Learning objectives
Hemoptysiscould bea life-threatening condition.
The definition is controversial but generally,
Authors define massivehemoptysisas any volume of expectorated blood that can cause respiratory failure.
Etiologies vary widely based on demographics.
In children,
infectious causes predominate in developing countries,
and cystic fibrosis predominates among children of European descent.
In adults,
malignancy,
bronchiectasis,
and chronic infection are the most common causes.
Treatment begins with resuscitation and airway protection,
followed by minimally invasive bronchoscopic and endovascular techniques.
Transcatheter embolization is the first-line treatment for massive hemoptysis and recurrent intractable...
Background
Massivehemoptysisis regarded as a potentially lethal condition that requires immediate action.
Although minorhemoptysisis frequently encountered by most clinicians,
massivehemoptysisin far less frequent and most physicians are not prepared to manage this time-sensitive clinical presentation in a systematic and timely fashion.Hemoptysis of as little as 300 mL is considered massive and can lead to death by asphyxiation.
The vast majority of cases of massive hemoptysis are caused by bronchial artery extravasation,and in these cases,
endovascular embolizationis usually employed as a first-line treatment.
The poor pulmonary reserveof...
Findings and procedure details
The interventional radiologist starts the procedure with puncture of the right common femoral artery using the Seldinger technique,
and a 5-French (F)
sheath insertion.
Thebronchial arteries is usuallyselected witha Cobra catheterand an angiography isperformed showing increased vascularity.
Usually,no active extravasation of contrast material is shown by angiograhy.
A 3F microcatheter is used so as to super-selectively catheterizebronchial arteries.
Embolization isperformed by injection of 500 to 700 micron particles until blood stasis isachieved.
Particle embolization is the standard because it allows for repeat embolization procedures ifbleeding...
Conclusion
Massivehemoptysisis an uncommon and severe conditionin childhood and in adult Patients.On the one hand,
embolizationcan be a treatment option in children with abnormal vasculature bleeding and can be repeated safely when needed.On the other hand,
endovascularembolization is the gold standard treatment in case of adult Patients.
References
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The bronchial arteries: an anatomic study of 105 humancadavers.
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Hemoptysis: etiology,
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Kato A,
Kudo S,
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Bronchial artery embolization for hemoptysis due to benigndisease: immediate and long-term results.
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Mossi F,
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Indicators predictive of embolization: analysis of 88 patientswith haemoptysis.
Radiol Med (Torino) 2003;105(1–2):48–55...