1
|
Spencer CM, Keilholtz BM, Palmer M, Vail SL. Factors Associated with Non-Fatal Strangulation Victimization in Intimate Relationships: A Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2024; 25:2103-2114. [PMID: 37941372 DOI: 10.1177/15248380231207874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Intimate partner violence (IPV) is a public health crisis across the globe, and one particular act of IPV, non-fatal strangulation, warrants serious attention. Non-fatal strangulation is a risk factor for intimate partner homicide (IPH) and can create long-term negative mental and physical health consequences. In this meta-analysis, we sought to examine factors associated with non-fatal strangulation victimization among women to help inform education and assessment efforts. Using database searches and Boolean search terms, a total of 16 studies met the inclusion criteria. A total of 16 factors that were found in at least two unique studies were examined. The strongest associated factors included physical IPV victimization, physical injury, IPH, and sexual IPV victimization. Other significant associated factors included lower education, anxiety symptoms, perceived risk of harm, post-traumatic stress symptoms, depressive symptoms, stalking victimization, and identifying as a Black woman. Experiencing childhood trauma, the length of the relationship, age, substance use, and identifying as Hispanic were not significantly related to strangulation victimization by an intimate partner. Education and assessment implications are discussed.
Collapse
|
2
|
Toh TW, Goh JHF, Lie SA, Leong CKL, Hwang NC. Clinical Approach to Massive Hemoptysis: Perioperative Focus on Causes and Management. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00374-4. [PMID: 38964992 DOI: 10.1053/j.jvca.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/30/2024] [Accepted: 06/03/2024] [Indexed: 07/06/2024]
Abstract
Massive hemoptysis is a time critical airway emergency in the perioperative setting, with an associated mortality exceeding 50%. Causes of hemoptysis in the perioperative setting include procedural complication, coagulopathy, malignancy, chronic lung disease, infection, left-sided cardiac disease, pulmonary vascular disease and autoimmune disease. A rapid and coordinated multidisciplinary response is required to secure the airway, isolate the lung, ensure adequate oxygenation and ventilation, identify the underlying cause and initiate specific systemic, bronchoscopic, endovascular, or surgical treatment. This review examines the etiology, pathophysiology, as well as approach to management and interventions in perioperative massive hemoptysis.
Collapse
Affiliation(s)
- Timothy Weiquan Toh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Jacqueline Hui Fen Goh
- Department of Anaesthesiology, Singapore General Hospital, Singapore; Department of Cardiothoracic Anaesthesia, National Heart Centre, Singapore
| | - Sui An Lie
- Department of Surgical Intensive Care, Singapore General Hospital, Singapore
| | - Carrie Kah Lai Leong
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Nian Chih Hwang
- Department of Anaesthesiology, Singapore General Hospital, Singapore; Department of Cardiothoracic Anaesthesia, National Heart Centre, Singapore.
| |
Collapse
|
3
|
Parrot A, Canellas A, Barral M, Gibelin A, Cadranel J. [Severe hemoptysis in the onco-hematology patient]. Rev Mal Respir 2024; 41:303-316. [PMID: 38155073 DOI: 10.1016/j.rmr.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 11/04/2023] [Indexed: 12/30/2023]
Abstract
In France, even though it occurs only exceptionally in cases of hemopathy, severe hemoptysis in cancer is the leading cause of hemoptysis. Without adequate treatment, in-hospital mortality exceeds 60%, even reaching 100% at 6 months. The management of severe hemoptysis should be discussed with the oncologist. Aside from situations of threatening hemoptysis, in which bronchoscopy should be performed immediately, CT angiography is an essential means of localizing the bleeding and determining the causes and the vascular mechanisms involved. In more than 90% of cases, hemoptysis is linked to systemic bronchial or non-bronchial hypervascularization, whereas in fewer than 5%, it is associated with pulmonary arterial origin or, exceptionally, with damage to the alveolar-capillary barrier. The most severely ill patients must be treated in intensive care in centers equipped with interventional radiology, thoracic surgery and, ideally, with interventional bronchoscopy. Interventional radiology is the first-line symptomatic treatment. In over 80% of cases, bronchial arteriography with embolization allows immediate control. Emergency surgery should be avoided, as it is associated with significant mortality. Appropriate and adequate care reduces hospital mortality to 30%, enabling patients to benefit from the most recent, survival-prolonging treatments.
Collapse
Affiliation(s)
- A Parrot
- Service de pneumologie et oncologie thoracique, Assistance publique-Hôpitaux de Paris, hôpital Tenon, Sorbonne université, 75970 Paris, France.
| | - A Canellas
- Service de pneumologie et oncologie thoracique, Assistance publique-Hôpitaux de Paris, hôpital Tenon, Sorbonne université, 75970 Paris, France
| | - M Barral
- Service de radiologie, Assistance publique-Hôpitaux de Paris, hôpital Tenon, Sorbonne université, 75970 Paris, France; UFR médecine, Sorbonne université, 75006 Paris, France
| | - A Gibelin
- Service de médecine intensive et réanimation, Assistance publique-Hôpitaux de Paris, hôpital Tenon, Sorbonne université, 75970 Paris, France
| | - J Cadranel
- Service de pneumologie et oncologie thoracique, Assistance publique-Hôpitaux de Paris, hôpital Tenon, Sorbonne université, 75970 Paris, France; UFR médecine, Sorbonne université, 75006 Paris, France
| |
Collapse
|
4
|
Devkota S, Bhujade H, Baloji A, Prabhakar N, Saroch A, Gorsi U. Successful Endovascular Management of Recurrent Hemoptysis due to Multiple Rasmussen Aneurysms in a Case of Pulmonary Tuberculosis: A Rare Case Scenario. Acta Med Litu 2024; 31:194-199. [PMID: 38978872 PMCID: PMC11227676 DOI: 10.15388/amed.2024.31.1.25] [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: 01/23/2024] [Revised: 03/25/2024] [Accepted: 05/29/2024] [Indexed: 07/10/2024] Open
Abstract
Background Hemoptysis is defined as coughing out of blood. Pulmonary tuberculosis is the most common cause of hemoptysis in tuberculosis-endemic countries like India. Rasmussen aneurysm is a pseudoaneurysm arising from the pulmonary artery adjacent to or within a tuberculous cavity. Chest radiographs, chest computed tomography angiography (CTA), and digital subtraction angiography (DSA) are the imaging tools for evaluating a case of hemoptysis. Case A 32-year-old man with a history of pulmonary tuberculosis presented with complaints of recurrent hemoptysis. On imaging evaluation, multiple pulmonary artery pseudoaneurysms were seen in the left lung. The patient was shifted to the DSA lab and the pseudoaneurysms were subsequently treated by endovascular coil embolization. Hemoptysis resolved following the procedure and the patient was again started on anti-tubercular therapy. Conclusion Endovascular coiling is minimally invasive, safe, and effective management of multiple Rasmussen aneurysms for preventing possible torrential blood loss and unfortunate death.
Collapse
Affiliation(s)
- Shritik Devkota
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Harish Bhujade
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Abhiman Baloji
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Nidhi Prabhakar
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Atul Saroch
- Department of Internal Medicine, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Ujjwal Gorsi
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| |
Collapse
|
5
|
Talwar S, Gangoor N, Maldar SB, Pinto CJ. Isolated unilateral pulmonary artery atresia in an adult presenting with cor pulmonale. BMJ Case Rep 2023; 16:e256663. [PMID: 38160026 PMCID: PMC10759026 DOI: 10.1136/bcr-2023-256663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Unilateral pulmonary artery atresia (UPAA) is a rare embryonic vascular malformation, leading to general presentations of exertional dyspnoea, pneumonia and haemoptysis. Our patient, a man in his early 30s, presented with a history of progressive breathlessness over a period of 2 years. History showed multiple admissions for pneumonia over his childhood and adolescence. Physical examination revealed a loud P2, an ejection systolic murmur and coarse crepitations in multiple lung fields. Severe pulmonary artery hypertension was noted on two-dimensional echocardiography. CT studies confirmed right pulmonary artery atresia with aspergilloma and bronchiectasis. With this diagnosis of UPAA, this case report intends to raise awareness among clinicians to consider this as a rare cause of cor pulmonale in an adult.
Collapse
Affiliation(s)
- Sidhant Talwar
- Department of Medicine, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
- Department of General Medicine, Vijaynagar Institute of Medical Sciences, Bellary, Karnataka, India
| | - Niranjan Gangoor
- Department of Medicine, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Shadab B Maldar
- Department of Medicine, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Christopher Jude Pinto
- Department of Medicine, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
- Department of Family Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| |
Collapse
|
6
|
Ahmed S, Hameed M, Al-Tikriti M, Elfert K, Hussein M, Albakri M, Singh R, Ul Haq I, Ahmad M, Thomas M. Etiology, diagnostic modalities, and short-term outcomes of hemoptysis-a retrospective cross-sectional study from a tertiary care center in Qatar. J Thorac Dis 2023; 15:6634-6643. [PMID: 38249873 PMCID: PMC10797390 DOI: 10.21037/jtd-23-939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/03/2023] [Indexed: 01/23/2024]
Abstract
Background Hemoptysis is a concerning symptom characterized by the expectoration of blood from the respiratory tract, which can range from mild to life-threatening. It can be caused by various underlying conditions. Accurate diagnosis is critical for effective management. The causes of hemoptysis can vary depending on geographic location and the population's composition. In this study, we aimed to examine the etiology, diagnostic methods, and short-term outcomes of hemoptysis in Qatar, focusing on data from Hamad General Hospital (HGH), which serves as a major tertiary care center in the country. Qatar has a diverse and dynamic population, primarily composed of expatriate workers, especially from South Asia. Previous data on hemoptysis in Qatar was collected between 1997 and 2007, when the population was considerably smaller and less diverse. Given the substantial growth in population and diversity since then, this study sought to provide updated information on the causes and outcomes of hemoptysis in the region. Methods This is a retrospective single center observational data review from the largest tertiary care center of Qatar, HGH. Patients who presented to HGH from 01/07/2015 to 30/06/2018 with hemoptysis were included in the study. Descriptive and summary statistics were described and analyzed using SPSS version 23. Results A total of 172 patients met the inclusion criteria. Most of the patients were male (74.4%) with a mean age of 37.9±16.4 years. South Asians (43.6%) accounted for the majority followed by Qatari nationals (20.3%). Mild hemoptysis was recorded in 89.5% of patients while only 3.5% had severe hemoptysis. The mean duration of hemoptysis was 1.72±0.72 days. The most common etiology was respiratory infection in 72.6% of the patients followed by tuberculosis (TB) and bronchiectasis 7% each. All patients were managed with observation or antimicrobials except two of the patients with severe hemoptysis who required bronchial artery embolization (BAE). There were no reports of recurrence of hemoptysis or deaths until hospital discharge. Conclusions Respiratory infection is the most common cause of hemoptysis at our center. Mild hemoptysis is the major presentation and the majority improved with conservative treatment.
