open
Abstract
Background Although not standard of care, Cystic Fibrosis patients with recurrent hemoptysis occasionally have coil embolization of bronchial arteries. In the event of recanalization of these arteries in this specific subset of patients, the presence of indwelling coils makes the prospect of conventional particle embolization more difficult, preventing both adequate catheterization of the coiled segment and reflux of the particles. Case presentation In this report, we describe a case of bronchial artery embolization of a complex Cystic Fibrosis patient with massive hemoptysis from recanalized coiled bronchial arteries utilizing a Scepter Balloon Catheter® (Microvention Terumo, USA) in administration of the liquid embolic agent Onyx® (Medtronic, USA). Conclusions The Scepter occlusion balloon catheter allowed for careful placement of the tip within the interstices of the pre-existing coils, allowing for Onyx injection directly into the coil mass without reflux, reconfirming the benefits of Onyx embolization in bronchial artery embolization and providing evidence that the Scepter occlusion balloon catheter should be added to the armamentarium of devices used in complex bronchial artery embolization for Cystic Fibrosis patients with massive hemoptysis.
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Affiliation(s)
- Raghav R Mattay
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
| | - Richard Shlansky-Goldberg
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Bryan A Pukenas
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
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Keshmiri MS, Shafaghi S, Sharif-Kashani B, Sadoughi A, Ghorbani F, Naghashzadeh F, Abedini A. Preemptive non-selective bronchial artery angioembolization to reduce recurrence rate of hemoptysis. Multidiscip Respir Med 2020; 15:723. [PMID: 33456774 PMCID: PMC7802011 DOI: 10.4081/mrm.2020.723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 11/30/2020] [Indexed: 11/23/2022] Open
Abstract
Background Massive hemoptysis which is presented in advanced lung diseases is a life-threatening condition. Bronchial artery embolization as a minimally invasive procedure is the treatment of choice either in first or recurrent hemoptysis. This study aimed to assess the early and late efficacy of bronchial angioembolization (BAE) without microcatheter. Methods In this prospective cohort study, all patients with hemoptysis who had undergone BAE from August 2018 to March 2019 were included. Angiographic patterns including bleeding sources, number of involved vessels, the underlying etiology, and recurrence rate were evaluated in a one-year follow up. Results 153 patients were included with mean age of 55 ±16 years. 68% of them were male and 58% had life-threatening massive hemoptysis. Three distinct angiographic patterns were recognized. The culprit bleeding vessel was bronchial in 126 (92%), intercostal in 4 (3%), and both vessels in 7 (5%) of cases (p<0.05). One vessel involvement was seen in 56 patients; however it was observed in 69% of non-cystic fibrosis lobar bronchiectasis patients. In 1, 3 and 12 months follow up, recurrent hemoptysis was reported in 15 (11%), 4 (2.5%), and 24 (15.5%), respectively. In 52% of cases, no abnormal vessels were observed during aorta injection, but culprit bronchial or intercostal arteries were found in selective investigational angiography. Conclusion BAE was successful in the control of hemoptysis and resulted in a low rate of recurrence in different types of lung diseases. This could be due to the embolization of all pathological arteries found during angiography which might have prevented recurrent bleeding.
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Affiliation(s)
- Mohammad Sadegh Keshmiri
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shadi Shafaghi
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Sharif-Kashani
- Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Sadoughi
- Divisions of Pulmonary and Critical Care, Albert Einstein College of Medicine, New York, USA
| | - Fariba Ghorbani
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Farah Naghashzadeh
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefeh Abedini
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ruthberg JS, Abrol A, Howard NS. Recurrent Hemoptysis: A Bronchial Dieulafoy's Lesion in a Pediatric Patient. Ann Otol Rhinol Laryngol 2020; 130:528-531. [PMID: 33025790 DOI: 10.1177/0003489420962132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This paper presents a case of a bronchial Dieulafoy's lesion in a pediatric patient with recurrent hemoptysis. CASE REPORT A 11-year old female presented multiple times with dry cough and hemoptysis to an outside hospital, each time leading to a diagnosis of epistaxis and subsequent discharge. When she arrived to our tertiary center with heavy hemoptysis and no evidence of epistaxis, the patient was urgently taken to the operating room by both the otolaryngology and pediatric pulmonology services. Active bleeding from a Dieulafoy's lesion on the right lower bronchus was found and selective embolization of two tortuous arteries was subsequently performed. The patient was discharged in stable condition without recurrence of hemoptysis over the last two months. CONCLUSION While rare, especially in pediatric patients, bronchial Dieulafoy's lesions may cause severe hemoptysis and should be considered in the differential diagnosis when the etiology for hemoptysis is unclear.
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Affiliation(s)
- Jeremy S Ruthberg
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Anish Abrol
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - N Scott Howard
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Department of Otolaryngology-Head and Neck Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA
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Lee SH, Lee JH, Chang JH, Kim SJ, Yoon HY, Shim SS, Kim MU, Choi SY, Ryu YJ. Hemoptysis requiring bronchial artery embolization in patients with nontuberculous mycobacterial lung disease. BMC Pulm Med 2019; 19:117. [PMID: 31248409 PMCID: PMC6598364 DOI: 10.1186/s12890-019-0881-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 06/19/2019] [Indexed: 11/10/2022] Open
Abstract
Background Although infections caused by nontuberculous mycobacteria (NTM) are increasing in prevalence, there are few data about hemoptysis in patients with NTM lung disease. This study investigated the characteristics and prognosis of hemoptysis secondary to NTM infection. Methods Following a retrospective review of cases managed between 2006 and 2016, 183 patients with NTM lung disease were enrolled and analyzed. Results Among 183 patients with NTM lung disease, Mycobacterium intracellulare (n = 64, 35%) was the major cause of NTM infection, followed by M. avium (n = 59, 32.2%) and M. abscessus complex (n = 40, 21.9%). Hemoptysis developed in 78 patients (42.6%), among whom 33 (42.3%) required bronchial artery embolization (BAE). Between patients with and without hemoptysis, there were no significant differences with respect to sex, radiographic manifestations, distribution over 3 lobes on chest computed tomography, history of pulmonary tuberculosis, antiplatelet or anticoagulation therapy, and species of NTM. However, mean age at diagnosis was significantly lower in the hemoptysis group in univariate and multivariate analyses (65.7 ± 12.8 vs. 59.7 ± 11.8, P = 0.002, odds ratio: 0.969, 95% confidence interval: 0.944–0.996). Among patients with hemoptysis, those requiring medical therapy and those requiring BAE were not significantly different in terms of demographic characteristics, radiographic manifestations, and distribution over 3 lobes. All patients who received BAE showed immediate clinical improvement, no procedure-related complications, and none of them died during the period under review. Conclusions NTM lung disease patients commonly experienced hemoptysis without specific risk factors except for relatively young age. Although some patients with hemoptysis needed BAE, the success rate of BAE was high, and there were no serious complications associated with BAE.
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Affiliation(s)
- Su Hwan Lee
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Hwa Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Republic of Korea
| | - Jung Hyun Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Republic of Korea
| | - Soo Jung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Republic of Korea
| | - Hee-Young Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Republic of Korea
| | - Sung Shine Shim
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Min Uk Kim
- Department of Radiology, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Sun Young Choi
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Yon Ju Ryu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Republic of Korea.
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Bronchial arterial embolization using a gelatin sponge for hemoptysis from pulmonary aspergilloma: comparison with other pulmonary diseases. Emerg Radiol 2019; 26:501-506. [PMID: 31129737 DOI: 10.1007/s10140-019-01695-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/07/2019] [Accepted: 05/13/2019] [Indexed: 01/20/2023]
Abstract
PURPOSE To evaluate the clinical outcomes of bronchial artery embolization (BAE) using a gelatin sponge for hemoptysis from pulmonary aspergilloma and compare them with treatment outcomes for hemoptysis from other diseases. METHODS Fifty-two patients underwent BAE using a gelatin sponge. The etiology of hemoptysis was pulmonary aspergilloma in 8 (PA group) and other diseases in 44 (control group). The technical success rate, clinical success rate, hemoptysis-free rate, and complication rate were compared between the PA group and control group. Technical success was defined as the complete cessation of the targeted feeding artery as confirmed by digital subtraction angiography, and clinical success as the cessation of hemoptysis within 24 h of BAE. Recurrent hemoptysis was defined as a single or multiple episodes of hemoptysis causing > 30 ml of bleeding per day. RESULTS Technical and clinical success rates were 100% in both groups. Hemoptysis-free rates were 85% at 6 months and 72% at 12-60 months in the control group, and 38% at 6-12 months and 25% thereafter in the PA group (P = 0.0009). No complications were observed following BAE in any case in the two groups. CONCLUSION BAE using a gelatin sponge may not be effective for hemoptysis from pulmonary aspergilloma.
