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Fukamatsu F, Yamada A, Yamada K, Nonaka T, Aonuma T, Tsukahara Y, Kawakami S, Sasaki H, Fujinaga Y. Serial assessment of computed tomography angiography for pulmonary and systemic arteries using a reduced contrast agent dose for the diagnosis of systemic artery-to-pulmonary artery shunts. Jpn J Radiol 2024; 42:460-467. [PMID: 38148339 PMCID: PMC11056326 DOI: 10.1007/s11604-023-01520-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/23/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE To evaluate the diagnostic performance and feasibility of a modified computed tomography (CT) scan protocol, we performed a serial assessment of the computed tomography angiography for pulmonary artery (CTA-P) and systemic artery (CTA-S) (CTA-PS) using a reduced contrast agent dose to diagnose systemic artery-to-pulmonary artery shunts (SPSs). MATERIALS AND METHODS Twenty-five patients who underwent multiphase contrast-enhanced chest CT and conventional chest angiography were included. Three image sets (CTA-P, CTA-S, and CTA-PS) were evaluated by two board-certified radiologists. The visualization of the CT image findings associated with SPSs, such as filling defects and enhancement in the pulmonary arteries, was evaluated using a 5-point scale. RESULTS The diagnostic performance (sensitivity, specificity, and accuracy) of CT imaging findings associated with SPSs in CTA-P and CTA-PS were as follows: CTA-P, 57.1%, 87.5%, and 62.0%; CTA-PS, 81.0%, 100.0%, and 84.0%. CT findings associated with SPSs in CTA-P were significantly sensitive to the CTA-PS protocol. There were no significant differences between the CTA-S and CTA-PS protocols. The area under the curve (AUC) of the CT imaging findings associated with SPSs in the CTA-P and CTA-PS groups was 0.835 and 0.911, respectively (P = 0.191). The AUC of the CT imaging findings associated with SPSs in CTA-S and CTA-PS were 0.891 and 0.926, respectively (P = 0.373). CONCLUSION CTA-PS using a reduced contrast agent dose protocol could improve the overall diagnostic confidence of SPSs, owing to better visualization of CT imaging findings associated with SPSs compared to individual assessments of CTA-P or CTA-S. Therefore, CTA-PS can be used as an alternative preembolization evaluation modality to conventional angiography in patients with hemoptysis suspected of having SPSs.
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Affiliation(s)
- Fumiaki Fukamatsu
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Akira Yamada
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
| | - Keiichi Yamada
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Tomofumi Nonaka
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Takanori Aonuma
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Yoshinori Tsukahara
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Satoshi Kawakami
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Hiroyuki Sasaki
- Division of Radiology, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Yasunari Fujinaga
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
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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.
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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
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Roussel A, Sage E, Roux A, Guth A, Mellot F, Gravel G. Bronchial artery embolization for hemoptysis in adult patients with cystic fibrosis: a single-center retrospective study. Acta Radiol 2023; 64:1381-1389. [PMID: 36802809 DOI: 10.1177/02841851221126833] [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: 11/17/2022]
Abstract
BACKGROUND Hemoptysis is a severe complication of cystic fibrosis (CF) for which bronchial artery embolization (BAE) is an efficient primary therapeutic option. However, recurrence is more frequent than for other etiologies of hemoptysis. PURPOSE To assess the safety and efficacy of BAE in patients with CF and hemoptysis and predictive factors for recurrent hemoptysis. MATERIAL AND METHODS This retrospective study reviewed all adult patients with CF treated by BAE for hemoptysis in our center from 2004 to 2021. The primary endpoint was the recurrence of hemoptysis after bronchial artery embolization. Secondary endpoints were overall survival and complications. We introduced the vascular burden (VB) defined as the sum of all bronchial artery diameters measured on pre-procedural enhanced computed tomography (CT) scans. RESULTS A total of 48 BAE were performed in 31 patients. A total of 19 recurrences occurred with a median recurrence-free survival of 3.9 years. In univariate analyzes, percentage of unembolized VB (%UVB) (hazard ratio [HR] = 1.034, 95% confidence interval [CI=1.016-1.052; P < 0.001) and %UVB vascularizing the suspected bleeding lung (%UVB-lat) (HR = 1.024, 95% CI=1.012-1.037; P < 0.001) were associated with recurrence. In multivariate analyzes, only %UVB-lat remained significantly associated with recurrence (HR = 1.020, 95% CI=1.002-1.038; P = 0.030). One patient died during follow-up. No complication of grade 3 or higher was reported according to the CIRSE classification system for complications. CONCLUSION When possible, unilateral BAE seems sufficient in patients with CF with hemoptysis even in such a diffuse disease involving both lungs. The efficiency of BAE could be improved by thoroughly targeting all arteries vascularizing the bleeding lung.