Collapse
Affiliation(s)
- Shakeel Ahmed
- Department of Respiratory Medicine, Al Wakra Hospital, Al Wakra, Qatar
| | - Mansoor Hameed
- Department of Chest, Hamad General Hospital, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medicine, Doha, Qatar
| | | | - Khaled Elfert
- Department of Medicine, St. Barnabas Hospital Health System, New York, NY, USA
| | - Mousa Hussein
- Department of Chest, Hamad General Hospital, Doha, Qatar
- Qatar University, Doha, Qatar
| | - Mutaz Albakri
- Department of Internal Medicine, Hebron University College of Medicine, Hebron, Palestine
| | - Rajvir Singh
- Department of Cardiology Research, Heart Hospital, HMC, Doha, Qatar
| | - Irfan Ul Haq
- Department of Chest, Hamad General Hospital, Doha, Qatar
| | - Mushtaq Ahmad
- Department of Chest, Hamad General Hospital, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medicine, Doha, Qatar
| | - Merlin Thomas
- Department of Chest, Hamad General Hospital, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medicine, Doha, Qatar
| |
Collapse
|
7
|
Alkazemi A, Kovacevic M, Dube K, Lauffenburger JC, Smith A, Malinowski S, Weinhouse GL. Effectiveness of Nebulized Tranexamic Acid in Patients with Moderate-to-Massive Hemoptysis at a Tertiary Academic Medical Center. J Aerosol Med Pulm Drug Deliv 2023; 36:309-315. [PMID: 37962861 DOI: 10.1089/jamp.2022.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
Introduction: The management of severe hemoptysis mainly consists of invasive interventional procedures, including angiographic bronchial artery embolization, various endobronchial interventions, and sometimes surgery. However, there are limited effective noninvasive medical therapies available. The objective of this analysis was to evaluate the effectiveness and safety of nebulized tranexamic acid (TXA) administration compared with conventional management in patients with hemoptysis. Methods: This Institutional Review Board-approved, single-center, retrospective matched cohort study was performed from January 1, 2018 to March 31, 2021. Electronic health record data were used to identify all adult inpatients with hemoptysis (International Classification of Diseases, Tenth Revision, code R04.2). All patients who received ≥1 dose of nebulized TXA were matched with up to five controls based on available severity criteria (hemoptysis severity, need for mechanical ventilation, and sequential organ failure assessment score at the time of hemoptysis diagnosis) with coarsened exact matching. The primary outcome was the need for invasive interventions for the management of hemoptysis. Secondary outcomes included time to hemoptysis resolution, duration of mechanical ventilation, hemoptysis recurrence, and hospital length of stay. Results: A total of 14 patients were treated with nebulized TXA; they were matched with 58 controls. Patients were 59.7% male, had a median age of 65.5 years, with airway disease (36.1%) being the major etiology of hemoptysis. There was no difference in the number of patients who required an invasive intervention between the TXA (35.7%) versus control group (56.9%), p = 0.344. Additionally, no difference was found in the time to hemoptysis resolution (p = 0.050), duration on mechanical ventilation (p = 0.128), hemoptysis recurrence (p = 1.000), or hospital length of stay (p = 0.139). Conclusions: In patients with hemoptysis, nebulized TXA may be considered as a noninvasive option for the management of hemoptysis. However, a larger analysis is warranted to determine the impact of nebulized TXA on invasive interventions for management.
Collapse
Affiliation(s)
- Afrah Alkazemi
- Department of Pharmacy Practice, College of Pharmacy, Kuwait University, Kuwait City, Kuwait
| | - Mary Kovacevic
- Department of Pharmacy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kevin Dube
- Department of Pharmacy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Julie C Lauffenburger
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Adam Smith
- Department of Respiratory Therapy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Stephen Malinowski
- Department of Respiratory Therapy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Gerald L Weinhouse
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
8
|
Du B, Zhang W, Shao X, An J, Ma H, Zhao X, Xu L, An D, Tian Y, Dong Y, Niu H. "Triple-low" radiation dose bronchial artery CT angiography before bronchial artery embolisation: a feasibility study. Clin Radiol 2023; 78:e1017-e1022. [PMID: 37813755 DOI: 10.1016/j.crad.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 09/01/2023] [Accepted: 09/12/2023] [Indexed: 10/11/2023]
Abstract
AIM To explore the feasibility of a "triple-low" dose (low tube voltage, low tube current, and low contrast agent volume) bronchial artery computed tomography (CT) angiography (CTA) to replace routine dose bronchial artery CTA before bronchial artery embolisation (BAE). MATERIALS AND METHODS CTA was obtained from 60 patients with body mass index (BMI) < 30 kg/m2 using a 256 multi-section iCT system, and they were divided into two groups: (1) group A: 100 kVp, 100 mAs, 50 ml contrast medium (CM); (2) group B: 120 kVp, automatic tube current modulation (ACTM), 80 ml CM. CT attenuation of the thoracic aorta, image noise, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated, and subjective image quality scores and traceability scores assessed. The effective radiation dose was calculated. RESULTS The radiation dose was reduced by 79.7% in group A compared to group B (p<0.05). The CT attenuation of the thoracic aorta was increased by approximately 13% in group A compared to group B (p<0.05). Higher image noise, lower SNR, and CNR were obtained in group A compared to group B (all p<0.05). Both subjective image quality scores and traceability scores did not differ between groups A and B (both p>0.05). CONCLUSION It is feasible to use the "triple-low" dose CTA protocol for patients with a body mass index (BMI) < 30 kg/m2. The radiation dose was reduced by 79.7%, and the dose of contrast medium was reduced by 37.5% to ensure the diagnostic value.
Collapse
Affiliation(s)
- B Du
- Department of Radiology, Hebei Medical University, No. 361 Zhongshan East Road, Shijiazhuang, 050011, Hebei, China
| | - W Zhang
- Chengde Medical University, Anyuan Road, Chengde, 067000, Hebei, China
| | - X Shao
- Department of Radiology, Hebei Medical University, No. 361 Zhongshan East Road, Shijiazhuang, 050011, Hebei, China
| | - J An
- Department of Interventional Treatment, First Hospital of Qinhuangdao, No. 258 Wenhua Road, Qinhuangdao, 066099, Hebei, China
| | - H Ma
- Chengde Medical University, Anyuan Road, Chengde, 067000, Hebei, China
| | - X Zhao
- Department of Radiology, Hebei Medical University, No. 361 Zhongshan East Road, Shijiazhuang, 050011, Hebei, China
| | - L Xu
- Department of Radiology, Hebei Medical University, No. 361 Zhongshan East Road, Shijiazhuang, 050011, Hebei, China
| | - D An
- Department of Interventional Treatment, First Hospital of Qinhuangdao, No. 258 Wenhua Road, Qinhuangdao, 066099, Hebei, China
| | - Y Tian
- Department of Interventional Treatment, First Hospital of Qinhuangdao, No. 258 Wenhua Road, Qinhuangdao, 066099, Hebei, China
| | - Y Dong
- Department of Interventional Treatment, First Hospital of Qinhuangdao, No. 258 Wenhua Road, Qinhuangdao, 066099, Hebei, China
| | - H Niu
- Department of Interventional Treatment, First Hospital of Qinhuangdao, No. 258 Wenhua Road, Qinhuangdao, 066099, Hebei, China.
| |
Collapse
|
9
|
Karlafti E, Tsavdaris D, Kotzakioulafi E, Kougias L, Tagarakis G, Kaiafa G, Netta S, Savopoulos C, Michalopoulos A, Paramythiotis D. Which Is the Best Way to Treat Massive Hemoptysis? A Systematic Review and Meta-Analysis of Observational Studies. J Pers Med 2023; 13:1649. [PMID: 38138876 PMCID: PMC10744930 DOI: 10.3390/jpm13121649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/21/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION Hemoptysis is one of the most common symptoms of respiratory system diseases. Common causes include bronchiectasis, tumors, tuberculosis, aspergilloma, and cystic fibrosis. The severity of hemoptysis varies from mild to moderate to massive hemoptysis and can easily lead to hemodynamic instability and death from suffocation or shock. Nevertheless, the most threatening hemoptysis that is presented to the emergency department and requires hospitalization is the massive one. In these cases, today, the most common way to manage hemoptysis is bronchial artery embolization (BAE). METHODS A systematic literature search was conducted in PubMed and Scopus from January 2017 (with the aim of selecting the newest possible reports in the literature) until May 2023 for studies reporting massive hemoptysis. All studies that included technical and clinical success rates of hemoptysis management, as well as rebleeding and mortality rates, were included. A proportional meta-analysis was conducted using a random-effects model. RESULTS Of the 30 studies included in this systematic review, 26 used bronchial artery embolization as a means of treating hemoptysis, with very high levels of both technical and clinical success (greater than 73.7% and 84.2%, respectively). However, in cases where it was not possible to use bronchial artery embolization, alternative methods were used, such as dual-vessel intervention (80% technical success rate and 66.7% clinical success rate), customized endobronchial silicone blockers (92.3% technical success rate and 92.3% clinical success rate), antifibrinolytic agents (50% clinical success rate), and percutaneous transthoracic embolization (93.1% technical success rate and 88.9% clinical success rate), which all had high success rates apart from antifibrinolytic agents. Of the 2467 patients included in these studies, 341 experienced rebleeding during the follow-up period, while 354 other complications occurred, including chest discomfort, fever, dysphagia, and paresis. A total of 89 patients died after an episode of massive hemoptysis or during the follow-up period. The results of the meta-analysis showed a pooled technical success of bronchial artery embolization equal to 97.22% and a pooled clinical success equal to 92.46%. The pooled recurrence was calculated to be 21.46%, while the mortality was 3.5%. These results confirm the ability of bronchial artery embolization in the treatment of massive hemoptysis but also emphasize the high rate of recurrence following the intervention, as well as the risk of death. CONCLUSION In conclusion, massive hemoptysis can be treated with great clinical and technical success using bronchial artery embolization, reducing mortality. Mortality has now been reduced to a small percentage of cases.
Collapse
Affiliation(s)
- Eleni Karlafti
- Emergency Department, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
- 1st Propaedeutic Department of Internal Medicine, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.K.); (G.K.); (C.S.)
| | - Dimitrios Tsavdaris
- 1st Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (D.T.); (S.N.); (A.M.); (D.P.)
| | - Evangelia Kotzakioulafi
- 1st Propaedeutic Department of Internal Medicine, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.K.); (G.K.); (C.S.)
| | - Leonidas Kougias
- Department of Radiology, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - Georgios Tagarakis
- Department of Cardiothoracic Surgery, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - Georgia Kaiafa
- 1st Propaedeutic Department of Internal Medicine, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.K.); (G.K.); (C.S.)
| | - Smaro Netta
- 1st Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (D.T.); (S.N.); (A.M.); (D.P.)
| | - Christos Savopoulos
- 1st Propaedeutic Department of Internal Medicine, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.K.); (G.K.); (C.S.)
| | - Antonios Michalopoulos
- 1st Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (D.T.); (S.N.); (A.M.); (D.P.)
| | - Daniel Paramythiotis
- 1st Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (D.T.); (S.N.); (A.M.); (D.P.)
| |
Collapse
|
10
|
Singhal R, K.B SB, Naranje P, Kazimi J, Garg PK, Chandra D, Popat BA, Shetty NS, Gorsi U, Vimala LR, Khera PS, Irodi A, Kulkarni S, Keshava SN, Bhalla AS. Society of Chest Imaging and Interventions Consensus Guidelines for the Interventional Radiology Management of Hemoptysis. Indian J Radiol Imaging 2023; 33:361-372. [PMID: 37362365 PMCID: PMC10289864 DOI: 10.1055/s-0043-1762552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
The recommendations from the Society of Chest Imaging and Interventions expert group comprehensively cover all the aspects of management of hemoptysis, highlighting the role of diagnostic and interventional radiology. The diversity existing in etiopathology, imaging findings, and management of hemoptysis has been addressed. The management algorithm recommends the options for effective treatment while minimizing the chances of recurrence, based on the best evidence available and opinion from the experts.