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Ittrich H, Bockhorn M, Klose H, Simon M. The Diagnosis and Treatment of Hemoptysis. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018. [PMID: 28625277 DOI: 10.3238/arztebl.2017.0371] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hemoptysis, i.e., the expectoration of blood from the lower airways, has an annual incidence of approximately 0.1% in ambulatory patients and 0.2% in inpatients. It is a potentially life-threatening medical emergency and carries a high mortality. METHODS This review article is based on pertinent publications retrieved by a selective search in PubMed. RESULTS Hemoptysis can be a sign of many different diseases. Its cause remains unknown in about half of all cases. Its more common recognized causes include infectious and inflammatory airway diseases (25.8%) and cancer (17.4%). Mild hemoptysis is self-limited in 90% of cases; massive hemoptysis carries a worse prognosis. In patients whose life is threatened by massive hemoptysis, adequate oxygenation must be achieved through the administration of oxygen, positioning of the patient with the bleeding side down (if known), and temporary intubation if necessary. A thorough diagnostic evaluation is needed to identify the underlying pathology, site of bleeding, and vascular anatomy, so that the appropriate treatment can be planned. The evaluation should include conventional chest x-rays in two planes, contrastenhanced multislice computerized tomography, and bronchoscopy. Hemostasis can be achieved at bronchoscopically accessible bleeding sites with interventionalbronchoscopic local treatment. Bronchial artery embolization is the first line of treatment for hemorrhage from the pulmonary periphery; it is performed to treat massive or recurrent hemoptysis or as a presurgical measure and provides successful hemostasis in 75-98% of cases. Surgery is indicated if bronchial artery embolization alone is not successful, or for special indications (traumatic or iatrogenic pulmonary/vascular injury, refractory asper gilloma). CONCLUSION The successful treatment of hemoptysis requires thorough diagnostic evaluation and close interdisciplinary collaboration among pulmonologists, radiologists, and thoracic surgeons.
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Affiliation(s)
- Harald Ittrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg; Department of General, Visceral and Thoracic Surgery, Center for Surgical Sciences, University Medical Center Hamburg-Eppendorf, Hamburg; Department of Pulmonology, II. Medical Clinic, University Medical Center Hamburg-Eppendorf, Hamburg
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Monroe EJ, Pierce DB, Ingraham CR, Johnson GE, Shivaram GM, Valji K. An Interventionalist's Guide to Hemoptysis in Cystic Fibrosis. Radiographics 2018. [PMID: 29528824 DOI: 10.1148/rg.2018170122] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Massive hemoptysis occurs in a minority of patients with cystic fibrosis, with an annual incidence of 1%. Although rare, massive hemoptysis can be a severe and potentially fatal complication of this disease. Beyond the acute life-threatening event, hemoptysis in patients with cystic fibrosis has been associated with faster decline in lung function, accelerated need for lung transplant, and increased mortality. The bronchial arteries are the culprit vessels in over 90% of cases of hemoptysis. This normally quiescent vascular system undergoes remarkable hypertrophy, collateralization, and angiogenesis before the onset of hemoptysis, introducing numerous pitfalls for the interventionalist. However, in experienced hands, bronchial artery embolization is a safe and potentially lifesaving therapy. Preprocedural noninvasive imaging, specifically computed tomographic angiography, has been repeatedly validated for helping to localize the likely site of bleeding, characterizing pertinent arterial anatomy, and promoting efficient and effective intervention; it has been recommended for all stable patients with hemoptysis. Success in the angiographic suite requires a thorough understanding of normal and variant bronchial arterial anatomy, appropriate patient selection, and a meticulous embolization technique. A meticulous approach to imaging and intervention, conscientious of both visualized and nonvisualized collateral pathways and nontarget vessels, can minimize potentially devastating complications. This review summarizes the current literature, modern procedural techniques, and emerging controversies, serving to guide an evolving approach to management of patients with cystic fibrosis and hemoptysis. ©RSNA, 2018.
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Affiliation(s)
- Eric J Monroe
- From the Department of Radiology, University of Washington, Seattle, Wash (E.J.M., D.B.P., C.R.I., G.E.J., G.M.S., K.V.); and Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, MA.7.220-Radiology, Seattle, WA 98105 (E.J.M., G.M.S.)
| | - David B Pierce
- From the Department of Radiology, University of Washington, Seattle, Wash (E.J.M., D.B.P., C.R.I., G.E.J., G.M.S., K.V.); and Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, MA.7.220-Radiology, Seattle, WA 98105 (E.J.M., G.M.S.)
| | - Christopher R Ingraham
- From the Department of Radiology, University of Washington, Seattle, Wash (E.J.M., D.B.P., C.R.I., G.E.J., G.M.S., K.V.); and Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, MA.7.220-Radiology, Seattle, WA 98105 (E.J.M., G.M.S.)
| | - Guy E Johnson
- From the Department of Radiology, University of Washington, Seattle, Wash (E.J.M., D.B.P., C.R.I., G.E.J., G.M.S., K.V.); and Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, MA.7.220-Radiology, Seattle, WA 98105 (E.J.M., G.M.S.)
| | - Giridhar M Shivaram
- From the Department of Radiology, University of Washington, Seattle, Wash (E.J.M., D.B.P., C.R.I., G.E.J., G.M.S., K.V.); and Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, MA.7.220-Radiology, Seattle, WA 98105 (E.J.M., G.M.S.)
| | - Karim Valji
- From the Department of Radiology, University of Washington, Seattle, Wash (E.J.M., D.B.P., C.R.I., G.E.J., G.M.S., K.V.); and Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, MA.7.220-Radiology, Seattle, WA 98105 (E.J.M., G.M.S.)
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Bronchial Artery Embolization with Large Sized (700-900 µm) Tris-acryl Microspheres (Embosphere) for Massive Hemoptysis: Long-Term Results (Clinical Research). Cardiovasc Intervent Radiol 2017; 41:225-230. [PMID: 29067512 DOI: 10.1007/s00270-017-1818-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 10/12/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate the safety, efficacy and long-term results of bronchial artery embolization with microsphere particles (Embosphere® Microspheres, BioSphere Medical, Rockland, MA) 700-900 µm in size for massive hemoptysis. METHODS One hundred and seventy-four patients (94 female, 80 male; mean age 39.4 ± 5.7) who had bronchial artery embolization for massive hemoptysis between January 2010 and October 2015 were incorporated in the study. Patients had hemoptysis with a mean volume of 525 ± 150 mL (median 500 mL, range 300-1200 mL) over a 24-h period. Underlying pathologies included bronchial artery hypertrophy due to bronchiectasis (56.3% [98/174]), lung cancer (29.9% [52/174]), tuberculosis (10.3% [18/174]) and the rest remained idiopathic (3.4% [6/174]). Mean bronchial artery diameter before the intervention was 3.8 ± 1.5 mm (median 4 mm, range 3.1-7.5 mm). Median follow-up period was 56 months (range 10-82 months). Primary objectives were the technical and clinical success. RESULTS Technical success was 100%. Clinical success for preventing massive hemoptysis was 91.9% (160/174). There was no procedure-related mortality or morbidities. Minor complications such as chest pain were observed in nine patients (5.0%). Recurrent hemoptysis (8.1%) was observed within 6 months in 14 patients, ten of whom were treated with a second embolization session and the remaining four with a total of three embolization sessions. CONCLUSION Bronchial artery embolization for massive hemoptysis with Embosphere particles 700-900 µm in size is a safe and effective method with high technical and clinical success rates. Long-term results are excellent.