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Affiliation(s)
- Alexandre Roussel
- Department of Diagnostic and Interventional Radiology, Foch Hospital, Suresnes, France
| | - Edouard Sage
- Department of Thoracic Surgery, Foch Hospital, Suresnes, France
| | - Antoine Roux
- Department of Pneumology, Foch Hospital, Suresnes, France
| | - Axel Guth
- Department of Diagnostic and Interventional Radiology, Foch Hospital, Suresnes, France
| | - François Mellot
- Department of Diagnostic and Interventional Radiology, Foch Hospital, Suresnes, France
| | - Guillaume Gravel
- Department of Diagnostic and Interventional Radiology, Foch Hospital, Suresnes, France
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Endovascular embolization for Rasmussen's aneurysm with massive hemoptysis: 3 case reports and literature review. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2022. [DOI: 10.1016/j.jrras.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kettenbach J, Ittrich H, Gaubert JY, Gebauer B, Vos JA. CIRSE Standards of Practice on Bronchial Artery Embolisation. Cardiovasc Intervent Radiol 2022; 45:721-732. [PMID: 35396612 PMCID: PMC9117352 DOI: 10.1007/s00270-022-03127-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 01/24/2022] [Indexed: 01/21/2023]
Abstract
This CIRSE Standards of Practice document is aimed at interventional radiologists and provides best practices for performing bronchial artery embolisation to effectively treat haemoptysis. It has been developed by an expert writing group established by the CIRSE Standards of Practice Committee.
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Affiliation(s)
- Joachim Kettenbach
- Landesklinikum Wiener Neustadt, Institute of Diagnostics, Interventional Radiology and Nuclear Medicine, Wiener Neustadt, Austria.
| | - Harald Ittrich
- Department of Diagnostic and Interventional Radiology, Schoen Clinic Hamburg Eilbek, Hamburg, Germany
| | - Jean Yves Gaubert
- Department of Radiology, Timone University Hospital, Marseille, France.,Laboratory of Experimental Interventional Imaging, Aix-Marseille University, Marseille, France
| | - Bernhard Gebauer
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Albert Vos
- Department of Interventional Radiology, St Antonius Hospital, Nieuwegein, Utrecht, The Netherlands
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Kumar KP, Bhalla AS, Goyal A, Naranje P, Guleria R, Mohan A, Singh UB. Aspergilloma morphology on CT angiography and its clinical impact in patients of haemoptysis. Curr Probl Diagn Radiol 2022; 51:699-706. [DOI: 10.1067/j.cpradiol.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/11/2022] [Accepted: 01/19/2022] [Indexed: 11/22/2022]
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Choi WS, Kim MU, Kim HC, Yoon CJ, Lee JH. Variations of bronchial artery origin in 600 patients: Systematic analysis with multidetector computed tomography and digital subtraction angiography. Medicine (Baltimore) 2021; 100:e26001. [PMID: 34087845 PMCID: PMC8183775 DOI: 10.1097/md.0000000000026001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 04/24/2021] [Indexed: 01/04/2023] Open
Abstract
To identify and evaluate the spectrum and prevalence of variations in bronchial artery (BA) origin by multidetector computed tomography (MDCT) and digital subtraction angiography (DSA) in a large population with hemoptysis.From July 2008 to June 2015, data from 600 individuals with hemoptysis who underwent MDCT and DSA were retrospectively analyzed. The pattern of BA origin was investigated and classified according to distribution.A total of 1674 BAs were evaluated, 866 were right BA and 808 were left BA. Most BAs originated from the upper descending thoracic aorta, classified as orthotopic origin (n = 1464, 87.5%). Among ectopic origin BAs (n = 210, 12.5%), concavity of the aortic arch was the most common (n = 107). The most common distribution pattern was a single artery in each side (n = 262). According to our classification, Type I was most common (n = 457), including BAs originating in orthotopic fashion from the descending thoracic aorta. Type II (n = 2) was defined as BAs originating from the aortic arch or ascending aorta. Type III (not found) was defined as BAs originating from subclavian arteries, common carotid arteries, and their branch vessels. Type IV (n = 92) was Type I and II combined, Type V (n = 41) was Type I and III combined, Type VI (not found) was Type II and III combined, and Type VII (n = 8) was Type I, II, and III combined.Variations of BA origin could be systematically described in detail.