Collapse
Affiliation(s)
- Rajat Singhal
- Department of Interventional Radiology, Division of Clinical Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Santhosh Babu K.B
- Department of Interventional Radiology, Division of Clinical Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Priyanka Naranje
- Department of Radio-Diagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Junaid Kazimi
- Department of Radio-Diagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Pawan K. Garg
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Jodhpur, Rajasthan, India
| | - Daksh Chandra
- Interventional Radiology Department, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Bhavesh A. Popat
- Department of Interventional Radiology, Hinduja Hospital, Mumbai, Maharashtra, India
- Department of Interventional Radiology, Breach Candy Hospital, Mumbai, Maharashtra, India
- Department of Interventional Radiology, Saifee Hospital, Mumbai, Maharashtra, India
| | - Nitin S. Shetty
- Interventional Radiology Department, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Ujjwal Gorsi
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Leena Robinson Vimala
- Department of Radiodiagnosis, Division of Clinical Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Pushpinder S. Khera
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Jodhpur, Rajasthan, India
| | - Aparna Irodi
- Department of Radiodiagnosis, Division of Clinical Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Suyash Kulkarni
- Interventional Radiology Department, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shyamkumar N. Keshava
- Department of Interventional Radiology, Division of Clinical Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ashu S. Bhalla
- Department of Radio-Diagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
11
|
Association between High Blood Pressure in the Emergency Department and Cryptogenic Hemoptysis. J Clin Med 2022; 11:jcm11185302. [PMID: 36142950 PMCID: PMC9504639 DOI: 10.3390/jcm11185302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 08/29/2022] [Accepted: 09/06/2022] [Indexed: 11/29/2022] Open
Abstract
Hemoptysis is a common cause of emergency department (ED) visits. There is little data about the role of systemic hypertension as a cause of hemoptysis. The aim of this study was to evaluate the association between systemic blood pressure and the unknown etiology of hemoptysis. This retrospective study included consecutive patients who visited the ED owing to hemoptysis and underwent a chest computed tomography between January 2011 and June 2021. Details of the initial blood pressure at the ED visit were compared between two groups with identified and unidentified causes of hemoptysis. In total, 1105 adult patients were included. The etiology of hemoptysis was identified in 1042 patients (94.3%) and remained unidentified in 63 patients (5.7%). The percentage of patients with severe hypertension was significantly higher in patients with unidentified causes of hemoptysis than in those with identified causes (35% vs. 11%, p < 0.001). In multivariate analysis, age, ever-smoker, and initial systolic blood pressure were significantly associated with hemoptysis of unidentified causes. Although further studies are needed, our findings suggest a possible association between high blood pressure and cryptogenic hemoptysis.
Collapse
|
12
|
Iqbal S, Nassar M, Kondaveeti R, O'Brien T, Siddiqui RS, Lopez R. Massive Hemoptysis in Previously Treated Pulmonary Tuberculosis: A Case Series. Cureus 2022; 14:e27882. [PMID: 36110488 PMCID: PMC9463861 DOI: 10.7759/cureus.27882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 11/10/2022] Open
Abstract
Hemoptysis in tuberculosis (TB) is associated with parenchymal distortion and vascular complications linked to prior pulmonary TB. Massive hemoptysis is defined as the expectoration of large volumes of blood. Massive hemoptysis can lead to high morbidity and mortality rates due to hemodynamic instability and airway compromise. In this case series, we present two cases with massive hemoptysis caused by the rupture of the bronchial artery, which achieved hemostasis after fluoroscopy-guided arterial embolization. This series highlights the multiple etiologies of hemoptysis in patients with post-pulmonary TB destruction and the need for various diagnostic and therapeutic modalities. Hemoptysis in patients with prior pulmonary TB can be massive and life-threatening. Timely diagnosis, accurate modality to isolate the source, and appropriate intervention could potentially prevent further lethal complications.
Collapse
|
13
|
Villgran VD, Lyons C, Nasrullah A, Clarisse Abalos C, Bihler E, Alhajhusain A. Acute Respiratory Failure. Crit Care Nurs Q 2022; 45:233-247. [PMID: 35617090 DOI: 10.1097/cnq.0000000000000408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Respiratory failure is one of the most common reasons for hospitalization and intensive care unit (ICU) admissions, and a diverse range of etiologies can precipitate it. Respiratory failure can result from various mechanisms such as hypoventilation, diffusion impairment, shunting, ventilation-perfusion mismatch, or a combination of those mentioned earlier. Hence, an accurate understanding of different pathophysiologic mechanisms is required for appropriate patient care. Prompt identification and treatment of various respiratory emergencies such as tension pneumothorax, massive hemoptysis, and high-risk pulmonary embolism lead to fewer complications, shorter ICU and hospital stay, and improved survival. This review article entails common respiratory failure pathologies encountered in the ICU and addresses their epidemiology, pathophysiology, clinical presentation, and management.
Collapse
Affiliation(s)
- Vipin Das Villgran
- Division of Pulmonary and Critical Care Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania (Drs Villgran, Nasrullah, Abalos, Bihler, and Alhajhusain); and Department of Nursing, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania (Ms Lyons)
| | | | | | | | | | | |
Collapse
|
14
|
Chen S, Zhang Y, Huang Z, Ma S, Chen G, Zhu D, Liu J, Tang C, Zhang H, Zhao Z. A novel angiographic classification of pseudoaneurysms of the pulmonary chronic inflammatory cavity based on selective angiograms and therapeutic implications. J Thorac Dis 2022; 14:1784-1793. [PMID: 35813718 PMCID: PMC9264097 DOI: 10.21037/jtd-21-1485] [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: 09/10/2021] [Accepted: 05/05/2022] [Indexed: 11/12/2022]
Abstract
Background Hemoptysis is a common clinical symptom. In the chronic tuberculosis cavity and chronic necrotizing pneumonia cavity, pseudoaneurysms (Pas) easily form and are prone to massive hemoptysis and repeated hemoptysis and can even endanger patient's life. However, it remains to be further analyzed whether Pas of the pulmonary chronic inflammatory cavity selectively affect the peripheral pulmonary branches. This study is based on selective angiography to classify peripheral pulmonary arterial Pas (PAPs) of the pulmonary chronic inflammatory cavity and to determine treatment options for PAPs, thereby guiding individualized clinical treatment. Methods Angiographic data of 392 noncancer patients undergoing hemoptysis were retrospectively analyzed. All of the patients underwent pulmonary and selective pulmonary angiography and bronchial and nonbronchial systemic collateral arterial angiography. A total of 9 patients had Pas of the pulmonary chronic inflammatory cavity, and a pseudoaneurysm systemic artery collateral (Pasac), inflow and outflow sections of the parent vessels, and direction of blood flow in the parent vessels were clearly observed with digital subtraction angiography (DSA) and/or C-arm cone-beam flat-panel detector computed tomography angiography (CBCTA). Patients with underlying disease had pulmonary tuberculosis (n=8) or lung abscess (n=1). The angiographic types of Pas were analyzed. Results Eight patients with chronic pulmonary tuberculosis and 1 patient with a necrotizing pneumonia cavity in the convalescent period were included in the study. Pas of the pulmonary chronic inflammatory cavity presented the following types: (I) pulmonary artery pseudoaneurysm (PAPa) (n=2 cases); (II) body arterial Pa (n=3 cases); and (III) systemic-pulmonary anastomosis Pa. Each type could be divided into two subtypes (n=4 cases). In nine cases, embolization and hemostasis were technically and clinically successful. Conclusions Pas of the pulmonary chronic inflammatory cavity are diverse (especially in cases of pulmonary tuberculosis). Angiographic typing plays a guiding role in the selection of an embolization strategy.
Collapse
Affiliation(s)
- Shengli Chen
- Department of Pulmonary and Critical Care Medicine, Interventional Radiology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Yuan Zhang
- Department of Pulmonary and Critical Care Medicine, Interventional Radiology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Zicheng Huang
- Department of Pulmonary and Critical Care Medicine, Interventional Radiology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Shuoyi Ma
- Department of Pulmonary and Critical Care Medicine, Interventional Radiology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Guodong Chen
- Department of Pulmonary and Critical Care Medicine, Interventional Radiology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Dongliang Zhu
- Department of Pulmonary and Critical Care Medicine, Interventional Radiology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Jianhua Liu
- Department of Pulmonary and Critical Care Medicine, Interventional Radiology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Chunmei Tang
- Department of Pulmonary Medicine, Guangzhou Chest Hospital, Guangzhou, China
| | - Hui Zhang
- Department of Radiology, Guangzhou Chest Hospital, Guangzhou, China
| | - Zhuxiang Zhao
- Department of Pulmonary and Critical Care Medicine, Interventional Radiology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| |
Collapse
|
15
|
Lamb CR, Yavarovich E, Kang V, Servais EL, Sheehan LB, Shadchehr S, Weldon J, Rousseau MJ, Tirrell GP. Performance of a new single-use bronchoscope versus a marketed single-use comparator: a bench study. BMC Pulm Med 2022; 22:189. [PMID: 35550062 PMCID: PMC9095814 DOI: 10.1186/s12890-022-01982-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 05/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Single-use flexible bronchoscopes eliminate cross contamination from reusable bronchoscopes and are cost-effective in a number of clinical settings. The present bench study aimed to compare the performance of a new single-use bronchoscope (Boston Scientific EXALT Model B) to a marketed single-use comparator (Ambu aScope 4), each in slim, regular and large diameters. METHODS Three bronchoscopy tasks were performed: water suction and visualization, "mucus" mass (synthetic mucoid mixture) suctioned in 30 s, and "mucus" plug (thicker mucoid mixture) suction. Suction ability, task completion times, and subjective ratings of visualization and overall performance on a scale of one to 10 (best) were compared. All bronchoscopy tasks were completed by 15 physicians representing diversity in specialization including pulmonary, interventional pulmonary, critical care, anesthesia, and thoracic surgery. Each physician utilized the six bronchoscope versions with block randomization by bronchoscope and task. RESULTS Aspirated mean mass of "mucus" using EXALT Model B Regular was comparable to that for an aScope 4 Large (41.8 ± 8.3 g vs. 41.5 ± 5.7 g respectively, p = 0.914). In comparisons of scopes with the same outer diameter, the aspirated mean mass by weight of water and "mucus" was significantly greater for EXALT Model B than for aScope 4 (p < 0.001 for all three diameters). Mean ratings for visualization attributes were significantly better for EXALT Model B compared to aScope 4 (p-value range 0.001-0.029). CONCLUSION A new single-use bronchoscope provided strong suction capability and visualization compared to same-diameter marketed single-use comparators in a bench model simulation.
Collapse
Affiliation(s)
- Carla R Lamb
- Division of Pulmonary and Critical Care, Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, MA, 01805, USA.
