Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
권호 표지
DOI QR코드

DOI QR Code

Usefulness of Multi-Detector Computed Tomography before Bronchoscopy and/or Bronchial Arterial Embolization for Hemoptysis

객혈 환자에서 기관지경술이나 기관지동맥색전술 시행 전의 다중절편 전산화 단층촬영의 유용성

  • Lee, Shin-Jae (Department of Radiology, CHA Bundang Medical Center, CHA University) ;
  • Rho, Ji-Young (Department of Radiology, CHA Bundang Medical Center, CHA University) ;
  • Yoo, Seung-Min (Department of Radiology, CHA Bundang Medical Center, CHA University) ;
  • Kim, Man-Deuk (Department of Radiology, CHA Bundang Medical Center, CHA University) ;
  • Lee, Ji-Hyun (Department of Internal Medicine, CHA Bundang Medical Center, CHA University) ;
  • Kim, Eun-Kyung (Department of Internal Medicine, CHA Bundang Medical Center, CHA University) ;
  • Cho, Young-Ah (Department of Radiology, CHA Bundang Medical Center, CHA University) ;
  • Lee, Sang-Min (Department of Radiology, CHA Bundang Medical Center, CHA University)
  • 이신재 (차의과학대학교 분당차병원 영상의학교실) ;
  • 노지영 (차의과학대학교 분당차병원 영상의학교실) ;
  • 유승민 (차의과학대학교 분당차병원 영상의학교실) ;
  • 김만득 (차의과학대학교 분당차병원 영상의학교실) ;
  • 이지현 (차의과학대학교 분당차병원 내과학교실) ;
  • 김은경 (차의과학대학교 분당차병원 내과학교실) ;
  • 조영아 (차의과학대학교 분당차병원 영상의학교실) ;
  • 이상민 (차의과학대학교 분당차병원 영상의학교실)
  • Received : 2009.12.18
  • Accepted : 2010.01.27
  • Published : 2010.02.28
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Recently, many institutions have acquired multi-detector computed tomography (MDCT) systems. This made it easier and more convenient to use MDCT as a initial diagnostic modality for hemoptysis. The purpose of this study was to evaluate the usefulness of MDCT before bronchoscopy and/or bronchial arterial embolization (BAE) for hemoptysis. Methods: We studied a total of 125 patients with hemoptysis who underwent, between 2006 and 2008, MDCT in a routine protocol before bronchoscopy and/or BAE. One hundred two patients underwent bronchoscopy and 29 patients underwent BAE. We compared the usefulness of MDCT and bronchoscopy for detecting the bleeding site and identifying the cause. We also evaluated our ability, using MDCT, to detect instances where the bronchial artery caused hemoptysis. Results: The rate of detection of a bleeding site was 75.5% on MDCT and 50.9% on bronchoscopy. MDCT and bronchoscopy detected the bleeding site in agreement in 62.7% of patients. MDCT alone found the bleeding site in 27.5% of cases. MDCT identified the cause of hemoptysis in 77.5% and bronchoscopy in 11.8%. In 29 patients who underwent BAE, we detected a total of 37 hypertrophied bronchial arteries that were causing hemoptysis. Of 37 bronchial arteries, 23 (62.2%) were depicted on MDCT. Conclusion: MDCT is superior to bronchoscopy for detecting the bleeding site and identifying the cause of hemoptysis. MDCT can also predict the side of affected bronchial artery with depiction of hypertrophied bronchial artery and localizing the bleeding site. Doing MDCT before bronchoscopy and BAE can provide a guideline for the next step.

