Purpose: To evaluate the role of multislice computed angiography of the bronchial arteries and nonbronchial systemic arteries in patients with hemoptysis when performed before arterial embolization procedure. Material...Purpose: To evaluate the role of multislice computed angiography of the bronchial arteries and nonbronchial systemic arteries in patients with hemoptysis when performed before arterial embolization procedure. Materials and Methods: Twenty-eight patients with hemoptysis underwent multislice CT angiography of the bronchial arteries with dual-source 64 × 2 detector row scanner before embolization. The transverse CT images as well as the multiplanar reconstructions, the maximum intensity projections and the three-dimensional CT images were used for the depiction of bronchial arteries (the total number of the bronchial arteries, the abnormal bronchial arteries, their origin at the aorta and the diameter of the ostium). The presence of nonbronchial systemic arteries regarded as causing hemoptysis was also evaluated. Digital angiography and selective arteriograms of abnormal bronchial and nonbronchial systemic arteries were performed based on the findings of multislice computed tomography (MDCT). Results: Seventy-eight (40 right and 38 left) bronchial arteries were detected at computed angiography (CTA). Forty of the seventy-eight bronchial arteries that were detected at CTA, were considered abnormal. On selective angiography 38 of these bronchial arteries were regarded as causing hemoptysis. Two of these arteries could not be selectively catheterized and therefore could not be evaluated. All 38 bronchial arteries regarded as causing hemoptysis at selective angiography were detected prospectively at CTA as abnormal. Four bronchial arteries that were found to be responsible for hemoptysis had diameter <2 mm. Twelve nonbronchial systemic arteries were considered to be abnormal on CTA scans. Ten of these twelve nonbronchial systemic arteries were regarded on selective angiography as causing hemoptysis. Two of these arteries were found normal on angiography. All 10 nonbronchial arteries regarded as causing hemoptysis were detected at CTA scans. All bronchial and nonbronchial arteries causing hemoptysis were successfully embolized. Conclusion: MDCT angiography allows detailed identification of abnormal bronchial and nonbronchial systemic arteries using a variety of reformatted images, providing a precise road map for the interventional radiologist.展开更多
Massive hemoptysis is one of the most dreaded of all respiratory emergencies and can have a variety of underlying causes. It is mostly caused by bleeding from bronchial circulation. Bronchial artery embolization is no...Massive hemoptysis is one of the most dreaded of all respiratory emergencies and can have a variety of underlying causes. It is mostly caused by bleeding from bronchial circulation. Bronchial artery embolization is now considered to be the treatment of choice for acute massive hemoptysis. Bronchial artery embolization (BAE) is a safe and effective nonsurgical treatment for patients with massive hemoptysis. However, nonbronchial systemic arteries can be a significant source of massive hemoptysis and a cause of recurrence after successful BAE. So knowledge of the bronchial artery anatomy, together with an understanding of the pathophysiologic features of massive hemoptysis, are essential for planning and performing BAE in affected patients. In addition, interventional radiologists should be familiar with the techniques, results, efficacy, safety and possible complications of BAE and with the characteristics of the various embolic agents. Bronchial arterial catheterisation in human via a percutaneous approach has been practiced for 32 years (1973) in the world and 20 years (1986) in China, initially for direct chemotherapy treatment for bronchial malignancies and then for the embolization of patients with massive haemoptysis. A review of clinical experience to evaluate technique,embolic materials,outcome and complications of BAE is presented.展开更多