- Department of Medicine, Tufts Medical Center, Boston, USA.
| | - Ekaterina Yavarovich
- Division of Pulmonary and Critical Care, Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, MA, 01805, USA
| | - Vincent Kang
- Division of Pulmonary and Critical Care, Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, MA, 01805, USA
| | - Elliot L Servais
- Division of Thoracic Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Lori B Sheehan
- Division of Anesthesiology, Lahey Hospital and Medical Center, Burlington, MA, USA
- Department of Medicine, Tufts Medical Center, Boston, USA
| | - Sara Shadchehr
- Division of Pulmonary and Critical Care, Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, MA, 01805, USA
- Department of Medicine, Tufts Medical Center, Boston, USA
| | - James Weldon
- Boston Scientific Corporation, Marlborough, MA, USA
| | | | | |
Collapse
|
16
|
Durão V, Simões A, Paula F, Mineiro A, Lousada N, Froes F. A rare but potentially fatal cause of hemoptysis. Pulmonology 2022; 28:406-408. [PMID: 35346639 DOI: 10.1016/j.pulmoe.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 11/26/2022] Open
Affiliation(s)
- V Durão
- Serviço de Pneumologia, Centro Hospitalar Lisboa Norte - Hospital Pulido Valente e Hospital de Santa Maria, Lisbon, Portugal.
| | - A Simões
- Serviço de Medicina Interna III, Centro Hospitalar Lisboa Norte - Hospital Pulido Valente e Hospital de Santa Maria, Lisbon, Portugal
| | - F Paula
- Serviço de Pneumologia, Centro Hospitalar Lisboa Norte - Hospital Pulido Valente e Hospital de Santa Maria, Lisbon, Portugal; Unidade de Cuidados Intensivos Médico-Cirúrgicos Respiratórios (UCIMCR), Centro Hospitalar Lisboa Norte - Hospital Pulido Valente e Hospital de Santa Maria, Lisbon, Portugal
| | - A Mineiro
- Serviço de Pneumologia, Centro Hospitalar Lisboa Norte - Hospital Pulido Valente e Hospital de Santa Maria, Lisbon, Portugal
| | - N Lousada
- Serviço de Cardiologia, Centro Hospitalar Lisboa Norte - Hospital Pulido Valente e Hospital de Santa Maria, Lisbon, Portugal
| | - F Froes
- Serviço de Pneumologia, Centro Hospitalar Lisboa Norte - Hospital Pulido Valente e Hospital de Santa Maria, Lisbon, Portugal; Unidade de Cuidados Intensivos Médico-Cirúrgicos Respiratórios (UCIMCR), Centro Hospitalar Lisboa Norte - Hospital Pulido Valente e Hospital de Santa Maria, Lisbon, Portugal
| |
Collapse
|
17
|
Yan HT, Lu GD, Huang XZ, Zhang DZ, Ge KY, Zhang JX, Liu J, Liu S, Shi HB, Zu QQ. Development of a model to predict recurrence after bronchial artery embolization for non-cancer related hemoptysis. BMC Pulm Med 2021; 21:419. [PMID: 34922497 PMCID: PMC8684203 DOI: 10.1186/s12890-021-01790-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 12/06/2021] [Indexed: 11/10/2022] Open
Abstract
Background Relapse after effective bronchial arterial embolization (BAE) for controlling hemoptysis is not uncommon. Studies reported diverse predictors of recurrence. However, a model to assess the probability of recurrence in non-cancer related hemoptysis patients after BAE has not been reported. This study was to develop a model to predict recurrence after BAE for non-cancer related hemoptysis. Methods The study cohort included 487 patients who underwent BAE for non-cancer-related hemoptysis between January 2015 and December 2019. We derived the model’s variables from univariate and multivariate Cox regression analyses. The model presented as a nomogram scaled by the proportional regression coefficient of each predictor. Model performance was assessed with respect to discrimination and calibration. Results One-month and 1-, 2-, 3- and 5-year recurrence-free rates were 94.5%, 88.0%, 81.4%, 76.2% and 73.8%, respectively. Risk factors for recurrence were underlying lung diseases and the presence of systemic arterial-pulmonary circulation shunts. This risk prediction model with two risk factors provided good discrimination (area under curve, 0.69; 95% confidence interval, 0.62–0.76), and lower prediction error (integrated Brier score, 0.143). Conclusion The proposed model based on routinely available clinical and imaging features demonstrates good performance for predicting recurrence of non-cancer-related hemoptysis after BAE. The model may assist clinicians in identifying higher-risk patients to improve the long-term efficacy of BAE.
Collapse
Affiliation(s)
- Hai-Tao Yan
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Guang-Dong Lu
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Xiang-Zhong Huang
- Department of Interventional Radiology, Jiangyin People's Hospital, Wuxi, 214400, China
| | - Da-Zhong Zhang
- Department of Interventional Radiology, Jiangsu Taizhou People's Hospital, Taizhou, 225300, China
| | - Kun-Yuan Ge
- Department of Interventional Radiology, Yixing People's Hospital, Wuxi, 214200, China
| | - Jin-Xing Zhang
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Jin Liu
- Department of Clinical Medicine Research Institution, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - Sheng Liu
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Hai-Bin Shi
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China.
| | - Qing-Quan Zu
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China.
| |
Collapse
|
18
|
Qi Y, Wang L, Qian L, Zhang X. The etiology, clinical profile, and outcome of diffuse alveolar hemorrhage in children: a ten-year single-center experience. Transl Pediatr 2021; 10:2921-2928. [PMID: 34976758 PMCID: PMC8649607 DOI: 10.21037/tp-21-283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/13/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Diffuse alveolar hemorrhage (DAH) is a life-threatening syndrome that may be caused by numerous disorders. There is scant data on the etiology and characteristics of DAH in children. METHODS We retrospectively reviewed the clinical records of patients admitted to a tertiary pediatric hospital with DAH over a 10-year period. The syndrome was classified into five groups according to different etiologies, and the characteristics and outcomes of patients were compared. RESULTS A total of 74 children were included in the study. Idiopathic pulmonary hemosiderosis (IPH) was the most frequent cause (64.9%), followed by miscellaneous causes (infection and other conditions) (16.2%), immune-mediated disorders (9.5%), liver dysfunction (5.4%), and cardiovascular disorders (4.1%). The median age of the patients was 3.5 years (ranging from 1.5 to 7 years), and no difference was found in the proportion of fever, crackles, and pulmonary infiltrates among the five etiological groups. There was no difference in the proportion of blood transfusions among the groups. Cardiac catheterization was performed on 31 patients for whom the diagnostic workup was negative and were suspected of having IPH, and abnormal signs were observed and bronchial artery embolization (BAE) was performed in all those patients. The patients with IPH had the lowest mortality, while those with DAH secondary to liver failure had the highest mortality. Patients in BAE group had a shorter duration of corticosteroids and a lower relapse rate than non-BAE group. CONCLUSIONS Idiopathic pulmonary hemosiderosis is a common etiology of DAH and has a good prognosis in children. Vascular abnormalities were observed in the patients with IPH. Further studies are needed to clarify the role of vascular malformations in IPH.
Collapse
Affiliation(s)
- Yuanyuan Qi
- Department of Respiratory Disease, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Libo Wang
- Department of Respiratory Disease, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Liling Qian
- Department of Respiratory Disease, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Xiaobo Zhang
- Department of Respiratory Disease, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| |
Collapse
|
19
|
Fukaya T, Kasai H, Sugiura T, Nagata J, Suzuki K, Ohashi K, Tanaka N, Abe M, Suga M, Sakao S, Suzuki T. Six Cases of Hemoptysis with Angiogenesis from Non-Bronchial Systemic Arteries. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e933187. [PMID: 34610006 PMCID: PMC8503798 DOI: 10.12659/ajcr.933187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although bronchial arteries are the most common cause of hemoptysis, other systemic arteries can cause hemoptysis and are potential pitfalls for successful embolization. CASE REPORT We present 6 cases of hemoptysis showing vascularization from systemic arteries other than bronchial arteries that presented to our department between 2013 and 2020. Chronic inflammatory diseases such as tuberculosis and pulmonary aspergillosis were the underlying diseases in 4 of the 6 cases. In all 6 cases, the lesions were close to the pleura. The abnormal non-bronchial systemic arteries were the internal thoracic artery in 4 cases, intercostal artery in 2 cases, lateral thoracic artery in 2 cases, and the subclavian, thyrocervical, and inferior phrenic arteries in 1 case each, all of which formed a shunt with the pulmonary artery. Additionally, depending on the location of the lesion, the non-bronchial systemic arteries near the lesion proliferated into the lung parenchyma through the adherent pleura. CONCLUSIONS When lesions are in contact with the pleura, various non-bronchial systemic arteries near the lesion can develop in the pulmonary parenchyma via the adherent pleura, which can cause hemoptysis. In patients with hemoptysis, it may be useful to evaluate chest contrast-enhanced computed tomography and angiography, while always accounting for the potential involvement of non-bronchial systemic arteries to ensure a safer and more reliable treatment.
Collapse
Affiliation(s)
- Takumi Fukaya
- Department of Medicine, School of Medicine, Chiba University, Chiba, Japan
| | - Hajime Kasai
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan.,Health Professional Development Center, Chiba University, Chiba, Japan
| | - Toshihiko Sugiura
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Jun Nagata
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kenichi Suzuki
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kana Ohashi
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Nozomi Tanaka
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Mitsuhiro Abe
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masaki Suga
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Seiichiro Sakao
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takuji Suzuki
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| |
Collapse
|
20
|
Charya AV, Holden VK, Pickering EM. Management of life-threatening hemoptysis in the ICU. J Thorac Dis 2021; 13:5139-5158. [PMID: 34527355 PMCID: PMC8411133 DOI: 10.21037/jtd-19-3991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/24/2020] [Indexed: 12/12/2022]
Abstract
Life-threatening hemoptysis is commonly encountered in the ICU and its management can be challenging even for experienced clinicians. Depending on the etiology and severity, one can tailor the treatment modality and therapeutic intervention(s). The grading of severity of hemoptysis varies greatly in the literature; however, unlike hemorrhage in other scenarios, small amounts of blood can significantly impair oxygenation and ventilation leading to cardiovascular collapse. Importantly, the initial evaluation and management should focus on airway and hemodynamic stabilization along with maintenance of oxygenation and ventilation. In this review, we discuss commonly encountered etiologies, vascular anatomy, diagnostic evaluation, and therapeutic interventions. We examine the evolving trends in etiologies of life-threating hemoptysis over the years. The role of flexible and rigid bronchoscopy as both a diagnostic and therapeutic modality is explored, as well as the use and indications of several bronchoscopic techniques, such as topical hemostatic agents, endobronchial tamponade, and tranexamic acid (TXA). In addition, we assess the use of multi-row detector computed tomography as the initial rapid diagnostic method of choice and its use in planning for definitive treatment. The efficacy and long-term results of bronchial artery embolization (BAE) are evaluated, as well as indications for surgical intervention. Furthermore, the importance of a multidisciplinary approach is emphasized. The necessary interplay between intensivists, consultative services, and radiologists is described in detail and an algorithmic management strategy incorporating the above is outlined. Given the complexity in management of life-threatening hemoptysis, this paper aims to summarize the available diagnostic and therapeutic methods and provide a standardized approach for the management of patients with this often difficult to treat condition.
Collapse
Affiliation(s)
- Ananth V Charya
- Division of Pulmonary and Critical Care Medicine, University of Maryland Medical Center, Baltimore, MD, USA
| | - Van K Holden
- Division of Pulmonary and Critical Care Medicine, Section of Interventional Pulmonology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Edward M Pickering
- Division of Pulmonary and Critical Care Medicine, Section of Interventional Pulmonology, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
21
|
Jajodia S, Goenka U, Jash D, Tiwary I, Goenka MK. Endovascular management of massive hemoptysis due to covid-19 related pulmonary artery pseudoaneurysm: A rare entity. Radiol Case Rep 2021; 16:3597-3601. [PMID: 34466180 PMCID: PMC8390365 DOI: 10.1016/j.radcr.2021.08.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 12/12/2022] Open
Abstract
Pulmonary artery pseudoaneurysms are rare causes of massive hemoptysis, even less common in setting of COVID-19 pneumonia. We describe and discuss an index case of cavitating COVID-19 pneumonia complicated by a pulmonary artery pseudoaneurysm without concomitant pulmonary thromboembolism. The patient presented with severe hemoptysis and was managed by endovascular coil embolization. Good technical and clinical success was achieved with complete resolution of hemoptysis.