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Affiliation(s)
- Won Seok Choi
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do
| | - Min Uk Kim
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital
| | - Chang Jin Yoon
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Hwan Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do
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Abstract
ABSTRACT Mycobacterium infection remains a leading cause of morbidity and mortality worldwide. Although rare, thoracic cardiovascular complications are associated with devastating consequences if not promptly diagnosed using computed tomography. Intrapulmonary complications include tuberculous aortitis, Rasmussen aneurysms, involvement of bronchial and nonbronchial systemic arteries, and thromboembolic events. Extrapulmonary complications include pericarditis, myocarditis, endocarditis, involvement of coronary arteries, annular-subvalvular left ventricle aneurysms and mediastinal fibrosis. This article will review these complications and their computed tomography features.
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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.
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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.
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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.
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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.
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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
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Davidson K, Shojaee S. Managing Massive Hemoptysis. Chest 2020; 157:77-88. [DOI: 10.1016/j.chest.2019.07.012] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/02/2019] [Accepted: 07/11/2019] [Indexed: 12/26/2022] Open
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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: 26] [Impact Index Per Article: 5.2] [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.
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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
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Multidetector computed tomography angiography prior to bronchial artery embolization helps detect culprit ectopic bronchial arteries and non-bronchial systemic arteries originating from subclavian and internal mammary arteries and improve hemoptysis-free early survival rate in patients with hemoptysis. Eur Radiol 2018; 29:1950-1958. [DOI: 10.1007/s00330-018-5767-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/14/2018] [Accepted: 09/14/2018] [Indexed: 12/19/2022]
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Gupta A, Sands M, Chauhan NR. Massive hemoptysis in pulmonary infections: bronchial artery embolization. J Thorac Dis 2018; 10:S3458-S3464. [PMID: 30505533 DOI: 10.21037/jtd.2018.06.147] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Amar Gupta
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mark Sands
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
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Parrot A, Tavolaro S, Voiriot G, Canellas A, Assouad J, Cadranel J, Fartoukh M. Management of severe hemoptysis. Expert Rev Respir Med 2018; 12:817-829. [PMID: 30198807 DOI: 10.1080/17476348.2018.1507737] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Though rare, severe hemoptysis (SH) is associated with a mortality rate exceeding 50% when not managed properly. Areas covered: This paper reviews the recent epidemiological data regarding SH, the role of multidetector computed tomography angiography (MDCTA), and fiberoptic bronchoscopy (FOB) in its management, as well as the value of current treatments. Expert commentary: MDCTA is becoming an essential modality, since it allows determining the location, etiology, and mechanism of the bleeding. FOB can be delayed, except when local control of bleeding is required. Emergency treatment relies on interventional radiology. Both bronchial and non-bronchial arteries should be explored during bronchial arteriography. Surgery must be considered in all operable patients if the cause of hemoptysis persists.