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Seki A, Shimono C. Transarterial chemoembolization for management of hemoptysis: initial experience in advanced primary lung cancer patients. Jpn J Radiol 2017; 35:495-504. [PMID: 28608003 DOI: 10.1007/s11604-017-0659-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 06/07/2017] [Indexed: 12/26/2022]
Abstract
PURPOSE To evaluate the hemostatic effects of transarterial infusion chemotherapy in addition to embolization (chemoembolization) for advanced primary lung cancer with tumor-related hemoptysis. MATERIALS AND METHODS Ten consecutive patients with stage IIIB/IV or recurrent primary lung cancer (squamous cell carcinoma in six, adenocarcinoma in four) who underwent chemoembolization for control of hemoptysis were enrolled. At enrollment, five patients were considered refractory and five had contraindications to standard therapies. The amount of hemoptysis was massive in two patients, moderate in seven, and slight in one. Transarterial infusion chemotherapy via feeding arteries using cisplatin (25 mg/m2) and 5-fluorouracil (300 mg/m2) was repeated every 3-4 weeks for three cycles. HepaSphere (100-150 µm) or gelatin sponge particles were selected as embolic materials depending on the presence of pulmonary shunts and were added for embolization just after drug infusion. RESULTS Hemoptysis improved in all patients (resolution in nine, significant decrease in one). The median hemostasis time was 11.9 months (range 2.7-25.9 months). The target pulmonary lesions shrank in seven patients, and pulmonary atelectasis disappeared in three of five patients. CONCLUSIONS Chemoembolization may be a palliative option with favorable hemostasis time for advanced primary lung cancer with hemoptysis.
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Affiliation(s)
- Akihiko Seki
- Department of Medical Oncology, Suita Tokushukai Hospital, 21-1 Senriokanishi, Suita, Osaka, 565-0814, Japan.
| | - Chigusa Shimono
- Department of Medical Oncology, Suita Tokushukai Hospital, 21-1 Senriokanishi, Suita, Osaka, 565-0814, Japan
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Abstract
From June 1993 to June 1998, 50 patients were admitted with life-threatening hemoptysis (> 150 mL blood in 24 hours) due to pulmonary tuberculosis in 40, malignancy in 5, nontuberculous bronchiectasis in 4, and lung sequestration in 1. All patients had bronchial angiography with one session of embolization in 35 and more than one session in 11; no embolization was required in 4 cases. Surgery was necessary for recurrent hemoptysis in 6 patients. There were significant recurrences in 19 patients, of whom 5 died. Predictors of recurrence were the presence of mycetoma and presentation in a state of collapse. The fatal recurrences all took place within 1 week of the initial embolization and were probably due to incomplete embolization. In patients restudied after significant recurrences within 1 week of embolization, new vessels needed to be embolized in addition to previously treated vessels. It is postulated that some bleeding vessels may be missed at initial angiography, possibly due to vasospasm or low flow, and these may resume bleeding when the patient's hemodynamic status improves. An angiogram within 24 hours of embolization could identify such patients and they should be offered surgery if they are fit.
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Affiliation(s)
- Yeong Phang Lim
- Departments of Surgery and Radiology Tan Tock Seng Hospital Singapore, Republic of Singapore
| | - Daniel Wong
- Departments of Surgery and Radiology Tan Tock Seng Hospital Singapore, Republic of Singapore
| | - Thirugnanam Agasthian
- Departments of Surgery and Radiology Tan Tock Seng Hospital Singapore, Republic of Singapore
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14
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Halezeroğlu S, Okur E. Thoracic surgery for haemoptysis in the context of tuberculosis: what is the best management approach? J Thorac Dis 2014; 6:182-5. [PMID: 24624281 DOI: 10.3978/j.issn.2072-1439.2013.12.25] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 12/12/2013] [Indexed: 11/14/2022]
Abstract
Haemoptysis is not an unusual finding in patients with old or active pulmonary tuberculosis. Because of bronchial artery or a branch of pulmonary artery erosion due to cavitary infiltration, bronchiectasis, fungus ball, broncholithiasis or destroyed lung, the bleeding can sometimes be a life-threatening situation. Assessment of the patient and finding the exact site of bleeding can be difficult especially in a patient with disseminated lung disease. Chest computerized tomography and bronchoscopy remain the methods of choice for lateralization of the disease. Some patients can be treated successfully with endobronchial interventions. Bronchial artery embolization can be rewarding in some patients but the recurrence rate is higher in tuberculosis than other etiologies of haemoptysis. Surgical resection of the lung, mainly lobectomy, remains a life-saving procedure but it should be performed very selectively to avoid higher postoperative morbidity and mortality. Different management options of haemoptysis in patients with pulmonary tuberculosis are discussed in this manuscript.
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Affiliation(s)
- Semih Halezeroğlu
- Thoracic Surgery Department, Acıbadem University, Faculty of Medicine, Istanbul, Turkey
| | - Erdal Okur
- Thoracic Surgery Department, Acıbadem University, Faculty of Medicine, Istanbul, Turkey
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15
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Woo S, Yoon CJ, Chung JW, Kang SG, Jae HJ, Kim HC, Seong NJ, Kim YJ, Woo YN. Bronchial artery embolization to control hemoptysis: comparison of N-butyl-2-cyanoacrylate and polyvinyl alcohol particles. Radiology 2013; 269:594-602. [PMID: 23801773 DOI: 10.1148/radiol.13130046] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE To retrospectively compare safety and effectiveness of embolic agents polyvinyl alcohol (PVA) particles versus n-butyl-2-cyanoacrylate (NBCA) for bronchial artery embolization (BAE) for control of hemoptysis. MATERIALS AND METHODS Institutional review board approved this retrospective study; informed consent was waived. From January 2005 to December 2008, 406 patients (242 men, 164 women; age range, 6-92 years) with major hemoptysis underwent BAE by using PVA particles (n = 293) or NBCA (n = 113). Technical and clinical success, complications, hemoptysis-free survival rates, and causes of recurrent hemoptysis were compared between PVA and NBCA groups. The differences in hemoptysis-free survival rates were assessed between subgroups stratified to underlying diseases. The predictive factor for recurrent hemoptysis was identified with Cox proportional hazard regression model. RESULTS Technical success was achieved in 93.9% (275 of 293) and 96.5% (109 of 113) of patients for PVA and NBCA, respectively (P = .463); clinical success was achieved in 92.2% (270 of 293) and 96.5% (109 of 113) of patients for PVA and NBCA, respectively (P = .180). Overall and major complication rates were not statistically different (overall complication rates: 34.1% for PVA, 31.0% for NBCA; P = .56; major complication rates: 0.3% for PVA, 0% for NBCA; P > .999). The 1-, 3-, and 5-year hemoptysis-free survival rates were, respectively, 77%, 68%, and 66% for PVA and 88%, 85%, and 83% for NBCA (P = .01). Recanalization of previously embolized vessels was more frequent in PVA group (21.5%) than in NBCA group (1.8%; P < .001). NBCA group showed hemoptysis-free survival rates superior to PVA group in patients with bronchiectasis (P = .016). PVA (P = .050) and aspergilloma (P < .001) were predictive factors for recurrent hemoptysis. CONCLUSION BAE with NBCA provided higher hemoptysis-free survival rates compared with PVA particles without increasing complication rates. This improvement was evident in patients with bronchiectasis and was caused by more durable embolic effect than PVA particles. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.13130046/-/DC1.
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Affiliation(s)
- Sungmin Woo
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul Korea
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16
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Abstract
Bronchial artery angiography with embolization has become a mainstay in the treatment of hemoptysis. Major complications are rare and immediate clinical success defined as cessation of hemorrhage ranges in most series from 85% to 100%, although recurrence of hemorrhage ranges from 10% to 33%. Bronchial artery embolization offers a minimally invasive procedure for even the most compromised patient serving as first-line treatment for hemorrhage as well as providing a bridge to more definitive medical or surgical intervention focused upon the etiology of the hemorrhage. The aim of this article is to summarize the etiologies, pathophysiology, and the diagnostic and management strategies of hemoptysis as related to bronchial artery embolization. In addition, the techniques of arteriography and embolization as well as associated procedural outcomes and complications are delineated.