Collapse
Affiliation(s)
- Surabhi Jajodia
- Department of Clinical imaging and Interventional Radiology, Apollo Multi Speciality Hospitals, 58, Canal circular road, Kolkata 700054, India
- Corresponding author. S. Jajodia.
| | - Usha Goenka
- Department of Clinical imaging and Interventional Radiology, Apollo Multi Speciality Hospitals, 58, Canal circular road, Kolkata 700054, India
| | - Debraj Jash
- Department of Pulmonary Medicine, Apollo Multi Speciality Hospitals, Kolkata, India
| | - Indrajeet Tiwary
- Institute of Gastro-sciences, Apollo Multi Speciality Hospitals, Kolkata, India
| | - Mahesh Kumar Goenka
- Institute of Gastro-sciences, Apollo Multi Speciality Hospitals, Kolkata, India
| |
Collapse
|
22
|
Robson PC, O’Connor D, Pardini P, Akard TF, Dietrich MS, Kotin A, Solomon A, Chawla M, Kennedy M, Solomon SB. Hemoptysis associated with percutaneous transthoracic needle biopsy: Development of critical events checklist and procedure outcomes. JOURNAL OF RADIOLOGY NURSING 2021; 40:221-226. [PMID: 34483778 PMCID: PMC8409504 DOI: 10.1016/j.jradnu.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND A percutaneous transthoracic needle biopsy (PTNB) is performed to obtain tissue for a pathologic diagnosis. A PTNB is necessary prior to the initiation of many cancer treatments. There is a risk of hemoptysis, the expectoration of blood, with the possibility for adverse, life-threatening outcomes. A critical event checklist is a cognitive aid used in an emergency to ensure critical steps are followed. To date, there are no known checklists published for management of PTNB-related, life-threatening hemoptysis. The purpose of this report is to describe the development and implementation of a critical event checklist and the adoption of the checklist into hemoptysis management. METHODS In March 2017, a process improvement team convened to evaluate the hemoptysis response using the Plan-Do-Study-Act (PDSA) methodology. The checklist was evaluated and updated through September 2019. The team educated Interventional Radiology (IR) clinicians on the new checklist and conducted simulations on its use. A retrospective chart review was performed on hemoptysis events between the ten-year period of October 1, 2008 and September 30, 2018 to evaluate the adoption of the checklist into practice. RESULTS There were 231 hemoptysis events occurring in 229 patients (2 with repeat biopsies). Prior to implementing the protocol and checklist, there were 166 (71.9%) hemoptysis events. After implementation there were 65 (28.1%) events. The median amount of documented blood expectorated with hemoptysis was 100 mL (IQR 20.0-300.0). Twenty-six patients were admitted after PTNB for reasons related to the hemoptysis event (11.3%). During the procedure, four (1.7%) patients with hemoptysis suffered a cardiac arrest. Prior to implementation of the protocol and critical events checklist, nurses positioned patients in the lateral decubitus (LD) position in 40 out of 162 (24.7%) cases. After implementation of the critical events checklist, nurses positioned patients in the LD position 42 out of 65 cases (64.6%) (OR=5.57(95% CI 2.99-10.367), p<0.001). DISCUSSION Interventional Radiology nurses successfully adopted the checklist into management of hemoptysis events. The reported incidence of hemoptysis suggests a need for IR teams to prepare for and simulate hemoptysis events. Future research is needed to evaluate the change in patient outcomes before and after critical events checklist implementation.
Collapse
Affiliation(s)
- Piera C. Robson
- Memorial Sloan Kettering Cancer Center Department of Nursing and, Vanderbilt University School of Nursing, 1275 York Avenue, S121, New York, NY 10065
| | - David O’Connor
- Memorial Sloan Kettering Cancer Center Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C-613D, New York, NY 10065
| | - Perri Pardini
- Memorial Sloan Kettering Cancer Center Department of Nursing, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, M2 D-desk, New York, NY 10065
| | - Terrah F. Akard
- Vanderbilt University School of Nursing, 461 21 Ave South, 514 Godchaux Hall, Nashville, TN 37240
| | - Mary S. Dietrich
- Vanderbilt University School of Nursing and School of Medicine (Biostatistics, VICC, Psychiatry), 461 21 Ave South, 410 Godchaux Hall, Nashville, TN 37240
| | - Alan Kotin
- Memorial Sloan Kettering Cancer Center, Department of Anesthesiology and Critical Care Medicine, 1275 York Avenue, C330A, New York, NY
| | - Alexandra Solomon
- Memorial Sloan Kettering Cancer Center, Department of Nursing, 1275 York Avenue, New York, NY
| | - Mohit Chawla
- Memorial Sloan Kettering Cancer Center, Department of Medicine, 1275 York Avenue, New York, NY
| | - Matthew Kennedy
- Memorial Sloan Kettering Cancer Center, Department of Nursing, 1275 York Avenue, New York, NY
| | - Stephen B. Solomon
- Memorial Sloan Kettering Cancer Center, Department of Radiology, Memorial Sloan Kettering Cancer Center, H118, 1275 York Avenue, New York, NY 10065
| |
Collapse
|
23
|
Ledda RE, Balbi M, Milone F, Ciuni A, Silva M, Sverzellati N, Milanese G. Imaging in non-cystic fibrosis bronchiectasis and current limitations. BJR Open 2021; 3:20210026. [PMID: 34381953 PMCID: PMC8328081 DOI: 10.1259/bjro.20210026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 01/21/2023] Open
Abstract
Non-cystic fibrosis bronchiectasis represents a heterogenous spectrum of disorders characterised by an abnormal and permanent dilatation of the bronchial tree associated with respiratory symptoms. To date, diagnosis relies on computed tomography (CT) evidence of dilated airways. Nevertheless, definite radiological criteria and standardised CT protocols are still to be defined. Although largely used, current radiological scoring systems have shown substantial drawbacks, mostly failing to correlate morphological abnormalities with clinical and prognostic data. In limited cases, bronchiectasis morphology and distribution, along with associated CT features, enable radiologists to confidently suggest an underlying cause. Quantitative imaging analyses have shown a potential to overcome the limitations of the current radiological criteria, but their application is still limited to a research setting. In the present review, we discuss the role of imaging and its current limitations in non-cystic fibrosis bronchiectasis. The potential of automatic quantitative approaches and artificial intelligence in such a context will be also mentioned.
Collapse
Affiliation(s)
- Roberta Eufrasia Ledda
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Maurizio Balbi
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Francesca Milone
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Andrea Ciuni
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Mario Silva
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Nicola Sverzellati
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Gianluca Milanese
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| |
Collapse
|
24
|
Chetana Shanmukhappa S, Lokeshwaran S, Kumar K S, Doraiswamy P. "Peanut saves the day": an innovative solution to massive, cryptogenic haemoptysis-a case study. Respirol Case Rep 2021; 9:e00754. [PMID: 33976883 PMCID: PMC8103091 DOI: 10.1002/rcr2.754] [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: 02/12/2021] [Revised: 03/29/2021] [Accepted: 04/07/2021] [Indexed: 11/09/2022] Open
Abstract
Massive (or life-threatening) haemoptysis is a time-sensitive emergency encountered by a physician that requires an interdisciplinary, collaborative effort to arrest the bleeding in a prompt and timely manner. Placement of an endobronchial Watanabe spigot (EWS) to halt haemoptysis is a relatively recent technique finding its wide application in airway pathology, with the current extension of its use to bronchial bleeding. However, the lack of immediate access to EWS gives rise to the need to innovate with day-to-day materials used in routine surgical practice and available in resource-limited settings, which may serve the purpose of a spigot. In this report, we bring to light a case of life-threatening, cryptogenic haemoptysis that was managed by a novel technique of using peanut gauze as a spigot resulting in a successful endobronchial tamponade.
Collapse
Affiliation(s)
| | | | - Sunil Kumar K
- Department of PulmonologyAster CMI HospitalBengaluruIndia
| | - Prakash Doraiswamy
- Department of Anaesthesia and Critical CareAster CMI HospitalBengaluruIndia
| |
Collapse
|
25
|
Abstract
OBJECTIVE. The purpose of this article is to review the clinical and imaging features of diffuse pulmonary hemorrhage. CONCLUSION. Diffuse pulmonary hemorrhage is a life-threatening syndrome associated with a wide variety of underlying pathologic categories. Nonspecific clinical and imaging features pose challenges to promptly diagnosing this condition. Chest radiography commonly shows alveolar opacification, and CT reveals the extent of disease. Integration of clinical, radiologic, laboratory, and pathologic findings facilitates timely diagnosis and etiologic identification.
Collapse
|
26
|
Fukaya T, Kasai H, Nagata J, Sugiura T. Haemoptysis due to an atypical right bronchial artery branching from the left subclavian artery evaluated by four-dimensional CT and bronchial arteriography. BMJ Case Rep 2021; 14:14/3/e239754. [PMID: 33692054 PMCID: PMC7949430 DOI: 10.1136/bcr-2020-239754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Haemoptysis can be a life-threatening condition, and bronchial artery embolisation (BAE) is the most effective treatment. A 19-year-old man who had been followed up for neutrophil migration failure and bronchiectasis since birth was admitted to our department with repeated haemoptysis. Contrast-enhanced CT revealed hyperplasia and tortuosity of the bronchial artery; however, it could not reveal the origin and running by the axial views. Three-dimensional (3D) and four-dimensional (4D) CT revealed branching of the right bronchial artery from the left subclavian artery and a bronchial artery–pulmonary artery shunt. Bronchial angiography confirmed these findings. Based on these findings, BAE was successfully performed. 3D and 4D CT can be useful for determining the cause of haemoptysis. Furthermore, evaluating the anatomy of bronchial arteries prior to BAE may be useful for performing safer procedures.
Collapse
Affiliation(s)
- Takumi Fukaya
- Medicine, School of Medicine, Chiba University, Chiba, Japan
| | - Hajime Kasai
- Department of Respirology, Chiba University Hospital, Chiba, Japan
| | - Jun Nagata
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Toshihiko Sugiura
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| |
Collapse
|
27
|
|
28
|
Ictus isquémico en territorio posterior como complicación de embolización de arterias bronquiales. Neurologia 2020; 35:588-589. [DOI: 10.1016/j.nrl.2019.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/13/2019] [Accepted: 03/03/2019] [Indexed: 11/22/2022] Open
|
29
|
Posterior circulation ischaemic stroke as a complication of bronchial artery embolisation. NEUROLOGÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.nrleng.2019.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
30
|
Le HY, Le VN, Pham NH, Phung AT, Nguyen TT, Do Q. Value of multidetector computed tomography angiography before bronchial artery embolization in hemoptysis management and early recurrence prediction: a prospective study. BMC Pulm Med 2020; 20:231. [PMID: 32867748 PMCID: PMC7457514 DOI: 10.1186/s12890-020-01271-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 08/19/2020] [Indexed: 12/19/2022] Open
Abstract
Background Multidetector computed tomography (MDCT) angiography is a useful examination to detect the source of the bleeding in patients with hemoptysis. The aim of the study was to prospectively evaluate the role and clinical efficacy of MDCT angiography before bronchial artery embolization (BAE) for the management of hemoptysis, and to investigate the predictors of early recurrence. Methods It is a double-center study which included 57 hemoptysis patients undergoing MDCT angiography prior to BAE from August 2019 to July 2020. A prospective analysis of culprit arteries detected by MDCT angiography allowed an evaluation of the role of this technique. A follow-up was done to assess the efficacy of BAE with preprocedural MDCT angiography and to explore the risk factors of early recurrent hemoptysis. Results The accuracy of MDCT angiography in the identification of culprit arteries was as high as 97.5%. The average number of total culprit arteries per patient was 2.75 ± 1.73. Among which, the average numbers of culprit ectopic bronchial arteries (BAs) and non-bronchial systemic arteries (NBSAs) per patient were 0.21 ± 0.41 and 1.04 ± 1.57, respectively. The immediate clinical success rate, total hemoptysis recurrence rate, and early hemoptysis recurrence rate of BAE following MDCT angiography were 94.7, 18.5, 16.7%, respectively. Aspergilloma (HR = 6.63, 95% CI: 1.31–33.60, p = 0.022) was associated with an increase in the risk of early recurrence. Conclusions MDCT angiography should be performed before BAE for the management of hemoptysis. Aspergilloma was an independent predictor for early recurrence.