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Affiliation(s)
- Antoine Parrot
- a Service de Pneumologie , AP-HP, Hôpitaux Universitaires de l'Est Parisien, Pôle TVAR, Hôpital Tenon , Paris , France
| | - Sebastian Tavolaro
- b Service de Radiologie , AP-HP, Hôpitaux Universitaires de l'Est Parisien Hôpital Tenon , Paris , France.,c Médecine Sorbonne Université , Paris , France
| | - Guillaume Voiriot
- c Médecine Sorbonne Université , Paris , France.,d Service de Réanimation et USC médico-chirurgicale , AP-HP, Hôpitaux Universitaires de l'Est Parisien, Pôle TVAR, Hôpital Tenon , Paris , France
| | - Antony Canellas
- a Service de Pneumologie , AP-HP, Hôpitaux Universitaires de l'Est Parisien, Pôle TVAR, Hôpital Tenon , Paris , France.,c Médecine Sorbonne Université , Paris , France
| | - Jalal Assouad
- c Médecine Sorbonne Université , Paris , France.,e Service de chirurgie thoracique et vasculaire , AP-HP, Hôpitaux Universitaires de l'Est Parisien, Pôle TVAR, Hôpital Tenon , Paris , France
| | - Jacques Cadranel
- a Service de Pneumologie , AP-HP, Hôpitaux Universitaires de l'Est Parisien, Pôle TVAR, Hôpital Tenon , Paris , France.,c Médecine Sorbonne Université , Paris , France
| | - Muriel Fartoukh
- c Médecine Sorbonne Université , Paris , France.,d Service de Réanimation et USC médico-chirurgicale , AP-HP, Hôpitaux Universitaires de l'Est Parisien, Pôle TVAR, Hôpital Tenon , Paris , France
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Single-phase Split-bolus Dual Energy Computed Tomography Angiography for Evaluation of Hemoptysis: A Novel Application. J Thorac Imaging 2018; 33:366-376. [PMID: 29979241 DOI: 10.1097/rti.0000000000000337] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to assess feasibility and overall utility of single-phase split-bolus dual energy computed tomography (DECT) angiography (DECTA) for evaluation of hemoptysis, and to establish an injection protocol for evaluation of hemoptysis, by comparing 2 contrast injection protocols. MATERIALS AND METHODS Using dual-source (80 and 140 kV), 2×128-slice equipment, DECTA was performed using 400 mg iodine/mL, 50 to 80 mL iodinated contrast in 257 patients (189 male individuals, 68 female individuals, age range: 15 to 76 y) presenting with hemoptysis. Initially, 50 patients were randomized into 2 groups for 2 different injection protocols (A and B). Images were assessed quantitative and qualitatively. Later, 207 patients were randomized using protocol B, which was technically simpler, and single-CT acquisition, for simultaneous opacification of systemic and pulmonary vessels. RESULTS Injection protocol A resulted in higher vessel attenuation, both in the aorta and in the pulmonary artery and its segmental branches; however, the difference was not statistically significant. No significant difference was noted in signal-to-noise ratio, contrast-to-noise ratio, as well as subjective image quality parameters. Overall optimal opacification of both systemic and pulmonary arteries was achieved in 247/257 patients. A total of 308 abnormal bronchial arteries were noted. A total of 392 nonbronchial systemic arteries were noted, the majority arising from posterior intercostals and subclavian artery branches. The pulmonary source of hemoptysis was identified in 9 patients (3 pulmonary thromboembolisms, 5 pulmonary artery pseudoaneurysms, and 1 pulmonary venous ectasia). CONCLUSION Combined DECTA is a novel technique that enables simultaneous evaluation of both systemic and pulmonary vascular cause of hemoptysis in a single acquisition with small contrast dose. Both injection protocols "A" and "B" were equally efficacious in simultaneous opacification of both the aorta and pulmonary arteries. To the best of our knowledge, such a protocol has never been described for hemoptysis evaluation.
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Zhao T, Wang S, Zheng L, Jia Z, Yang Y, Wang W, Sun H. The Value of 320-Row Multidetector CT Bronchial Arteriography in Recurrent Hemoptysis after Failed Transcatheter Arterial Embolization. J Vasc Interv Radiol 2017; 28:533-541.e1. [DOI: 10.1016/j.jvir.2017.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 01/05/2017] [Accepted: 01/09/2017] [Indexed: 10/20/2022] Open
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Multi-detector CT in Evaluation of Hemoptysis. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0208-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Mohamed SA, Mousa EM, Hamed AM, Amin SE, Abdel Aziz NM. Utility of multidetector row computed tomography and virtual bronchoscopy in evaluation of hemoptysis due to lung cancer. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2016. [DOI: 10.1016/j.ejcdt.2015.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Mohamed SA, Mousa EM, Hamed AM, Amin SE, Abdel Aziz NM. Utility of multidetector row computed tomography in the management of hemoptysis: An experience from Upper Egypt. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2016. [DOI: 10.1016/j.ejcdt.2015.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Girón Moreno RM, Caballero P, Friera A. Multidetector computed tomography angiography for pre-embolization assessment in cystic fibrosis patients with massive haemoptysis. Respir Med 2014; 108:816-7. [DOI: 10.1016/j.rmed.2013.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 12/16/2013] [Indexed: 10/25/2022]
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Oh THT, Wang TKM, Ramming J, Ramanathan T. First elective thoracic endovascular aortic repair to treat hemoptysis due to bronchiectasis. Am J Respir Crit Care Med 2013; 188:517-9. [PMID: 23947527 DOI: 10.1164/rccm.201210-1823cr] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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