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Affiliation(s)
- David R Sopko
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
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17
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Burdick TR, Hoffer EK, Kooy T, Ghodke B, Starnes BW, Valji K, Goldberg S, Hallam D, Andrews RT. Which Arteries Are Expendable? The Practice and Pitfalls of Embolization throughout the Body. Semin Intervent Radiol 2011; 25:191-203. [PMID: 21326510 DOI: 10.1055/s-0028-1085925] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This article outlines general concepts of, and strategies for, therapeutic embolization throughout the body, touching on all major arterial distributions. Clinical scenarios that allow or prevent safe embolization of vessels are presented. Specific agents are recommended where appropriate, as are alternate approaches when embolization is not an option. Pre-embolization precautions and adjunctive measures are described in high-risk areas.
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Affiliation(s)
- Thomas R Burdick
- Department of Radiology, University of Washington, Seattle, Washington
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18
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Sidhu M, Wieseler K, Burdick TR, Shaw DWW. Bronchial artery embolization for hemoptysis. Semin Intervent Radiol 2011; 25:310-8. [PMID: 21326520 DOI: 10.1055/s-0028-1085931] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Bronchial artery bleeding is the most common cause of life-threatening hemoptysis. The most common underlying etiologies include tuberculosis, bronchiectasis, aspergillosis, and cystic fibrosis. Bronchial artery embolization is an important treatment for significant hemoptysis, given its high early success rate and relatively low risk compared with alternative medical and surgical treatments. In this article, the relevant anatomy and pathophysiology leading to bronchial artery bleeding is discussed, including the roles of parenchymal lung diseases and of collateral and aberrant vessels. The indications for treatment, success rate, and complication rate for bronchial artery embolization are reviewed. Preprocedure clinical stabilization and evaluation, including the roles of radiographs, bronchoscopy, and computed tomography examination are evaluated. Details of technique, including the published variety of approaches, and an emphasis on avoidance of nontarget embolization of important mediastinal structures and of the anterior spinal artery are discussed.
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Affiliation(s)
- Manrita Sidhu
- Children's Hospital and Regional Medical Center, Seattle, Washington
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19
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Bilbao JI, Martínez-Cuesta A, Urtasun F, Cosín O. Complications of embolization. Semin Intervent Radiol 2011; 23:126-42. [PMID: 21326756 DOI: 10.1055/s-2006-941443] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Embolization is a remarkably versatile procedure used in nearly all vascular and nonvascular systems to treat a wide range of pathology. The published literature is rich with studies demonstrating the enormous therapeutic potential offered by embolization procedures, and the possibilities continue to expand with the advent of new embolization agents and techniques. Unfortunately, with this variety and innovation comes a wide spectrum of potential complications, not always easy to classify and summarize, associated with embolization. This article reviews the procedures and associated complications of arterial and venous embolization procedures, organized by vascular distribution.
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Affiliation(s)
- José I Bilbao
- Department of Radiology, Clínica Universitaria de Navarra, Pamplona, Spain
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20
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Lopez JK, Lee HY. Bronchial artery embolization for treatment of life-threatening hemoptysis. Semin Intervent Radiol 2011; 23:223-9. [PMID: 21326768 DOI: 10.1055/s-2006-948759] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Massive hemoptysis is an emergent and life-threatening condition with a broad range of underlying causes. Fortunately, massive hemoptysis accounts for a minority of cases of hemoptysis, ~5%. Unlike hemorrhage in other areas of the body, the primary cause of death from pulmonary hemorrhage is most commonly asphyxiation rather than exsanguination. Given the limited capacity for the lung to preserve oxygen transfer in the setting of massive hemoptysis, a rapid and effective method for controlling hemorrhage is essential to minimize death in patients demonstrating respiratory compromise. Since its introduction in 1973, bronchial artery embolization has proven to be a safe and effective tool for the treatment of massive hemoptysis and is now considered the treatment of choice, with initial success rates ranging from 77 to 94%. The long-term control rate of hemoptysis ranges from 70 to 85% and is largely a function of the degree of inflammation and the natural progression of the underlying disease. This article reviews the current literature on bronchial artery embolization for the treatment of massive hemoptysis.
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Affiliation(s)
- January K Lopez
- Department of Radiology, University of California at Los Angeles
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21
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Dave BR, Sharma A, Kalva SP, Wicky S. Nine-Year Single-Center Experience With Transcatheter Arterial Embolization for Hemoptysis: Medium-Term Outcomes. Vasc Endovascular Surg 2011; 45:258-68. [DOI: 10.1177/1538574410395036] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To determine the medium-term efficacy of transcatheter arterial embolization (TAE) for hemoptysis. Materials and Methods: A total of 128 TAE were performed from April 1999 to April 2008 in 58 patients (30:28 F:M) with mean age of 49 (range:16-89). Major causes of hemoptysis included cystic fibrosis/bronchiectasis (24 of 58); lung metastasis (8 of 58); lung cancer (7 of 58); fungal infection (4 of 58). Follow-up was available in 57 of 58 for a median of 1.28 years. Primary and secondary efficacy of TAE for hemoptysis was calculated using Kaplan-Meier estimates. Results: Technical and clinical successes were estimated at 58 (100%) of 58 and 57 (98%) of 58, respectively. Recurrent hemoptysis occurred in 40% (23 of 58). In all, 34% (20 of 58) died during follow-up. Kaplan-Meier estimates for primary and secondary efficacy of TAE at 2, 4, 6, and 8 years were 0.82, 0.46, 0.17, and 0.09 (benign disease) and 0.30, 0, 0, and 0 (malignant disease), respectively. Conclusion: TAE is an effective treatment for hemoptysis in both short- and medium-terms, especially in benign lung disease.
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Affiliation(s)
- Bhavika R. Dave
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,
| | - Ashish Sharma
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Sanjeeva P. Kalva
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Stephan Wicky
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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22
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Chun JY, Morgan R, Belli AM. Radiological management of hemoptysis: a comprehensive review of diagnostic imaging and bronchial arterial embolization. Cardiovasc Intervent Radiol 2010; 33:240-50. [PMID: 20058006 DOI: 10.1007/s00270-009-9788-z] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 12/08/2009] [Indexed: 01/06/2023]
Abstract
Hemoptysis can be a life-threatening respiratory emergency and indicates potentially serious underlying intrathoracic disease. Large-volume hemoptysis carries significant mortality and warrants urgent investigation and intervention. Initial assessment by chest radiography, bronchoscopy, and computed tomography (CT) is useful in localizing the bleeding site and identifying the underlying cause. Multidetector CT angiography is a relatively new imaging technique that allows delineation of abnormal bronchial and nonbronchial arteries using reformatted images in multiple projections, which can be used to guide therapeutic arterial embolization procedures. Bronchial artery embolization (BAE) is now considered to be the most effective procedure for the management of massive and recurrent hemoptysis, either as a first-line therapy or as an adjunct to elective surgery. It is a safe technique in the hands of an experienced operator with knowledge of bronchial artery anatomy and the potential pitfalls of the procedure. Recurrent bleeding is not uncommon, especially if there is progression of the underlying disease process. Prompt repeat embolization is advised in patients with recurrent hemoptysis in order to identify nonbronchial systemic and pulmonary arterial sources of bleeding. This article reviews the pathophysiology and causes of hemoptysis, diagnostic imaging and therapeutic options, and technique and outcomes of BAE.