BACKGROUND Bronchial Dieulafoy’s disease(BDD)is characterized by the erosion of an anomalous artery in the submucosa of the bronchus.The etiology of pediatric BDD is mainly congenital dysplasia of bronchus and pulmon...BACKGROUND Bronchial Dieulafoy’s disease(BDD)is characterized by the erosion of an anomalous artery in the submucosa of the bronchus.The etiology of pediatric BDD is mainly congenital dysplasia of bronchus and pulmonary arteries,which is different from chronic inflammatory injury of the airway in adult patients.The internal thoracic artery,subclavian artery,and intercostal artery are known to be involved in the blood supply to the BDD lesion in children.CASE SUMMARY We report a case of BDD in a 4-year-old boy with recurrent hemoptysis for one year.Selective angiography showed a dilated right bronchial artery,and anastomosis of its branches with the right lower pulmonary vascular network.Bronchoscopy showed nodular protrusion of the bronchial mucosa with a local scar.Selective embolization of the bronchial artery was performed to stop bleeding.One month after the first intervention,the symptoms of hemoptysis recurred.A computed tomography angiogram(CTA)showed another tortuous and dilated feeding artery in the right lower lung,which was an abnormal ascending branch of the inferior phrenic artery(IPA).The results of angiography were consistent with the CTA findings.The IPA was found to be another main supplying artery,which was not considered during the first intervention.Finally,the IPA was also treated by microsphere embolization combined with coil interventional closure.During the one-year follow-up,the patient never experienced hemoptysis.CONCLUSION The supplying arteries of the bleeding lesion in children with BDD may originate from multiple different aortopulmonary collateral arteries,and the IPA should be considered to reduce missed diagnosis.CTA is a noninvasive radiological examination for the screening of suspected vessels,which shows a high coincidence with angiography,and can serve as the first choice for the diagnosis of BDD.展开更多
Background: It is very important to enhance the therapeutic effect and prognosis of severe tuberculous hemoptysis after the determining of its etiological cause and the source of bleeding. The etiology and integrated ...Background: It is very important to enhance the therapeutic effect and prognosis of severe tuberculous hemoptysis after the determining of its etiological cause and the source of bleeding. The etiology and integrated curative effect of severe hemoptysis due to pulmonary tuberculosis among 112 inpatients were analyzed. Materials and Methods: The cause was retrospectively analysed. The integrated management effect after the follow-up of mean three years in 112 cases with severe hemoptysis being resulted from pulmonary tuberculosis from June 2008 to July 2012 was described. Active pulmonary tuberculosis ranked the first cause of lower respiratory tract bleeding (32/112, 28.5%), followed by old pulmonary tuberculosis (28/112, 25.0%), tuberculous bronchiectasis (25/112, 22.3%), purified tuberculous cavity (12/112, 10.7%), fungal infection in old pulmonary tuberculosis cavity (9/112, 7.1%), or broncholithiasis (6/112, 5.4%). Almost all suffers with severe hemoptysis were treated by an integrated management, including psychology, anticoagulants, vasoconstrictor agents. Etiological treatment including anti-tuberculosis and anti-infection was simultaneously or subsequently involved. Sixty-four inpatients with severe hemoptysis being failed to be cured by medical treatment were then received selective bronchial artery embolization. Four patients were received surgical wedge resection, lobectomy or pneumonectomy. The total cure rate added up to 98.2% after mean three years’ follow-up. The mortality was 1.8%. Conclusions: Active pulmonary tuberculosis was still responsible for the severe hemoptysis in the southeast region of China. Severe hemoptysis of pulmonary tuberculosis was also resulted from stable tuberculosis, tuberculous bronchiectasis, tuberculosis cavity, fungal infection, or broncholithiasis. Better clinical therapeutic effect could be attained by early etiological diagnosis and comprehensive treatment strategy.展开更多
Background：Hemoptysis is a significant clinical entity with high morbidity and potential mortality.Both medical management （in terms of resuscitation and bronchoscopic interventions） and surgery have severe limitat...Background：Hemoptysis is a significant clinical entity with high morbidity and potential mortality.Both medical management （in terms of resuscitation and bronchoscopic interventions） and surgery have severe limitations in these patients population.Bronchial artery embolization （BAE） represents the first-line treatment for hemoptysis.This article discusses clinical analysis,embolization approach,outcomes and complications of BAE for the treatment of hemoptysis.Methods：A retrospective analysis of 344 cases,who underwent bronchial arteriography at Tianjin Haihe Hospital between 2006 and 2013.Several aspects of outcome were analyzed：Demographics,clinical presentation,radiographic studies,results,complications and follow-up of BAE.Results：Three hundred and forty-four consecutive patients underwent bronchial arteriography,336 of 344 patients （97.7%） performed BAE; there were 1530 coils for 