Collapse
Affiliation(s)
- Huu Y Le
- Department of Respiratory Diseases, Military Hospital 103, Hanoi, Vietnam.,Division of Interventional Radiology, Military Hospital 103, Hanoi, Vietnam
| | - Van Nam Le
- Department of Infectious Diseases, Military Hospital 103, Hanoi, Vietnam
| | - Ngoc Hung Pham
- Department of Epidemiology, Vietnam Military Medical University, Hanoi, Vietnam
| | - Anh Tuan Phung
- Division of Interventional Radiology, Military Hospital 103, Hanoi, Vietnam.,Department of Diagnostic Radiology, Military Hospital 103, Hanoi, Vietnam
| | - Thanh Tung Nguyen
- Department of Respiratory Diseases, Military Hospital 103, Hanoi, Vietnam.,Division of Interventional Radiology, Military Hospital 103, Hanoi, Vietnam
| | - Quyet Do
- Department of Respiratory Diseases, Military Hospital 103, Hanoi, Vietnam. .,Department of Medicine, Vietnam Military Medical University, Hanoi, Vietnam.
| |
Collapse
|
31
|
Khan BJ, Khanolkar U, Raj V, Ashok KG. Saphenous vein graft aneurysm - Unusual cause of hemoptysis: A case report and review of literature. J Postgrad Med 2020; 66:165-168. [PMID: 32675454 PMCID: PMC7542063 DOI: 10.4103/jpgm.jpgm_187_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Hemoptysis due to saphenous venous graft (SVG) aneurysm is an extremely rare condition and published literature has described the role of conservative management, surgical resection, and covered stent. Here, we report a successful placement of a covered stent for SVG aneurysm in a 56-year-old male who presented with hemoptysis. He was a known diabetic and had undergone a coronary artery bypass grafting 5 years ago. Computed tomography (CT) chest and fiberoptic bronchoscopy performed in another local hospital had revealed blood in the left lingula with spillover into the left lung parenchyma. Hence, he had received empirical anti-tuberculosis medication for 2 months without any improvement. He was referred to our hospital for further management of hemoptysis. Multidetector CT (MDCT) angiography of the chest covering coronaries performed at our hospital revealed SVG aneurysm that was managed with covered stent placement.
Collapse
Affiliation(s)
- B J Khan
- Department of Pulmonology, Narayana Health City, Bengaluru, India
| | - U Khanolkar
- Department of Cardiology, Narayana Health City, Bengaluru, India
| | - V Raj
- Department of Radiology and Imaging Services, Narayana Health City, Bengaluru, India
| | - K G Ashok
- Department of Radiology and Imaging Services, Narayana Health City, Bengaluru, India
| |
Collapse
|
32
|
Sarioglu O, Capar AE, Yavuz MY, Belet U. Angiographic Findings and Outcomes of Bronchial Artery Embolization in Patients with Pulmonary Tuberculosis. Eurasian J Med 2020; 52:126-131. [PMID: 32612418 DOI: 10.5152/eurasianjmed.2020.19221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/24/2019] [Indexed: 11/22/2022] Open
Abstract
Objective We aimed to evaluate the angiographic findings and outcomes of bronchial artery embolization in tuberculosis patients and to compare them with those of non-tuberculosis patients. Materials and Methods Patients who underwent bronchial artery embolization in a single interventional radiology department with hemoptysis were reviewed. A total of 89 patients (66 males and 23 females; mean age 52.71±15.37) were incorporated in the study. The patients were divided into two groups: tuberculosis group (n=36) and non-tuberculosis group (16 malignancy, 22 bronchiectasis, 6 pulmonary infection, 5 chronic obstructive pulmonary disease, 4 idiopathic; n=53). Angiography and embolization procedure were performed by interventional radiologists with 5, 10, and 20 years of experience. Angiographic findings were classified as tortuosity, hypertrophy, hypervascularity, aneurysm, bronchopulmonary shunt, extravasation, and normal bronchial artery. Chi-square test was used to compare angiographic findings between tuberculosis and non-tuberculosis patient groups. Results Bronchopulmonary shunt was found to be significantly higher in the tuberculosis group as compared to that in the non-tuberculosis group (p=0.002). Neither of the groups showed a statistically significant difference with respect to recurrence (p=0.436). Conclusion Bronchial artery embolization is a useful and effective treatment method of hemoptysis in tuberculosis. Evaluation of bronchopulmonary shunts in patients with tuberculosis is critical for the reduction of catastrophic complications.
Collapse
Affiliation(s)
- Orkun Sarioglu
- Department of Radiology, Health Sciences University, Tepecik Educational and Research Hospital, Izmir, Turkey
| | - Ahmet Ergin Capar
- Department of Radiology, Health Sciences University, Tepecik Educational and Research Hospital, Izmir, Turkey
| | - Melike Yuksel Yavuz
- Department of Chest Diseases, Izmir Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Umit Belet
- Department of Radiology, Health Sciences University, Tepecik Educational and Research Hospital, Izmir, Turkey
| |
Collapse
|
33
|
Abstract
Rationale. Hemoptysis is a rare but often life-threatening condition in pediatric patients. Massive hemoptysis can easily lead to asphyxia, respiratory failure, shock, and even death. The most common causes of severe hemoptysis are lower respiratory tract infection, vascular malformation, and bronchial foreign body. We present an unusual case of massive hemoptysis caused by malformation of the bronchial artery, which includes bronchial artery hypertrophy, bronchial-pulmonary artery fistula, and ectopic bronchial artery. Patient. An 11-year-old boy was admitted to the hospital with mild hemoptysis lasting for the two preceding days. He did not report any discomfort, such as fever or chest pain. His complete blood count and coagulation function were normal. Chest X-ray documented lower right pneumonia. Massive hemoptysis occurred on the night of the admission. Diagnosis. Bronchial arteriography revealed that the right lower bronchial artery and the ectopic bronchial artery from the renal artery were the responsible vessels for hemoptysis. Interventions. The boy underwent a successful bronchial artery embolization and bronchoscopy to remove the blood clot from the airway. Outcomes. After bronchial artery embolization and bronchoscopy, the boy recovered without complications. Hemoptysis and chest pain disappeared, and chest radiographs returned to normal. Lessons. Bronchial arterial bleeding often presents as life-threatening massive hemoptysis. Patients should immediately receive hemostatic treatment and undergo chest CTA, bronchial arteriography, BAE, and bronchoscopy according to their condition. Rapid identification of the etiology and symptomatic treatment are critical to saving the lives of children.
Collapse
|
34
|
Esophageal Bronchial Artery Fistulaization: A Complication of an Endobronchial Ultrasound. ACG Case Rep J 2020; 7:e00355. [PMID: 32548187 PMCID: PMC7224716 DOI: 10.14309/crj.0000000000000355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 02/03/2020] [Indexed: 12/17/2022] Open
Abstract
Bronchial artery pseudoaneurysms are an extremely rare cause of upper gastrointestinal bleeding. The presence of a bronchial artery pseudoaneurysm resulting in an esophageal fistula is an entity that, to our knowledge, has yet to be described. Successful management requires an interdisciplinary approach to guide closure of the defects. We present a novel case of an esophageal fistula and bronchial artery pseudoaneurysm resulting from an endobronchial ultrasound-guided transbronchial needle aspiration successfully managed by endoscopic therapy and coil embolization.
Collapse
|
35
|
Dormagen JB, Verma N, Fink KR. Imaging in Oncologic Emergencies. Semin Roentgenol 2020; 55:95-114. [PMID: 32438984 DOI: 10.1053/j.ro.2019.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Nupur Verma
- Department of Radiology, University of Florida, Gainesville, FL
| | | |
Collapse
|
36
|
Almeida J, Leal C, Figueiredo L. Evaluation of the bronchial arteries: normal findings, hypertrophy and embolization in patients with hemoptysis. Insights Imaging 2020; 11:70. [PMID: 32430593 PMCID: PMC7237606 DOI: 10.1186/s13244-020-00877-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/21/2020] [Indexed: 11/25/2022] Open
Abstract
The enlargement of the bronchial arteries occurs in a multitude of congenital and acquired diseases and is responsible for the majority of cases of hemoptysis. In this review, we provide a simplified imaging approach to the evaluation of the bronchial arteries. We highlight the anatomy and function of the bronchial arteries, typical imaging findings, how to recognize bronchial artery dilatation, and its underlying causes. Contrast-enhanced computer tomography plays a major role in diagnosing bronchial artery enlargement and also improves treatment planning. Bronchial artery embolization has proven to be effective in controlling the potential hazardous hemoptysis.
Collapse
Affiliation(s)
- João Almeida
- Department of Radiology, Hospital de Santa Marta, Rua de Santa Marta, 1169-024, Lisbon, Portugal.
| | - Cecília Leal
- Department of Radiology, Hospital de Santa Marta, Rua de Santa Marta, 1169-024, Lisbon, Portugal
| | - Luísa Figueiredo
- Department of Radiology, Hospital de Santa Marta, Rua de Santa Marta, 1169-024, Lisbon, Portugal
| |
Collapse
|
37
|
Kathuria H, Hollingsworth HM, Vilvendhan R, Reardon C. Management of life-threatening hemoptysis. J Intensive Care 2020; 8:23. [PMID: 32280479 PMCID: PMC7132983 DOI: 10.1186/s40560-020-00441-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/09/2020] [Indexed: 12/14/2022] Open
Abstract
It is estimated that 5-14% of patients presenting with hemoptysis will have life-threatening hemoptysis, with a reported mortality rate between 9 and 38%. This manuscript provides a comprehensive literature review on life-threatening hemoptysis, including the etiology and mechanisms, initial stabilization, and management of patients. There is no consensus on the optimal diagnostic approach to life-threatening hemoptysis, so we present a practical approach to utilizing chest radiography, computed tomography, and bronchoscopy, alone or in combination, to localize the bleeding site depending on patient stability. The role of angiography and embolization as well as bronchoscopic and surgical techniques for the management of life-threatening hemoptysis is reviewed. Through case presentation and flow diagram, an overview is provided on how to systematically evaluate and treat the bronchial arteries, which are responsible for hemoptysis in 90% of cases. Treatment options for recurrent hemoptysis and definitive management are discussed, highlighting the role of bronchial artery embolization for recurrent hemoptysis.