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Affiliation(s)
- Joo-Young Chun
- Department of Radiology, St. George's Hospital, Blackshaw Road, London SW17 0QT, UK
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23
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Yun J, Na KJ, Chekar JK, Jeong IS, Song SY, Oh SG. The Clinical Effects of Surgical Treatment for Hemoptysis due to Inflammatory Lung Disease. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2010. [DOI: 10.5090/kjtcs.2010.43.2.144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jusik Yun
- Department of Thoracic and Cardiovascular Surgery, Mokpo National Hospital
| | - Kook-Joo Na
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School
| | - Jay-Key Chekar
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School
| | - In-Seok Jeong
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School
| | - Sang-Yun Song
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital
| | - Sang-Gi Oh
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School
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24
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Andréjak C, Parrot A, Bazelly B, Ancel PY, Djibré M, Khalil A, Grunenwald D, Fartoukh M. Surgical lung resection for severe hemoptysis. Ann Thorac Surg 2009; 88:1556-65. [PMID: 19853112 DOI: 10.1016/j.athoracsur.2009.06.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Revised: 05/29/2009] [Accepted: 06/04/2009] [Indexed: 02/09/2023]
Abstract
BACKGROUND The role of surgical lung resection in the management of severe hemoptysis has evolved after advances in interventional radiology. We sought to describe the indications for surgical lung resection in such patients and to identify predictive factors of postoperative complications. METHODS This study is a retrospective analysis (May 1995 to July 2006) of consecutive patients referred to the intensive care unit of a tertiary hospital for severe hemoptysis who underwent surgical lung resection. RESULTS Among 813 patients referred for severe hemoptysis, 111 underwent surgical lung resection. Interventional radiology had been first attempted in 87 patients (78%); 68 underwent surgery because of a failed procedure (n = 28) or bleeding persistence or recurrence within 72 hours despite a completed procedure (n = 40); 19 patients underwent surgery after bleeding control. The remaining 24 patients (22%) were directly referred to the surgeon (5 for emergency surgery). Overall, surgery was performed in emergency (n = 48), scheduled after bleeding control (n = 48), or planned after discharge (n = 15). The main indications for surgery were mycetoma, cancer, bronchiectasis, and active tuberculosis. Surgery for mycetoma (odds ratio, 9.4; 95% confidence interval, 2.8 to 32), emergency surgery (odds ratio, 5.3; 95% confidence interval, 1.8 to 16), and pneumonectomy (odds ratio, 4.7; 95% confidence interval, 1.2 to 18) independently predicted complications. Fifteen patients died in the intensive care unit, of whom 14 underwent emergency surgery. Chronic alcoholism (odds ratio, 4.6; 95% confidence interval, 1.1 to 19), the need for mechanical ventilation or vasoactive drugs on admission (odds ratio, 8.2; 95% confidence interval, 1.9 to 35), and blood transfusion before surgery (odds ratio, 8; 95% confidence interval, 1.5 to 42) predicted mortality. CONCLUSIONS Attempting at controlling bleeding with first-line nonsurgical approaches appears necessary to optimize the operative conditions and improve outcome of patients with severe hemoptysis.
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Affiliation(s)
- Claire Andréjak
- Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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25
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Labbe V, Roques S, Boughdène F, Razazi K, Khalil A, Parrot A, Fartoukh M. Shock Complicating Successful Bronchial Artery Embolization for Severe Hemoptysis. Chest 2009; 135:215-217. [DOI: 10.1378/chest.08-0491] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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26
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Baltacioğlu F, Cimşit NC, Bostanci K, Yüksel M, Kodalli N. Transarterial microcatheter glue embolization of the bronchial artery for life-threatening hemoptysis: technical and clinical results. Eur J Radiol 2008; 73:380-4. [PMID: 19070980 DOI: 10.1016/j.ejrad.2008.10.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Revised: 09/06/2008] [Accepted: 10/14/2008] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To report our experience with transarterial glue embolization of the bronchial artery for life-threatening hemoptysis. MATERIALS AND METHODS Twenty-five patients underwent bronchial artery embolization, using coaxial microcatheter technique, with a liquid agent, n-butyl-2-cyanoacrylate (NBCA), named glue, for life-threatening hemoptysis. The technical and clinical outcomes were followed in terms of immediate control of bleeding, recurrence of hemoptysis and complications of the procedure. RESULTS Four patients had acute hemoptysis when they were evaluated. The average number of arteries embolized per patient was 2.9. BAEs were successful in controlling hemoptysis immediately in all 25 patients (100%) and in 24 patients (96%) at 1 month follow-ups. One patient had recurrent hemoptysis on the tenth day after embolization. The follow-up time ranged from 2 to 63 months (mean 14 months). Six patients (25%) died all as a result of their disease process. Bleeding recurred in 3 patients after 30 days (7th, 11th, 12th months). One patient had vomitting attacks with dysphagia after the procedure that lasted 24h. Three patients had transient thoracic pain lasting 3-5 days. There were no procedure related spinal or vascular complications. CONCLUSIONS Glue embolization with microcatheter technique is a safe and effective treatment in cases of life-threatening hemoptysis with a very high rate of success and low rate of complications.
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Affiliation(s)
- Feyyaz Baltacioğlu
- Marmara University School of Medicine, Department of Radiology, Istanbul, Turkey.
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27
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Abstract
Transcatheter embolization has become a first-line therapy in the management of hemoptysis. Knowledge of the arterial anatomy and variants is the key to safe and successful procedure.
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Affiliation(s)
- Jean-Pierre Pelage
- Department of Radiology, Hôpital Ambroise Paré, Université Paris Ile-de-France Ouest 9, Boulogne-Billancourt, France.
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28
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Aetiology, diagnosis and management of infective causes of severe haemoptysis in intensive care units. Curr Opin Pulm Med 2008; 14:195-202. [PMID: 18427242 DOI: 10.1097/mcp.0b013e3282f79663] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF THE REVIEW Infective causes of severe haemoptysis have progressively shifted to causes related to chronic inflammatory lung diseases. Physicians should, however, recognize the most common of them, for example necrotizing parenchymal infections, tuberculosis and mycetoma. RECENT FINDINGS The recent increase in the incidence of a devastating Panton-Valentine leukocidin-associated staphylococcal pneumonia has reminded us of the crucial role of prompt diagnosis and management. General supportive care should be administered to prevent asphyxiation in addition to starting appropriate antibiotics as soon as possible. Once the bleeding has been controlled, the diagnostic strategy should integrate a detailed medical history, physical examination, Gram stain of the respiratory specimens and chest radiograph. Computed tomography scan has dramatically improved the diagnosis and the treatment of infective causes of severe haemoptysis by assessing the cause and mechanism(s) of haemoptysis. Although bronchial arteries are the major source of bleeding, nonbronchial systemic and pulmonary arteries' involvement should be feared, especially in haemoptysis related to tuberculosis and mycetoma. SUMMARY Endovascular therapy should be first attempted to control the bleeding and then elective surgery performed in case of localized lesion and adequate pulmonary function. Fibreoptic bronchoscopy with broncho-alveolar lavage remains the cornerstone of diagnosis in immunocompromised hosts with haemoptysis and in the rare cases of alveolar haemorrhage related to infectious diseases.
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Kvale PA, Selecky PA, Prakash UBS. Palliative care in lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007; 132:368S-403S. [PMID: 17873181 DOI: 10.1378/chest.07-1391] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
UNLABELLED GOALS/OBJECTIVES: To review the scientific evidence on symptoms and specific complications that are associated with lung cancer, and the methods available to palliate those symptoms and complications. METHODS MEDLINE literature review (through March 2006) for all studies published in the English language, including case series and case reports, since 1966 using the following medical subject heading terms: bone metastases; brain metastases; cough; dyspnea; electrocautery; hemoptysis; interventional bronchoscopy; laser; pain management; pleural effusions; spinal cord metastases; superior vena cava syndrome; and tracheoesophageal fistula. RESULTS Pulmonary symptoms that may require palliation in patients who have lung cancer include those caused by the primary cancer itself (dyspnea, wheezing, cough, hemoptysis, chest pain), or locoregional metastases within the thorax (superior vena cava syndrome, tracheoesophageal fistula, pleural effusions, ribs, and pleura). Respiratory symptoms can also result from complications of lung cancer treatment or from comorbid conditions. Constitutional symptoms are common and require attention and care. Symptoms referable to distant extrathoracic metastases to bone, brain, spinal cord, and liver pose additional problems that require a specific response for optimal symptom control. There are excellent scientific data regarding the management of many of these issues, with lesser evidence from case series or expert opinion on other aspects of providing palliative care for lung cancer patients. CONCLUSIONS Palliation of symptoms and complications in lung cancer patients is possible, and physicians who provide such care must be knowledgeable about these issues.
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Affiliation(s)
- Paul A Kvale
- Division of Pulmonary, Critical Care, Allergy, Immunology, and Sleep Disorders Medicine, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA.
