Utility of Fiberoptic Bronchoscopy Before Bronchial Artery Embolization  for Massive Hemoptysis

Hsiao, Eric; Kirsch, Carl M.; Kagawa, Frank T.; Wehner, John H.; Jensen, William A.; Baxter, Richard

doi:10.2214/ajr.177.4.1770861

Cited by 152 publications

(107 citation statements)

References 30 publications

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“…A contrast extravasation as a specific sign of haemorrhage is rarely seen, with reported prevalence from 3.6-10.7% because the bleeding from bronchial arteries is slow and intermittent. 1,2,10,11 The comparison of the signs of bleeding and hypervascularization of the lung parenchyma were indicators of the lesion localization and haemorrhage in all patients (11/11; 100%). Besides those findings, at least one of the following pathognomonic signs was present in all our patients: AV fistulas in 6/11 (54.5%); tortuous, hypertrophic arteries in 8/11 (72.7%); and arterial aneurysms in 3/11 (27.3%) patients.…”

Section: Discussionmentioning

confidence: 94%

Transcatheter embolization of bronchial arteries in the treatment of haemoptysis

Vidjak¹,

Novačić²,

Hebrang³

et al. 2009

Radiology and Oncology

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Section: Discussionmentioning

confidence: 94%

Transcatheter embolization of bronchial arteries in the treatment of haemoptysis

Vidjak¹,

Novačić²,

Hebrang³

et al. 2009

Radiology and Oncology

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“…3) can assess the potential for a possible source of bleeding of the bronchial artery as well as identifying possible branches supplying the spine. Active bleeding which can be recognized by extravasation from a branch of the bronchial artery can be demonstrated in about 3.6 -10.8 % of cases and then only during an episode of massive hemoptysis [61,85,86]. The diameter of the bronchial arteries in cases of chronic inflammatory pulmonary disease is generally between 2 -3 mm [17], however it can be several millimeters, especially in patients with cystic fibrosis ( • " Fig.…”

Section: Technologymentioning

confidence: 99%

“…A promptly performed bronchoscopy (BSK) supports finding the cause and side localization of the bleeding [16,60], although correct side localization of the bleeding can be achieved in only about half the patients [58,61]. This can be performed easily and quickly as an initial fiber optic examination (fiber optic bronchoscopy -FOB) and as a rigid bronchoscopy in the case of more massive hemoptysis.…”

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confidence: 99%

“…Today, a thoracic CT scan should be performed in addition to bronchoscopy, due to the improved information that imaging technology can provide to localize bleeding (63 -100 % accuracy in identifying the proper lobe) [61,63], as well as to disclose the cause of hemoptysis. This is supported by low-dose acquisition methods (automatic tube current modulation(ATCM)) for longitudinal and angle modulation [64,65] and iterative image reconstruction methods (e. g. iDose 4 (Philips), ADMIRE/SA-FIRE/IRIS (Siemens), ASIR (GE).…”

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confidence: 99%

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Radiologic Management of Haemoptysis: Diagnostic and Interventional Bronchial Arterial Embolisation

Ittrich

Klose

Adam

2014

Fortschr Röntgenstr

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Hemoptysis can be a life-threatening pulmonary emergency with high mortality, is symptomatic of an underlying severe pulmonary disease and requires immediate diagnosis and treatment. Diagnostically, bronchoscopy, conventional chest x-ray and contrast-enhanced multislice computed tomography (MSCT) with CT angiography (CTA) provide information regarding the underlying pulmonary disease, bleeding site, the vascular anatomy of the bronchial arteries (BA) and extrabronchial branches, as well a basis for planning of endovascular intervention. Therapeutically, bronchial artery embolization (BAE) is a safe and effective technique in the hands of an experienced interventionist with profound knowledge of the BA anatomy and possible pitfalls as well as experience with first-line therapy of recurrent and massive hemoptysis or as an intervention prior to elective surgery. Recurrent episodes of hemoptysis are not uncommon and require a prompt repeat BAE after exclusion of extrabronchial systemic and pulmonary artery bleeding sources. This review article should give an overview of the history, anatomical and pathophysiological basics and the clinical context of hemoptysis and diagnosis, as well as a survey of management, treatment and results of BAE. Key Points: ??Hemoptyses are life threatening and require urgent diagnostic and therapy. ??Chest x-ray, bronchoscopy, and contrast-enhanced MSCT with CTA should be carried out before therapeutic bronchial artery embolization (BAE). ??BAE for the treatment of massive and recurrent hemoptysis is safe and effective. ??False embolization in spinal branches of BA are the most serious complication of a BAE. ??Repeatedly BAE refractory cases should undergo elective surgery. Citation Format: ??Ittrich H, Klose H, Adam G Radiologisches Management von H?moptysen: Diagnostik und Interventionelle Bronchialarterienembolisation. Fortschr R?ntgenstr 2015; 187: 248???259

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“…[100][101][102] Routine chest x-ray is readily available and helpful; however, in a retrospective evaluation of 208 patients with hemoptysis, Hirshberg et al 103 found that radiography was diagnostic in only 50% of cases. Bronchoscopy is by far more accurate, but the role of fiberoptic bronchoscopy in the setting of massive active hemoptysis is still controversial.…”

Section: Diagnosis Of Hemoptysismentioning

confidence: 99%

Complications Leading to Sudden Cardiac Death in Pulmonary Arterial Hypertension

Demerouti

Manginas²,

Athanassopoulos

et al. 2012

Respir Care

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SummaryPulmonary arterial hypertension (PAH) is a disease of small pulmonary arteries, characterized by vascular proliferation and remodeling. Progressive increase in pulmonary vascular resistance ultimately leads to right ventricular heart failure and death. PAH-specific drug therapy has improved clinical outcomes and survival. While the survival is better, progression of pulmonary vasculopathy contributes to pulmonary artery dilatation. Left main compression syndrome, pulmonary artery dissection, pulmonary artery rupture, and severe hemoptysis are reported as complications leading to sudden cardiac death, an event encountered more often in PAH patients. The advent of PAHtargeted drug therapy has reduced referral for lung transplantation; however, severe complications require rapid diagnosis, decision making, and possible registration on a lung transplantation waiting list. PAH referral centers provide multidisciplinary emergency care and specific therapeutic management, contributing to improved quality of life and survival for PAH patients. We review the complications leading to sudden death in PAH. Key words: pulmonary hypertension; pulmonary artery dissection; pulmonary artery rupture; left main compression syndrome. [Respir Care 2013;58(7):1246 -1254.

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Utility of Fiberoptic Bronchoscopy Before Bronchial Artery Embolization for Massive Hemoptysis

Abstract: Fiberoptic bronchoscopy before bronchial artery embolization is unnecessary in patients with hemoptysis of known causation if the site of bleeding can be determined from radiographs and no bronchoscopic airways management is needed.

Cited by 152 publications

References 30 publications

Transcatheter embolization of bronchial arteries in the treatment of haemoptysis

Transcatheter embolization of bronchial arteries in the treatment of haemoptysis

Radiologic Management of Haemoptysis: Diagnostic and Interventional Bronchial Arterial Embolisation

Complications Leading to Sudden Cardiac Death in Pulmonary Arterial Hypertension

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