Collapse
Affiliation(s)
- Hasmeena Kathuria
- 1The Pulmonary Center, Boston University School of Medicine, 72 E. Concord St R304, Boston, MA 02118 USA
| | - Helen M Hollingsworth
- 1The Pulmonary Center, Boston University School of Medicine, 72 E. Concord St R304, Boston, MA 02118 USA
| | - Rajendran Vilvendhan
- 2Interventional Radiology, Department of Radiology, Boston Medical Center, Boston, MA USA
| | - Christine Reardon
- 1The Pulmonary Center, Boston University School of Medicine, 72 E. Concord St R304, Boston, MA 02118 USA
| |
Collapse
|
38
|
Chen Y, Wang KF, Wang ZW, Liu CZ, Jin ZY. Value of CT-Angiography in the Emergency Management of Severe Hemoptysis. ACTA ACUST UNITED AC 2020; 34:194-198. [PMID: 31601302 DOI: 10.24920/003482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective To depict imaging anatomy of bronchial artery (BA) using multidetector CT-angiography (MDCTA) and evaluate the value of MDCTA for management of hemoptysis patients requiring admission to emergency room. Methods We retrospectively studied the clinical and radiological data of patients with severe hemoptysis (≥100 ml of expectorated blood in a 24-hour period) requiring admission to emergency room from Jan 1, 2013 to Dec 31, 2015. Patients' images of MDCTA, treatment modalities, and outcome were discussed. Results A total of 108 patients underwent MDCTA scans. Etiology of hemoptysis was mainly bronchiectasis (44%), tuberculosis sequelae (26%) and tumor (18%). MDCTA visualized 197 traceable BAs and also suggested the involvement of 35 nonbronchial systemic arteries. The mean diameter of BAs, measured at the level of the bronchial bifurcation in the mediastinum, was 2.8±1.2 mm. The mean diameter of BAs, for 52 patients who only received conservative treatment, was 2.9±1.1 mm, and was not significantly larger than that of BAs for 56 patients who underwent bronchial artery embolization (BAE) for continued bleeding which did not resolve after conservative treatment (2.7±1.1 mm, P = 0.94). The technical success rate of embolization was 95% (53/56). Clinical success rate during follow-up was achieved in 50 (94%) of 53 patients who had undergone embolization. Conclusions MDCTA provides useful information for identifying the anatomical characteristics of bleeding-related BAs and nonbronchial systemic arteries for the management of patients with severe hemoptysis. However, MDCTA could not determine the individuals who need BAE through measuring diameter of BAs.
Collapse
Affiliation(s)
- Ying Chen
- Department of Radiology, Peking the 6th Hospital, Beijing 100007, China
| | - Ke-Fei Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China
| | - Zhi-Wei Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China
| | - Chang-Zhu Liu
- Department of Radiology, Peking the 6th Hospital, Beijing 100007, China
| | - Zheng-Yu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China
| |
Collapse
|
39
|
Yabuuchi Y, Goto H, Nonaka M, Tachi H, Akiyama T, Arai N, Ishikawa H, Hyodo K, Nemoto K, Miura Y, Hase I, Usui S, Oh-Ishi S, Hayashihara K, Saito T, Chonan T. A case of Marfan syndrome with massive haemoptysis from collaterals of the lateral thoracic artery. BMC Pulm Med 2020; 20:4. [PMID: 31914988 PMCID: PMC6951026 DOI: 10.1186/s12890-019-1033-1] [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: 07/02/2019] [Accepted: 12/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Marfan Syndrome (MFS) is a heritable connective tissue disorder with a high degree of clinical variability including respiratory diseases; a rare case of MFS with massive intrathoracic bleeding has been reported recently. CASE PRESENTATION A 32-year-old man who had been diagnosed with MFS underwent a Bentall operation with artificial valve replacement for aortic dissection and regurgitation of an aortic valve in 2012. Warfarin was started postoperatively, and the dosage was gradually increased until 2017, when the patient was transported to our hospital due to sudden massive haemoptysis. Computed tomography (CT) with a maximum intensity projection (MIP) revealed several giant pulmonary cysts with fluid levels in the apex of the right lung with an abnormal vessel from the right subclavian artery. Transcatheter arterial embolization was performed with angiography and haemostasis was achieved, which suggested that the bleeding vessel was the lateral thoracic artery (LTA) branch. CT taken before the incident indicated thickening of the cystic wall adjacent to the thorax; therefore, it was postulated that the bleeding originated from fragile anastomoses between the LTA and pulmonary or bronchial arteries. It appears that the vessels exhibited inflammation that began postoperatively, which extended to the cysts. CONCLUSION We experienced a case of MFS with massive haemoptysis from the right LTA. We have to be aware of the possibility that massive haemoptysis could be induced in MFS with inflamed pulmonary cysts.
Collapse
Affiliation(s)
- Yuki Yabuuchi
- Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, 825, Terunuma, Tokai-mura, Ibaraki, Naka-gun, 319-1113, Japan.
| | - Hitomi Goto
- Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, 825, Terunuma, Tokai-mura, Ibaraki, Naka-gun, 319-1113, Japan
| | - Mizu Nonaka
- Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, 825, Terunuma, Tokai-mura, Ibaraki, Naka-gun, 319-1113, Japan
| | - Hiroaki Tachi
- Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, 825, Terunuma, Tokai-mura, Ibaraki, Naka-gun, 319-1113, Japan
| | - Tatsuya Akiyama
- Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, 825, Terunuma, Tokai-mura, Ibaraki, Naka-gun, 319-1113, Japan
| | - Naoki Arai
- Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, 825, Terunuma, Tokai-mura, Ibaraki, Naka-gun, 319-1113, Japan
| | - Hiroaki Ishikawa
- Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, 825, Terunuma, Tokai-mura, Ibaraki, Naka-gun, 319-1113, Japan
| | - Kentaro Hyodo
- Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, 825, Terunuma, Tokai-mura, Ibaraki, Naka-gun, 319-1113, Japan
| | - Kenji Nemoto
- Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, 825, Terunuma, Tokai-mura, Ibaraki, Naka-gun, 319-1113, Japan
| | - Yukiko Miura
- Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, 825, Terunuma, Tokai-mura, Ibaraki, Naka-gun, 319-1113, Japan
| | - Isano Hase
- Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, 825, Terunuma, Tokai-mura, Ibaraki, Naka-gun, 319-1113, Japan
| | - Shingo Usui
- Department of Clinical Research, National Hospital Organization, Ibaraki Higashi National Hospital, Ibaraki, Japan
| | - Shuji Oh-Ishi
- Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, 825, Terunuma, Tokai-mura, Ibaraki, Naka-gun, 319-1113, Japan
| | - Kenji Hayashihara
- Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, 825, Terunuma, Tokai-mura, Ibaraki, Naka-gun, 319-1113, Japan
| | - Takefumi Saito
- Department of Respiratory Medicine, National Hospital Organization, Ibaraki Higashi National Hospital, 825, Terunuma, Tokai-mura, Ibaraki, Naka-gun, 319-1113, Japan
| | - Tatsuya Chonan
- Department of Medicine, Nikko Memorial Hospital, Ibaraki, Japan
| |
Collapse
|
40
|
Abstract
This article reviews the most common oncologic emergencies encountered by the radiation oncologist, including malignant spinal cord compression, intramedullary spinal cord metastasis, superior vena cava syndrome, hemoptysis, and airway compromise caused by tumor. Important trials evaluating different treatments for these emergencies are reviewed. The role of corticosteroids, surgery, chemotherapy, and radiation therapy in these patients is discussed and patient-specific treatment guidelines are suggested.
Collapse
Affiliation(s)
- Mannat Narang
- Department of Radiation Oncology, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA
| | - Pranshu Mohindra
- Department of Radiation Oncology, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA
| | - Mark Mishra
- Department of Radiation Oncology, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA
| | - William Regine
- Department of Radiation Oncology, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA
| | - Young Kwok
- Department of Radiation Oncology, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA.
| |
Collapse
|
41
|
Bhalla AS, Das A, Naranje P, Irodi A, Raj V, Goyal A. Imaging protocols for CT chest: A recommendation. Indian J Radiol Imaging 2019; 29:236-246. [PMID: 31741590 PMCID: PMC6857267 DOI: 10.4103/ijri.ijri_34_19] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/06/2019] [Accepted: 03/21/2019] [Indexed: 12/20/2022] Open
Abstract
Computed Tomography (CT) is the mainstay of diagnostic imaging evaluation of thoracic disorders. However, there are a number of CT protocols ranging from a simple non-contrast CT at one end of the spectrum, and CT perfusion as a complex protocol available only on high-end scanners. With the growing diversity, there is a pressing need for radiologists, and clinicians to have a basic understanding of the recommended CT examinations for individual indications. This brief review aims to summarise the currently prevalent CT examination protocols, including their recommended indications, as well as technical specifications for performing them.
Collapse
Affiliation(s)
- Ashu Seith Bhalla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Vellore, Tamil Nadu, India
| | - Abanti Das
- Department of Radiodiagnosis, Safdarjung Hospital and Vardhaman Mahavir Medical College, Vellore, Tamil Nadu, India
| | - Priyanka Naranje
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Vellore, Tamil Nadu, India
| | - Aparna Irodi
- Department of Radiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Vimal Raj
- Department of Radiology, Narayana Institute of Cardiac Sciences, 258A, Hosur Rd, Bommasandra Industrial Area, Bengaluru, Karnataka, India
| | - Ankur Goyal
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Vellore, Tamil Nadu, India
| |
Collapse
|
42
|
Abstract
Radiology plays a key role in the diagnosis of bronchiectasis, defined as permanent dilatation of the bronchial lumen. Volumetric thin-section multidetector computed tomography is an excellent noninvasive modality to evaluate bronchiectasis. Bronchiectasis is categorised by morphological appearance. Cylindrical bronchiectasis has a smooth tubular configuration and is the most common form. Varicose bronchiectasis has irregular contours with alternating dilating and contracting lumen. Cystic bronchiectasis is the most severe form and exhibits saccular dilatation of bronchi. Bronchial dilatation is the hallmark of bronchiectasis and is evaluated in relation to the accompanying pulmonary artery. A broncho–arterial ratio exceeding 1:1 should be considered abnormal. Normal bronchi are narrower in diameter the further they are from the lung hila. Lack of normal bronchial tapering over 2 cm in length, distal from an airway bifurcation, is the most sensitive sign of bronchiectasis. Findings commonly associated with bronchiectasis include bronchial wall thickening, mucus plugging and tree-in-bud opacities. Bronchiectasis results from a myriad of conditions, with post-infectious bronchiectasis being the most common. Imaging can sometimes discern the cause of bronchiectasis. However, in most cases it is nonspecific or only suggestive of aetiology. While morphological types are nonspecific, the distribution of abnormality offers clues to aetiology. Bronchiectasis is a chronic progressive condition with significant disease burden and frequent exacerbations for which the diagnosis relies on cross-sectional imaginghttp://bit.ly/2NxOLky
Collapse
Affiliation(s)
- Gunnar Juliusson
- Dept of Radiology, Landspitali University Hospital, Reykjavik, Iceland
| | - Gunnar Gudmundsson
- Dept of Respiratory Medicine, Landspitali University Hospital, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| |
Collapse
|
43
|
|
44
|
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.