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Parrot A, Khalil A, Roques S, Andréjak C, Savale L, Carette MF, Mayaud C, Bazelly B, Fartoukh M. [Management of severe hemoptysis: experience in a specialized center]. REVUE DE PNEUMOLOGIE CLINIQUE 2007; 63:202-10. [PMID: 17675944 DOI: 10.1016/s0761-8417(07)90125-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Bronchiectasis, cancer and tuberculosis account for the majority of haemoptysis requiring intensive care unit admission. Bedside evaluation (volume and bronchoscopic active bleeding) is safe to screen patients for arteriography and bronchial artery embolisation (BAE). First-line interventional arteriography should be favour over surgery in patients with non traumatic life-threatening hemoptysis. Surgery must be reserved in cases of failure or recurrence of bleeding after BAE.
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Affiliation(s)
- A Parrot
- Service de Pneumologie et Unité de Réanimation, Hôpital Tenon, AP-HP, 4, rue de la Chine, 75970 Paris Cedex 20
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31
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Fartoukh M. Hémoptysie. Rev Mal Respir 2007. [DOI: 10.1016/s0761-8425(07)91580-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Fartoukh M, Khalil A, Louis L, Carette MF, Bazelly B, Cadranel J, Mayaud C, Parrot A. An integrated approach to diagnosis and management of severe haemoptysis in patients admitted to the intensive care unit: a case series from a referral centre. Respir Res 2007; 8:11. [PMID: 17302979 PMCID: PMC1802746 DOI: 10.1186/1465-9921-8-11] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2006] [Accepted: 02/15/2007] [Indexed: 11/11/2022] Open
Abstract
Background Limited data are available concerning patients admitted to the intensive care unit (ICU) for severe haemoptysis. We reviewed a large series of patients managed in a uniform way to describe the clinical spectrum and outcome of haemoptysis in this setting, and better define the indications for bronchial artery embolisation (BAE). Methods A retrospective chart review of 196 patients referred for severe haemoptysis to a respiratory intermediate care ward and ICU between January 1999 and December 2001. A follow-up by telephone interview or a visit. Results Patients (148 males) were aged 51 (± sd, 16) years, with a median cumulated amount of bleeding averaging 200 ml on admission. Bronchiectasis, lung cancer, tuberculosis and mycetoma were the main underlying causes. In 21 patients (11%), no cause was identified. A first-line bronchial arteriography was attempted in 147 patients (75%), whereas 46 (23%) received conservative treatment. Patients who underwent BAE had a higher respiratory rate, greater amount of bleeding, persistent bloody sputum and/or evidence of active bleeding on fiberoptic bronchoscopy. When completed (n = 131/147), BAE controlled haemoptysis in 80% of patients, both in the short and long (> 30 days) terms. Surgery was mostly performed when bronchial arteriography had failed and/or bleeding recurred early after completed BAE. Bleeding was controlled by conservative measures alone in 44 patients. The ICU mortality rate was low (4%). Conclusion Patients with evidence of more severe or persistent haemoptysis were more likely to receive BAE rather than conservative management. The procedure was effective and safe in most patients with severe haemoptysis, and surgery was mostly reserved to failure of arteriography and/or early recurrences after BAE.
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Affiliation(s)
- Muriel Fartoukh
- Service de Pneumologie et Unité de Réanimation Respiratoire, Hôpital Tenon, Assistance Publique – Hôpitaux de Paris and Université Pierre et Marie Curie, 4 Rue de la Chine, 75020 Paris, France
| | - Antoine Khalil
- Service de Radiologie, Hôpital Tenon, Assistance Publique – Hôpitaux de Paris and Université Pierre et Marie Curie, 4 Rue de la Chine, 75020 Paris, France
| | - Laurence Louis
- Service de Pneumologie et Unité de Réanimation Respiratoire, Hôpital Tenon, Assistance Publique – Hôpitaux de Paris and Université Pierre et Marie Curie, 4 Rue de la Chine, 75020 Paris, France
| | - Marie-France Carette
- Service de Radiologie, Hôpital Tenon, Assistance Publique – Hôpitaux de Paris and Université Pierre et Marie Curie, 4 Rue de la Chine, 75020 Paris, France
| | - Bernard Bazelly
- Service de Chirurgie Thoracique et Vasculaire, Hôpital Tenon, Assistance Publique – Hôpitaux de Paris and Université Pierre et Marie Curie, 4 Rue de la Chine, 75020 Paris, France
| | - Jacques Cadranel
- Service de Pneumologie et Unité de Réanimation Respiratoire, Hôpital Tenon, Assistance Publique – Hôpitaux de Paris and Université Pierre et Marie Curie, 4 Rue de la Chine, 75020 Paris, France
| | - Charles Mayaud
- Service de Pneumologie et Unité de Réanimation Respiratoire, Hôpital Tenon, Assistance Publique – Hôpitaux de Paris and Université Pierre et Marie Curie, 4 Rue de la Chine, 75020 Paris, France
| | - Antoine Parrot
- Service de Pneumologie et Unité de Réanimation Respiratoire, Hôpital Tenon, Assistance Publique – Hôpitaux de Paris and Université Pierre et Marie Curie, 4 Rue de la Chine, 75020 Paris, France
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Corr P. Management of severe hemoptysis from pulmonary aspergilloma using endovascular embolization. Cardiovasc Intervent Radiol 2006; 29:807-10. [PMID: 16810459 DOI: 10.1007/s00270-005-0329-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE To determine the effectiveness of endovascular embolization as a temporizing measure in the management of severe hemoptysis caused by intracavitary pulmonary aspergilloma. METHODS Patients presenting with hemoptysis, estimated to be more than 300 ml in the preceding 24 hr, in whom a radiological diagnosis of pulmonary aspergilloma was made on chest radiographs and/or computed tomography of the chest were subjected to bronchial and systemic arteriography and embolization using triacryl microspheres. RESULTS Twelve patients with upper lobe intracavitary aspergillomas were managed with embolization. In 11 patients hemoptysis stopped within 24 hr and with no recurrence over the next 4 weeks. In 1 patient hemoptysis persisted and an upper lobe lobectomy was performed. CONCLUSION Embolization of bronchial and systemic arteries is an effective method for treating acute severe hemoptysis from intracavitary aspergillomas, allowing the patient time to recover for definitive surgical management.
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Affiliation(s)
- Peter Corr
- Department of Radiology, University of KwaZulu Natal, Nelson Mandela Medical School, Private bag 7, Congella 4013, Durban, South Africa.
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Jeong YJ, Kim CW, Kim KI, Shin SM, Seo IJ, Lee IS, Lee MK. Prediction of Recurrent Hemoptysis With MDCT Angiography. J Comput Assist Tomogr 2006; 30:662-8. [PMID: 16845300 DOI: 10.1097/00004728-200607000-00018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To identify the computed tomography (CT) findings to predict recurrent bleeding in patients with massive hemoptysis. METHODS Fifty-eight patients with massive hemoptysis underwent both CT and conventional bronchial angiography for bronchial artery embolization. Retrospective analysis was done to analyze the statistical differences in the initial CT findings between the nonrecurrent and recurrent hemoptysis groups using the Mann-Whitney U test and the chi or Fisher exact test. Stepwise logistic regression analysis was used to find predictive variables for the recurrence of hemoptysis. RESULTS After embolization, recurrence of hemoptysis was observed in 15 of 58 patients (26%). The diameter of bronchial (P = 0.001) and nonbronchial systemic arteries (P < 0.05), total number of dilated bronchial and nonbronchial systemic arteries (P = 0.001), pleural thickening (P = 0.01), extrapleural fat thickening (P = 0.004), and enhancing vascular structures within the extrapleural fat layer (P = 0.04) were significantly different in the nonrecurrent and recurrent hemoptysis groups. Stepwise logistic regression analysis showed that the total number of dilated bronchial and nonbronchial systemic arteries (odds ratio, 3.540; 95% confidence interval: 1.175, 10.662; P = 0.025) was a significant CT variable associated with the recurrence of hemoptysis. CONCLUSIONS CT bronchial angiography may help in the prediction of recurrent bleeding in patients with massive hemoptysis.