Keywords

References

  1. Jean-Baptiste E. Clinical assessment and management of massive hemoptysis. Crit Care Med 2000;28:1642-7. https://doi.org/10.1097/00003246-200005000-00066
  2. Sirajuddin A, Mohammed TL. A 44-year-old man with hemoptysis: a review of pertinent imaging studies and radiographic interventions. Cleve Clin J Med 2008;75: 601-7. https://doi.org/10.3949/ccjm.75.8.601
  3. Tsoumakidou M, Chrysofakis G, Tsiligianni I, Maltezakis G, Siafakas NM, Tzanakis N. A prospective analysis of 184 hemoptysis cases: diagnostic impact of chest X-ray, computed tomography, bronchoscopy. Respiration 2006;73:808-14. https://doi.org/10.1159/000091189
  4. Bidwell JL, Pachner RW. Hemoptysis: diagnosis and management. Am Fam Physician 2005;72:1253-60.
  5. Khalil A, Soussan M, Mangiapan G, Fartoukh M, Parrot A, Carette MF. Utility of high-resolution chest CT scan in the emergency management of haemoptysis in the intensive care unit: severity, localization and aetiology. Br J Radiol 2007;80:21-5. https://doi.org/10.1259/bjr/59233312
  6. Hsiao EI, Kirsch CM, Kagawa FT, Wehner JH, Jensen WA, Baxter RB. Utility of fiberoptic bronchoscopy before bronchial artery embolization for massive hemoptysis. AJR Am J Roentgenol 2001;177:861-7. https://doi.org/10.2214/ajr.177.4.1770861
  7. Revel MP, Fournier LS, Hennebicque AS, Cuenod CA, Meyer G, Reynaud P, et al. Can CT replace bronchoscopy in the detection of the site and cause of bleeding in patients with large or massive hemoptysis? AJR Am J Roentgenol 2002;179:1217-24. https://doi.org/10.2214/ajr.179.5.1791217
  8. Yoon YC, Lee KS, Jeong YJ, Shin SW, Chung MJ, Kwon OJ. Hemoptysis: bronchial and nonbronchial systemic arteries at 16-detector row CT. Radiology 2005;234: 292-8. https://doi.org/10.1148/radiol.2341032079
  9. Khalil A, Fartoukh M, Tassart M, Parrot A, Marsault C, Carette MF. Role of MDCT in identification of the bleeding site and the vessels causing hemoptysis. AJR Am J Roentgenol 2007;188:117-25. https://doi.org/10.2214/AJR.05.1578
  10. Chung MJ, Lee JH, Lee KS, Yoon YC, Kwon OJ, Kim TS. Bronchial and nonbronchial systemic arteries in patients with hemoptysis: depiction on MDCT angiography. AJR Am J Roentgenol 2006;186:649-55. https://doi.org/10.2214/AJR.04.1961
  11. Bruzzi JF, Remy-Jardin M, Delhaye D, Teisseire A, Khalil C, Remy J. Multi-detector row CT of hemoptysis. Radiographics 2006;26:3-22. https://doi.org/10.1148/rg.261045726
  12. Remy-Jardin M, Bouaziz N, Dumont P, Brillet PY, Bruzzi J, Remy J. Bronchial and nonbronchial systemic arteries at multi-detector row CT angiography: comparison with conventional angiography. Radiology 2004; 233:741-9. https://doi.org/10.1148/radiol.2333040031
  13. Remy J, Voisin C, Dupuis C, Beguery P, Tonnel AB, Denies JL, et al. Treatment of hemoptysis by embolization of the systemic circulation. Ann Radiol (Paris) 1974;17:5-16.
  14. Unsal E, Koksal D, Cimen F, Taci Hoca N, Sipit T. Analysis of patients with hemoptysis in a reference hospital for chest diseases. Tuberk Toraks 2006;54:34-42.
  15. Eisenhuber E, Brunner C, Bankier AA. Blood clots mimicking peripheral intrabronchial tumors in patients with hemoptysis: CT and bronchoscopic findings. J Comput Assist Tomogr 2000;24:47-51. https://doi.org/10.1097/00004728-200001000-00009
  16. Ekim H, Sanisoglu I, Akar H. Hemoptysis: bronchoscopic- computed tomographic correlation in ninety eight cases. Eastern J Med 2000;5:21-5.

Cited by

  1. Korean Clinical Imaging Guideline for Hemoptysis vol.78, pp.2, 2018, https://doi.org/10.3348/jksr.2018.78.2.81