920 arteries embolized; the main responsible sources for bleeding were right bronchial artery （29.7%）,left bronchial artery （21.6%）,combined right and left bronchial trunk （18.4%）,right intercostal arteries （13.3%）; 61 patients （17.7%） had recurrent hemoptysis within 1 month after undergoing BAE,74 patients （21.5%） had recurrent hemoptysis over 1 month after undergoing BAE; The common complications of BAE included subintimal dissection,arterial perforation by a guide wire,fever,chest pain,dyspnea,etc.The follow-up was completed in 248 patients,28 patients had been dead,21 patients still bleed,92 patients had lost to follow-up.Conclusions：The technique of BAE is a relatively safe and effective method for controlling hemoptysis.The complications of BAE are rare.Although the long-term outcome in some patients is not good,BAE may be the only life-saving treatment option in patients who are poor surgical candidates.展开更多
文摘Purpose: To evaluate the role of multislice computed angiography of the bronchial arteries and nonbronchial systemic arteries in patients with hemoptysis when performed before arterial embolization procedure. Materials and Methods: Twenty-eight patients with hemoptysis underwent multislice CT angiography of the bronchial arteries with dual-source 64 × 2 detector row scanner before embolization. The transverse CT images as well as the multiplanar reconstructions, the maximum intensity projections and the three-dimensional CT images were used for the depiction of bronchial arteries (the total number of the bronchial arteries, the abnormal bronchial arteries, their origin at the aorta and the diameter of the ostium). The presence of nonbronchial systemic arteries regarded as causing hemoptysis was also evaluated. Digital angiography and selective arteriograms of abnormal bronchial and nonbronchial systemic arteries were performed based on the findings of multislice computed tomography (MDCT). Results: Seventy-eight (40 right and 38 left) bronchial arteries were detected at computed angiography (CTA). Forty of the seventy-eight bronchial arteries that were detected at CTA, were considered abnormal. On selective angiography 38 of these bronchial arteries were regarded as causing hemoptysis. Two of these arteries could not be selectively catheterized and therefore could not be evaluated. All 38 bronchial arteries regarded as causing hemoptysis at selective angiography were detected prospectively at CTA as abnormal. Four bronchial arteries that were found to be responsible for hemoptysis had diameter <2 mm. Twelve nonbronchial systemic arteries were considered to be abnormal on CTA scans. Ten of these twelve nonbronchial systemic arteries were regarded on selective angiography as causing hemoptysis. Two of these arteries were found normal on angiography. All 10 nonbronchial arteries regarded as causing hemoptysis were detected at CTA scans. All bronchial and nonbronchial arteries causing hemoptysis were successfully embolized. Conclusion: MDCT angiography allows detailed identification of abnormal bronchial and nonbronchial systemic arteries using a variety of reformatted images, providing a precise road map for the interventional radiologist.
文摘Massive hemoptysis is one of the most dreaded of all respiratory emergencies and can have a variety of underlying causes. It is mostly caused by bleeding from bronchial circulation. Bronchial artery embolization is now considered to be the treatment of choice for acute massive hemoptysis. Bronchial artery embolization (BAE) is a safe and effective nonsurgical treatment for patients with massive hemoptysis. However, nonbronchial systemic arteries can be a significant source of massive hemoptysis and a cause of recurrence after successful BAE. So knowledge of the bronchial artery anatomy, together with an understanding of the pathophysiologic features of massive hemoptysis, are essential for planning and performing BAE in affected patients. In addition, interventional radiologists should be familiar with the techniques, results, efficacy, safety and possible complications of BAE and with the characteristics of the various embolic agents. Bronchial arterial catheterisation in human via a percutaneous approach has been practiced for 32 years (1973) in the world and 20 years (1986) in China, initially for direct chemotherapy treatment for bronchial malignancies and then for the embolization of patients with massive haemoptysis. A review of clinical experience to evaluate technique,embolic materials,outcome and complications of BAE is presented.
基金the National Natural Science Foundation of China,No.81701888Science-Technology Support Plan Projects of Sichuan Province,No.2019YFS0239 and No.2023YFS0206.