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Affiliation(s)
- Yeon Joo Jeong
- Department of Diagnostic Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Pusan National University, Pusan, Korea
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de Gregorio MA, Medrano J, Mainar A, Alfonso ER, Rengel M. Endovascular Treatment of Massive Hemoptysis by Bronchial Artery Embolization: Short-Term and Long-Term Follow-Up Over a 15-Year Period. ACTA ACUST UNITED AC 2006; 42:49-56. [PMID: 16539933 DOI: 10.1016/s1579-2129(06)60117-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To present our experience of using arterial embolization for the endovascular treatment of massive hemoptysis along with the results of follow-up over a 15-year period. PATIENTS AND METHODS A total of 401 patients with hemoptysis were referred to the minimally invasive surgery unit of the Hospital Universitario Lozano Blesa de Zaragoza between April 1989 and September 2004 for diagnosis and possible endovascular treatment. Of those patients, 314 met criteria for massive hemoptysis and treatment was attempted using embolization in 287 (91.4%). The most common cause of hemoptysis was bronchiectasis (n=99, 31.5%), followed by lesions due to tuberculosis (n=57, 18.1%) and chronic bronchitis (n=47, 14.9%). RESULTS Angiography of the bronchial arteries provided evidence to account for the hemoptysis in 287 patients (91.4%). The affected arteries were satisfactorily embolized in 281 (97.9%). Endovascular treatment was clinically successful in 256 of those patients (91.1%). Embolization had to be repeated during the hospital stay in 19 patients (6.7%) and was effective in 52.6% of those cases. The 6 patients in whom embolization was not satisfactory underwent thoracotomy. The mean follow-up in 201 patients (71.5%) was 2372.5 days (range, 61-5475 days). Eighty patients (28.4%) were lost to follow-up for various reasons and at different points. Recurrence of hemoptysis occurred on 1 or more occasions in 45 patients (22.3%) but only 21 (10.4%) required repeat embolization. Minor complications that did not require treatment were observed in 88 patients (28.0%). CONCLUSIONS Embolization of bronchial arteries is a nonsurgical treatment that is safe and effective in patients with massive hemoptysis.
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Affiliation(s)
- M A de Gregorio
- Unidad de Cirugía Mínimamente Invasiva Guiada por Imagen, Universidad de Zaragoza, Zaragoza, Spain.
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de Gregorio M, Medrano J, Mainar A, Alfonso E, Rengel M. Tratamiento endovascular mediante embolización arterial bronquial en la hemoptisis masiva. Seguimiento a corto y largo plazo durante 15 años. Arch Bronconeumol 2006. [DOI: 10.1157/13084394] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Chung WY, Byun MK, Park MS, Hahn CH, Kang SM, Lee DY, Kim YS, Kim SK, Kim SK, Chang J. Risk Factors of Recurrent Hemoptysis after Bronchial Artery Embolization. Tuberc Respir Dis (Seoul) 2006. [DOI: 10.4046/trd.2006.60.1.65] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Wou Young Chung
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Min Kwang Byun
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Moo Suk Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Hoon Hahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Shin Myung Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Do Yon Lee
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Young Sam Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Se Kyu Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 Project for Medical Sciences, Yonsei University College of Medicine, Seoul, Korea
- Cancer Metastasis Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Kyu Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Chang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
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Corr PD. Bronchial Artery Embolization for Life-Threatening Hemoptysis Using Tris-Acryl Microspheres: Short-Term Result. Cardiovasc Intervent Radiol 2005; 28:439-41. [PMID: 15959698 DOI: 10.1007/s00270-004-0227-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A prospective study of 70 patients with life-threatening hemoptysis who had bronchial and systemic artery embolization with tris-acryl linked microspheres was performed over 15 months. The procedure was technically successful in 90% of patients and at 24 hr after the procedure (87%). Recurrent hemoptysis occurred in 13% of patients within the first week. Chest pain was experienced following embolization in 7% of patients. The mortality was 10% due to the inclusion of patients with pulmonary metastases. Bronchial artery embolization using microspheres is an effective and well-tolerated treatment for patients with life-threatening hemoptysis who are not surgical candidates.
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Affiliation(s)
- Peter D Corr
- Department of Radiology, Inkosi Albert Luthuli and Wentworth Hospitals, University of KwaZulu Natal, Private Bag 7, Congella, Durban, South Africa.
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Abstract
Lung cancer often is associated with significant morbidity, which has a detrimental effect on quality of life. Supportive care plays a central role in the multimodal treatment of lung cancer. Palliation of symptoms often improves quality of life and compliance with therapy. New developments in supportive care, reviewed here, include management of symptoms of the disease, such as respiratory problems, pain, and cachexia, as well as effects of treatment, including chemotherapy-induced nausea and vomiting, neutropenia, anemia, and mucositis. In the past few years, significant advances have been made in this field; however, palliation of the symptoms of lung cancer remains an area of active investigation.
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Affiliation(s)
- Michelle Boyar
- Department of Medicine, Columbia University Medical Center, 177 Fort Washington Avenue, MHB6-435, New York, NY 10032, USA
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de Gracia J, de la Rosa D, Catalán E, Alvarez A, Bravo C, Morell F. Use of endoscopic fibrinogen-thrombin in the treatment of severe hemoptysis. Respir Med 2003; 97:790-5. [PMID: 12854628 DOI: 10.1016/s0954-6111(03)00032-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Bronchial artery embolization (BAE) is the treatment of choice in the majority of patients with severe hemoptysis. However, this procedure may be unavailable and even fail or be counterindicated in 4-13% of cases. In these cases, the efficacy of fibrinogen-thrombin (FT) instilled endoscopically as treatment for massive hemoptysis was assessed. Between August 1993 and February 1996 a prospective clinical study was performed. FT instillation was indicated in all patients with severe hemoptysis (> 150 ml/12 h) in whom BAE had failed, was counterindicated or not available. FT was instilled endoscopically. Patients were followed up until June 2001. Eleven of 101 patients (11%) with hemoptysis > 150 ml/12 h in whom BAE was not possible or proved ineffective were included. The severe hemoptysis was controlled immediately in all cases. During the follow-up period (mean: 39.4 months), early relapse of the severe hemoptysis occurred in two patients (18%) and a long-time relapse in one. Mean procedure duration was 3 min and no attributable complications were observed in any case. In conclusion, these results suggest that topical treatment with FT could be considered in the initial endoscopic evaluation of patients with severe hemoptysis while awaiting BAE or surgery, or as alternative treatment to arterial embolization when the latter is not available, has proved ineffective or is counterindicated.
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Affiliation(s)
- Javier de Gracia
- Servei de Pneumologia, Hospital Universitari Vail d'Hebron, Barcelona, Spain.
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Abstract
Hemoptysis is a common complaint the emergency physician encounters. Most cases are minor and treatable or self-limited. In many cases a cause is never determined. Massive hemoptysis is an occasional occurrence that must be assessed and managed swiftly. The initial approach is no different than that for any bleeding or respiratory or hemodynamically unstable patient. The emergency physician must stabilize, localize, and stop bleeding, and include required specialists to achieve that purpose. The management suggestions presented in this article are simplistic. The emergence of improved CT technology and new bronchoscopic and angiographic techniques has provided safe and effective alternatives to surgery for many causes of hemoptysis. Surgery, however, continues to be the treatment of choice for some. Being familiar with the broad list of causes is imperative to keeping an approach organized.
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Affiliation(s)
- Robert Corder
- Department of Surgery, Division of Emergency Medicine, University of Maryland School of Medicine, 419 West Redwood Street, Suite 280, Baltimore, MD 21201, USA.
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Yoon W, Kim YH, Kim JK, Kim YC, Park JG, Kang HK. Massive hemoptysis: prediction of nonbronchial systemic arterial supply with chest CT. Radiology 2003; 227:232-8. [PMID: 12601194 DOI: 10.1148/radiol.2271020324] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the diagnostic accuracy of chest computed tomography (CT) in the prediction of a nonbronchial systemic arterial supply in patients with massive hemoptysis. MATERIALS AND METHODS Forty consecutive patients with massive hemoptysis underwent contrast material-enhanced CT. Massive hemoptysis was defined as the expectoration of 300-600 mL of blood per day. Two CT features were considered to be suggestive of a nonbronchial systemic arterial supply: (a) pleural thickness of more than 3 mm adjacent to the parenchymal lesion and (b) enhancing vascular structures within the extrapleural fat layer. Conventional angiography was used as the standard of reference. CT scans were evaluated by two radiologists in consensus. The CT findings were compared with those of conventional angiography. The sensitivity, specificity, predictive values, and accuracy of CT for predicting the presence of a nonbronchial systemic arterial supply were assessed. RESULTS In the determination of a nonbronchial systemic arterial supply, CT had a sensitivity of 80%, specificity of 84%, positive predictive value of 73%, negative predictive value of 91%, and accuracy of 84%. Sensitivity was highest for predicting the branches of subclavian and axillary arterial supply and was lowest for predicting the internal mammary arterial supply. Specificity and accuracy were highest for predicting the intercostal arterial supply. CONCLUSION CT demonstrates acceptable sensitivity, specificity, and accuracy in the prediction of a nonbronchial systemic arterial supply in patients with massive hemoptysis.