Collapse
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.
| |
Collapse
|
45
|
Hao D, Basnet S, Melnick S, Kim J. Negative pressure pulmonary edema-related diffuse alveolar hemorrhage associated with Sevoflurane and cigarette smoking. J Community Hosp Intern Med Perspect 2019; 9:247-251. [PMID: 31258867 PMCID: PMC6586085 DOI: 10.1080/20009666.2019.1608140] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/12/2019] [Indexed: 12/11/2022] Open
Abstract
Negative-pressure pulmonary edema (NPPE)-related diffuse alveolar hemorrhage (DAH) is an underdiagnosed clinical entity seen with alveolar capillary damage. The pathophysiology of type I NPPE is generation of a negative pleural pressure against an upper airway obstruction. We suspect this process was facilitated by preexisting alveolar damage with smoking and administration of the irritating and coagulopathic inhaled anesthetic sevoflurane. We present a case of a healthy 31-year-old man who developed postoperative hemoptysis, diffuse ground-glass opacity and infiltrates on computed tomography (CT) of the chest, anemia, and hypoxic respiratory failure. A diagnosis of DAH was made and a serologic workup for systemic disorders including vasculitis and connective tissue diseases was negative. The patient rapidly improved with supportive care and had complete resolution of his bilateral infiltrates on repeat chest x-ray two weeks later. Our literature review identified three cases of DAH in the setting of sevoflurane administration. Our case illustrates the importance of including NPPE-related DAH on the differential of post-operative hemoptysis, especially in association with sevoflurane administration and a history of cigarette smoking.
Collapse
Affiliation(s)
- David Hao
- Department of Medicine, Reading Hospital, West Reading, PA, USA
| | - Sijan Basnet
- Department of Medicine, Reading Hospital, West Reading, PA, USA
| | - Stephen Melnick
- Department of Medicine, Reading Hospital, West Reading, PA, USA
| | - James Kim
- Pulmonary and Critical Care Medicine, Respiratory Specialists, Reading, PA, USA
| |
Collapse
|
46
|
A prospective interventional registry of short-term dual-antiplatelet treatment after implantation of drug-eluting stents in patients with atrial fibrillation requiring oral anticoagulation therapy. Cardiovasc Interv Ther 2019; 35:150-161. [PMID: 31093885 DOI: 10.1007/s12928-019-00589-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 05/10/2019] [Indexed: 10/26/2022]
Abstract
There are limited data regarding the use of antithrombotic therapy in patients with atrial fibrillation (AF) who underwent percutaneous coronary intervention (PCI) with drug-eluting stents (DES). In this prospective interventional study, we evaluated the feasibility of short-term dual-antiplatelet therapy (DAPT) after DES implantation in AF patients treated with oral anticoagulation (OAC). The antithrombotic regimen in the present study was 1-month DAPT, followed by single-antiplatelet therapy with OAC. A total of 285 consecutive patients were enrolled between 2015 and 2017. The mean CHA2DS2-VASc score was 3.91 ± 1.51. The duration of DAPT was 28.5 ± 11.5 days. At 1-year follow-up, serious bleeding complications, defined as Bleeding Academic Research Consortium type ≥ 2, were observed in 27 patients (9.5%). Multivariate analysis showed that previous history of bleeding episodes (P = 0.009) and continuation of aspirin (P = 0.003) were independent predictors for the serious bleeding complications. High ORBIT (P = 0.008) and PRECISE-DAPT (P = 0.002) scores were associated with the bleeding complications, and the cut-off values were 5.00 and 49.0, respectively. No definite stent thrombosis occurred in any of the patients. Short-term DAPT is feasible in AF patients treated with OAC after undergoing PCI with DES. The previous history of bleeding episodes and long-term aspirin use were associated with their 1-year serious bleeding events.
Collapse
|
47
|
Ando T, Kawashima M, Masuda K, Takeda K, Okuda K, Suzuki J, Ohshima N, Horibe M, Tamura A, Nagai H, Matsui H, Ohta K. Exacerbation of chronic pulmonary aspergillosis was associated with a high rebleeding rate after bronchial artery embolization. Respir Investig 2019; 57:260-267. [PMID: 30692051 DOI: 10.1016/j.resinv.2018.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/07/2018] [Accepted: 12/18/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Hemoptysis is a common symptom associated with chronic pulmonary aspergillosis (CPA). While surgery is the primary choice to manage hemoptysis, it is often avoided because patients with CPA are more likely to have complications such as respiratory insufficiency and low pulmonary function. Bronchial artery embolization (BAE) may be considered one of the treatments of massive and persistent hemoptysis for such patients. METHODS We retrospectively reviewed medical records of 41 patients, admitted to National Hospital Organization Tokyo National Hospital, Tokyo, Japan with hemoptysis arising from CPA between January 2011 to December 2016, who were considered inoperable and had undergone BAE. RESULTS Out of the 41 cases analyzed in this study, 21 (51.2%) developed rebleeding after BAE within the mean follow-up duration of 24 months. The non-rebleeding rate of patients after BAE was 92.7% within a month and 65.8% within a year. Patients who developed rebleeding had significantly more non-bronchial systemic arteries responsible for the bleeding compared with patients who did not develop rebleeding (mean of 2.55 vs. 4.86, respectively, P = 0.011). Patients with stable or improved radiological findings demonstrated significantly lower rebleeding rates than those with radiological deterioration (P < 0.001). The non-rebleeding patients had significantly better survival than those with rebleeding (79.7% vs. 39.9% over 5 years, P = 0.046). CONCLUSIONS Bronchial artery embolization was effective in controlling hemoptysis in patients with CPA, especially those who could not undergo surgical resection. However, disease control of CPA was important to prevent rebleeding over the long term and to improve survival after BAE.
Collapse
Affiliation(s)
- Takahiro Ando
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose, Tokyo 204-8585, Japan.
| | - Masahiro Kawashima
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose, Tokyo 204-8585, Japan.
| | - Kimihiko Masuda
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose, Tokyo 204-8585, Japan.
| | - Keita Takeda
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose, Tokyo 204-8585, Japan.
| | - Kenichi Okuda
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose, Tokyo 204-8585, Japan.
| | - Junko Suzuki
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose, Tokyo 204-8585, Japan.
| | - Nobuharu Ohshima
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose, Tokyo 204-8585, Japan.
| | - Mitsuko Horibe
- Radiology Department, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose, Tokyo 204-8585, Japan.
| | - Atsuhisa Tamura
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose, Tokyo 204-8585, Japan.
| | - Hideaki Nagai
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose, Tokyo 204-8585, Japan.
| | - Hirotoshi Matsui
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose, Tokyo 204-8585, Japan.
| | - Ken Ohta
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose, Tokyo 204-8585, Japan.
| |
Collapse
|
48
|
Seyyedi SR, Sadeghipour P, Sadr M, Shafe O, Moosavi J, Aloosh O, Abedini A, Sharif-Kashani B. Outcomes and Complications of Bronchial Angioembolization in Patients with Massive Hemoptysis. TANAFFOS 2019; 18:310-314. [PMID: 32607111 PMCID: PMC7309885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Massive hemoptysis is a potentially life threatening medical condition and one major problem for both patients and physicians. Choosing the appropriate treatment for the patients is crucial in order to decrease the complications and increase the success rate. Hence, in this study the outcomes and complications of bronchial angioembolization (BAE) were determined in patients with massive hemoptysis. MATERIALS AND METHODS In this prospective cohort, 189 consecutive patients with moderate and severe hemoptysis who had referred to two large cardiovascular centers were enrolled. The Chest X Ray, CT Scan, Fiberoptic Bronchoscopy, Selective and Nonselective Bronchial Angiography were performed in patients. The outcomes with 20-month follow-up were compared. RESULTS The immediate success rate was 97.3%. In 79.7% there were no complications. Temporary chest pain, subintimal dissection, temporary dysphagia, and pancreatitis were seen in 12.3, 2.4, 5.1, and 0.5%, respectively, without any major complication. The in-hospital mortality rate was 1.1% and mortality during 20-month follow-up was 9.6%, and recurrence rate was 28.3% on total. CONCLUSION Our case series showed that BAE is a safe and effective method in treating patients with hemoptysis. Compared to surgery, the procedure is faster and less invasive and might be used both as first line or bridging therapy. Importantly, no major complications have been detected.
Collapse
Affiliation(s)
- Seyed Reza Seyyedi
- Lung Transplantation Research Center, Department of Cardiology, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parham Sadeghipour
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Makan Sadr
- Virology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Omid Shafe
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Jamal Moosavi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Oldooz Aloosh
- Lung Transplantation Research Center, Department of Cardiology, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefeh Abedini
- Lung Transplantation Research Center, Department of Cardiology, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Sharif-Kashani
- Lung Transplantation Research Center, Department of Cardiology, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Correspondence to: Sharif-Kashani B, Address: Lung Transplantation Research Center, Department of Cardiology, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Email address:
| |
Collapse
|
49
|
Forbearance With Bronchoscopy. Chest 2019; 155:834-847. [DOI: 10.1016/j.chest.2018.08.1035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/01/2018] [Accepted: 08/06/2018] [Indexed: 02/06/2023] Open
|
50
|
Fu Z, Liang Y, Zhao W, Tian J, Cai F, Zhang X. Safety and efficacy of transcatheter embolization in patients with massive hemoptysis due to intercostal pulmonary venous shunts. Radiol Med 2019; 124:588-594. [PMID: 30852790 DOI: 10.1007/s11547-019-01020-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 02/25/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Bronchial hemoptysis induced by intercostal pulmonary venous shunt (IPVS) is clinically rare. Pulmonary lesions on pleural surface may facilitate opening of vascular network. This retrospective study investigated safety and efficacy of embolization agents with small-particle embolization treating patients with massive hemoptysis due to IPVS. METHODS Patients with massive hemoptysis (n = 207) underwent computed tomography angiography of bronchial artery. Depending on results, selective or superselective digital subtraction angiography and embolization were performed. Polyvinyl alcohol (300-500 μm), or microcoils combined with polyvinyl alcohol, was utilized according to IPVS volume. Vital signs of each patient were closely monitored. RESULTS Of 207 patients with massive hemoptysis, 24 (11.6%) had IPVS syndrome. Patients with IPVS had concomitant bronchiectasis (54.2%), followed by tuberculosis (25.0%). Embolizations were performed in 39 culprit intercostal arteries; 37 (94.9%) of these were successfully embolized. Of the latter, 30 and 7 arteries were embolized, respectively, by polyvinyl alcohol alone or polyvinyl alcohol particles combined with microcoils. Embolization failed in one case because the agents could not enter the intercostal artery. If artery dissection occurred during procedure, microcoils were utilized to embolize the main artery. No skin necrosis, spinal artery embolization, or death occurred. Immediate clinical success was achieved in 22 patients (91.7%) after embolization. Two patients (8.3%) experienced recurrence of hemoptysis. Only four patients experienced mild hemoptysis during the 24-month follow-up with the efficiency of 75.0%. CONCLUSIONS Intercostal artery embolization with 300-500 μm alone or combined with microcoils is a safe and effective procedure in patients with IPVS-induced bronchial hemoptysis.
Collapse
Affiliation(s)
- Zhigang Fu
- First College of Clinical Medical Science, China Three Gorges University, Yichang, 443003, China.,Department of Radiology, Yichang Central People's Hospital, 183 Yiling Road, Yichang, 443003, China
| | - Yonghui Liang
- First College of Clinical Medical Science, China Three Gorges University, Yichang, 443003, China.,Department of Radiology, Yichang Central People's Hospital, 183 Yiling Road, Yichang, 443003, China
| | - Wengjiang Zhao
- Department of Radiology, Yichang Central People's Hospital, 183 Yiling Road, Yichang, 443003, China
| | - Jie Tian
- Department of Radiology, Yichang Central People's Hospital, 183 Yiling Road, Yichang, 443003, China
| | - Fei Cai
- Department of Radiology, Yichang Central People's Hospital, 183 Yiling Road, Yichang, 443003, China
| | - Xiaolin Zhang
- First College of Clinical Medical Science, China Three Gorges University, Yichang, 443003, China. .,Department of Radiology, Yichang Central People's Hospital, 183 Yiling Road, Yichang, 443003, China.
| |
Collapse
|