文摘BACKGROUND Bronchial Dieulafoy’s disease(BDD)is characterized by the erosion of an anomalous artery in the submucosa of the bronchus.The etiology of pediatric BDD is mainly congenital dysplasia of bronchus and pulmonary arteries,which is different from chronic inflammatory injury of the airway in adult patients.The internal thoracic artery,subclavian artery,and intercostal artery are known to be involved in the blood supply to the BDD lesion in children.CASE SUMMARY We report a case of BDD in a 4-year-old boy with recurrent hemoptysis for one year.Selective angiography showed a dilated right bronchial artery,and anastomosis of its branches with the right lower pulmonary vascular network.Bronchoscopy showed nodular protrusion of the bronchial mucosa with a local scar.Selective embolization of the bronchial artery was performed to stop bleeding.One month after the first intervention,the symptoms of hemoptysis recurred.A computed tomography angiogram(CTA)showed another tortuous and dilated feeding artery in the right lower lung,which was an abnormal ascending branch of the inferior phrenic artery(IPA).The results of angiography were consistent with the CTA findings.The IPA was found to be another main supplying artery,which was not considered during the first intervention.Finally,the IPA was also treated by microsphere embolization combined with coil interventional closure.During the one-year follow-up,the patient never experienced hemoptysis.CONCLUSION The supplying arteries of the bleeding lesion in children with BDD may originate from multiple different aortopulmonary collateral arteries,and the IPA should be considered to reduce missed diagnosis.CTA is a noninvasive radiological examination for the screening of suspected vessels,which shows a high coincidence with angiography,and can serve as the first choice for the diagnosis of BDD.
文摘Background: It is very important to enhance the therapeutic effect and prognosis of severe tuberculous hemoptysis after the determining of its etiological cause and the source of bleeding. The etiology and integrated curative effect of severe hemoptysis due to pulmonary tuberculosis among 112 inpatients were analyzed. Materials and Methods: The cause was retrospectively analysed. The integrated management effect after the follow-up of mean three years in 112 cases with severe hemoptysis being resulted from pulmonary tuberculosis from June 2008 to July 2012 was described. Active pulmonary tuberculosis ranked the first cause of lower respiratory tract bleeding (32/112, 28.5%), followed by old pulmonary tuberculosis (28/112, 25.0%), tuberculous bronchiectasis (25/112, 22.3%), purified tuberculous cavity (12/112, 10.7%), fungal infection in old pulmonary tuberculosis cavity (9/112, 7.1%), or broncholithiasis (6/112, 5.4%). Almost all suffers with severe hemoptysis were treated by an integrated management, including psychology, anticoagulants, vasoconstrictor agents. Etiological treatment including anti-tuberculosis and anti-infection was simultaneously or subsequently involved. Sixty-four inpatients with severe hemoptysis being failed to be cured by medical treatment were then received selective bronchial artery embolization. Four patients were received surgical wedge resection, lobectomy or pneumonectomy. The total cure rate added up to 98.2% after mean three years’ follow-up. The mortality was 1.8%. Conclusions: Active pulmonary tuberculosis was still responsible for the severe hemoptysis in the southeast region of China. Severe hemoptysis of pulmonary tuberculosis was also resulted from stable tuberculosis, tuberculous bronchiectasis, tuberculosis cavity, fungal infection, or broncholithiasis. Better clinical therapeutic effect could be attained by early etiological diagnosis and comprehensive treatment strategy.
文摘Background：Hemoptysis is a significant clinical entity with high morbidity and potential mortality.Both medical management （in terms of resuscitation and bronchoscopic interventions） and surgery have severe limitations in these patients population.Bronchial artery embolization （BAE） represents the first-line treatment for hemoptysis.This article discusses clinical analysis,embolization approach,outcomes and complications of BAE for the treatment of hemoptysis.Methods：A retrospective analysis of 344 cases,who underwent bronchial arteriography at Tianjin Haihe Hospital between 2006 and 2013.Several aspects of outcome were analyzed：Demographics,clinical presentation,radiographic studies,results,complications and follow-up of BAE.Results：Three hundred and forty-four consecutive patients underwent bronchial arteriography,336 of 344 patients （97.7%） performed BAE; there were 1530 coils for 920 arteries embolized; the main responsible sources for bleeding were right bronchial artery （29.7%）,left bronchial artery （21.6%）,combined right and left bronchial trunk （18.4%）,right intercostal arteries （13.3%）; 61 patients （17.7%） had recurrent hemoptysis within 1 month after undergoing BAE,74 patients （21.5%） had recurrent hemoptysis over 1 month after undergoing BAE; The common complications of BAE included subintimal dissection,arterial perforation by a guide wire,fever,chest pain,dyspnea,etc.The follow-up was completed in 248 patients,28 patients had been dead,21 patients still bleed,92 patients had lost to follow-up.Conclusions：The technique of BAE is a relatively safe and effective method for controlling hemoptysis.The complications of BAE are rare.Although the long-term outcome in some patients is not good,BAE may be the only life-saving treatment option in patients who are poor surgical candidates.