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Affiliation(s)
- Woong Yoon
- Department of Diagnostic Radiology, Chonnam National University Medical School, Chonnam National University Hospital, 8 Hak-1-dong, Dong-gu, Gwangju 501-757, South Korea.
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Abstract
The majority of patients who acquire lung cancer will have troublesome symptoms at some time during the course of their disease. Some of the symptoms are common to many types of cancers, while others are more often encountered with lung cancer than other primary sites. The most common symptoms are pain, dyspnea, and cough. This document will address the management of these symptoms, and it will also address the palliation of specific problems that are commonly seen in lung cancer: metastases to the brain, spinal cord, and bones; hemoptysis; tracheoesophageal fistula; and obstruction of the superior vena cava.
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Affiliation(s)
- Paul A Kvale
- Division of Pulmonary, Critical Care, Allergy, Immunology, and Sleep Disorders Medicine, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI 48202, USA.
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Yoon W, Kim JK, Kim YH, Chung TW, Kang HK. Bronchial and nonbronchial systemic artery embolization for life-threatening hemoptysis: a comprehensive review. Radiographics 2002; 22:1395-409. [PMID: 12432111 DOI: 10.1148/rg.226015180] [Citation(s) in RCA: 324] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Massive hemoptysis is one of the most dreaded of all respiratory emergencies and can have a variety of underlying causes. In 90% of cases, the source of massive hemoptysis is the bronchial circulation. Diagnostic studies for massive hemoptysis include radiography, bronchoscopy, and computed tomography (CT) of the chest. Bronchoscopy and chest radiography have been considered the primary methods for the diagnosis and localization of hemoptysis. Many researchers currently suggest that CT should be performed prior to bronchoscopy in all cases of massive hemoptysis. Bronchial artery embolization (BAE) is a safe and effective nonsurgical treatment for patients with massive hemoptysis. However, nonbronchial systemic arteries can be a significant source of massive hemoptysis and a cause of recurrence after successful BAE. Knowledge of the bronchial artery anatomy, together with an understanding of the pathophysiologic features of massive hemoptysis, are essential for planning and performing BAE in affected patients. In addition, interventional radiologists should be familiar with the techniques, results, and possible complications of BAE and with the characteristics of the various embolic agents used in the procedure.
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Affiliation(s)
- Woong Yoon
- Department of Diagnostic Radiology, Chonnam National University Hospital, Chonnam National University Medical School, 8 Hak-1-dong, Dong-gu, Gwangju 501-757, South Korea.
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Abstract
STUDY OBJECTIVES The management of life-threatening hemoptysis frequently poses a therapeutic dilemma because such patients are often poor surgical risks. Less often, patients refuse surgical intervention. The value of percutaneous embolotherapy, a useful alternative in these situations, was assessed. DESIGN, SETTING, PATIENTS, INTERVENTIONS Sixteen consecutive patients who underwent percutaneous embolotherapy for life-threatening hemoptysis in a tertiary-care hospital were evaluated retrospectively. The bronchial arteries, as well as other intrathoracic arteries, were evaluated and selectively embolized if they were considered to supply the pathologic area from which the hemoptysis arose. RESULTS The most common cause for hemoptysis was posttuberculous bronchiectasis (n = 12) with or without mycetomas. Ten patients required blood transfusions before embolotherapy. Pleural disease was noted on the chest radiograph in 13 patients and was generally associated with the presence of nonbronchial systemic collateral vessels. In three patients, arteries other than the bronchial arteries were the only source of hemoptysis. Percutaneous embolotherapy was successful in controlling the hemoptysis in all patients. The only complication documented was a transient paraparesis in one patient. Six patients did not return for follow-up. Of the remaining 10 patients, 3 patients had minor episodes of hemoptysis that were treated conservatively with success. One patient had significant recurrent hemoptysis that was managed with radiotherapy. One patient subsequently underwent a lobectomy. CONCLUSION Percutaneous embolotherapy is a useful therapeutic modality in the management of life-threatening hemoptysis. The contribution of nonbronchial systemic collateral vessels, particularly where there is evidence of coexistent pleural disease, should always be suspected. In experienced hands, this is a safe and potentially life-saving procedure.
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Affiliation(s)
- Michelle L Wong
- Respiratory Unit, Department of Medicine, Chris Hani Baragwanath Hospital, and the University of the Witwatersrand, Johannesburg, South Africa.
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Abstract
Interventional Radiology is a technique based medical specialty, using all available imaging modalities (fluoroscopy, ultrasound, computed tomography, magnetic resonance, angiography) for guidance of interventional techniques for diagnostic or therapeutic purposes. Actual, percutaneous transthoracic needle biopsy includes core needle biopsy besides fine needle aspiration. Any pleural, pulmonary or mediastinal fluid or gas collection is amenable to percutaneous pulmonary catheter drainage. Treatment of haemoptysis of the bronchial artery or pulmonary artery origin, transcatheter embolization of pulmonary arteriovenous malformations and pseudoaneurysms, angioplasty and stenting of the superior vena caval system and percutaneous foreign body retrieval are well established routine procedures, precluding unnecessary surgery. These techniques are safe and effective in experienced hands. Computed tomography is helpful in pre- and postoperative imaging of patients being considered for endobronchial stenting. Many procedures can be performed on an outpatient basis, thus increasing the cost-effectiveness of radiologically guided interventions in the thorax.
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Affiliation(s)
- B Ghaye
- Dept of Medical Imaging, University Hospital Sart Tilman, Liège, Belgium
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Abstract
STUDY OBJECTIVES To delineate current chest clinicians' approaches to the management of patients with life-threatening hemoptysis. DESIGN Survey during a computer-assisted interactive continuing medical education presentation. SETTING The 1998 American College of Chest Physicians (ACCP) Annual Scientific Assembly. PARTICIPANTS Chest clinicians attending the respiratory emergency symposium. RESULTS Most clinicians (86%) had cared for patients with life-threatening hemoptysis, and 28% had cared for patients with fatal events during the previous year. Those clinicians favored management in the ICU setting (95%) with early endotracheal intubation (85%), and they tended to use a large-bore, single-lumen endotracheal tube (57%). The majority (64%) favored the early performance of diagnostic bronchoscopy during the first 24 h. Most clinicians (79%) used the flexible instrument, a higher frequency than respondents at a similar symposium on hemoptysis at the 1988 ACCP meeting (48%; p < 0.0001). Most current clinicians (77%) had experience with endobronchial measures to control bleeding, but few (14%) found them to be consistently worthwhile. Chest CT scanning was often helpful in diagnosis (55%). In their management of bleeding, half of these clinicians favored the use of interventional angiography, even in operable patients, which is a substantial change from 1988 when 23% had favored this approach (p < 0.0001). CONCLUSIONS During the past decade, life-threatening hemoptysis has remained an important problem. Flexible bronchoscopy and interventional angiography have become increasingly established, more widely accepted approaches to patient care.
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Affiliation(s)
- E F Haponik
- Department of Internal Medicine, Section on Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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Saluja S, Henderson KJ, White RI. Embolotherapy in the bronchial and pulmonary circulations. Radiol Clin North Am 2000; 38:425-48, ix. [PMID: 10765399 DOI: 10.1016/s0033-8389(05)70172-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This two-part article first discusses the role of bronchial artery transcatheter embolotherapy in the management of patients with hemoptysis. Following this discussion, the authors review pulmonary arteriovenous malformations, their embolization, follow-up protocols, and outcome criteria as currently practiced at the authors' Vascular Malformation Center.
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Affiliation(s)
- S Saluja
- Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
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