Severe hemoptysis: From diagnosis to embolization

Abstract

Severe hemoptysis is life-threatening to patients because of the asphyxia it causes. The diagnosis and treatment are therefore urgent and chest imaging is essential. Multidetector CT-angiography provides an exhaustive non-invasive assessment which includes localization, mechanisms, causes and severity of the hemoptysis. It is an invaluable step in preparation for endovascular treatment which is the first line invasive therapy, particularly with bronchial arteriography embolization in the majority of cases (over 90%) and erosion or rupture of the pulmonary artery in less than 10% of cases. Hemoptysis control is achieved in 65 to 92% of cases depending on the cause.

Massive hemoptysis in a patient with pulmonary embolism, a real therapeutic conundrum

“…CT angiography is very useful for the detection of the site of haemorrhage and the detection of the possible causes related with hemoptysis. The investigation should be performed in deep inspiration and coverage should include the area between the lung apices to the hilum of the kidneys, from the supra-aortic vessels to the origin of the inferior diaphragmatic arteries [2]. CT angiography can also demonstrate a cause and/or signs of alveolar or bronchial flooding with intraluminal clots [2].…”

“…The investigation should be performed in deep inspiration and coverage should include the area between the lung apices to the hilum of the kidneys, from the supra-aortic vessels to the origin of the inferior diaphragmatic arteries [2]. CT angiography can also demonstrate a cause and/or signs of alveolar or bronchial flooding with intraluminal clots [2]. However, despite all investigative procedures, the aetiology of hemoptysis may remain unknown in up to 5–10% of patients as in the first episode which our patient had experienced 5 years ago.…”

“…During selective bronchial artery cannulation, it is possible to identify the site of bleeding, and perform embolization using a variety of permanent (micro-particles, isobutyl-2-cyanoacrylate, metallic coils or absorbable (gelatin pledgets) embolic materials within the feeding vessel as to achieve haemostasis. Hemoptysis control ranges from 65 to 92% [2]. In this case NBCA was used.…”

Vascular emergencies: Diagnosis and treatment

“…• subarachnoid hemorrhages and intracranial aneurysms [1][2][3]; • multiple injuries -damage to the aorta and its branches [4][5][6][7]; • gastrointestinal hemorrhage both from arterial causes and from portal hypertension [8,9]; • rupture of aneurysms of visceral branches of the aorta [10]; • the specific treatment of postoperative or postinterventional radiology and soft tissue oncology bleeding [11][12][13][14]; • hemoptysis and epistaxis [15,16].…”

POINT: Should All Initial Episodes of Hemoptysis Be Evaluated by Bronchoscopy? Yes

“…Hemoptysis is one of the leading causes for pulmonary admissions and consultations, 1 and can be both frightening (for the patient and provider) and life-threatening (for the patient). One of the first questions the physician will encounter is "should bronchoscopy be performed for all initial episodes?"…”