Arteries / Aorta, Pulmonary vessels, Cardiovascular system, CT, CT-Angiography, Catheter arteriography, Comparative studies, Decision analysis, Embolisation, Haemorrhage
S. Richter Sgourdos, G. Sgourdos, S. D. Qanadli, C. Beigelman-Aubry; Lausanne/CH
Imaging findings OR Procedure details
25 consecutive patients (12 women,
13 men) with a mean age of 50±39 years (min 15,
max 89) presenting with submassive or massive hemoptysis who had CT angiography were included in the study.
We analyzed vascular abnormalities including bronchial (BA),
systemic non-bronchial (SNBA) and pulmonary arteries (PA),
and parenchymal changes.
The CT findings were compared to those obtained from transcatheter angiography (TCA).
According to the TCA,
BA were responsible for hemoptysis in 25 cases and the SNBA in 4 cases and no patient had PA as origin of hemoptysis.
The number and origin of BA were correctly identified in 12 (66.7%),
and abnormal SNBA were correctly identified in 10 (90.1%) of cases.
CT correctly predicted the site of embolization in 19 cases (76%).
Two pulmonary arteries were identified as abnormal on CT,
one of them being wrongly identified as the site of bleeding.
The causal or associated diseases were the following: broncho-pulmonary carcinoma (n=11),
malignant hemangioendothelioma (n=1),
cystic fibrosis (n=7),
cryptogenic hemoptysis in a patient known for COPD (n=1),
focal bronchectasia (n=4) and tuberculosis sequellae (n=1).
1 to 5 illustrate the case of a 15-year-old patient with cystic fibrosis.
In this case, a good concordance between CT findings and the embolization site of the right BA was observed.
6 to 9 illustrate the case of a 58-year-old patient with a right pulmonary adenocarcinoma. There was also a good concordance between CT findings and the site of embolization of right SNBA.
10 to 13 illustrate the case of the same patient as the previous one,
admitted for a new episode of hemoptysis. Because the right bronchial artery was not reported as enlarged with CT,
this led to a false-negative CT finding (Non-concordance between the CT and the embolization site of the right BA).
14 to 17 illustrate the case of a 32-year-old patient with an aggressive hemangioendothelioma probably arising from the right pulmonary artery.
In this case,
a branch issued form the pulmonary artery was falsely considered as the site of bleeding,
leading to a false-positive interpretation of the CT (Non-concordance between the CT and the site of the embolization).