Limits...
Radiological findings and outcomes of bronchial artery embolization in cryptogenic hemoptysis.

Kervancioglu S, Bayram N, Gelebek Yilmaz F, Sanli M, Sirikci A - J. Korean Med. Sci. (2015)

Bottom Line: Surgery is not a reasonable option because there is no underlying identifiable pathology.A comparison of the bronchial artery abnormalities between the cryptogenic and non-cryptogenic hemoptysis groups showed that only extravasation was more statistically significant in the cryptogenic hemoptysis group than in the non-cryptogenic hemoptysis group, while the other bronchial artery abnormalities, such as bronchial artery dilatation, hypervascularity, and bronchial-to-pulmonary shunting, showed no significant difference between groups.Involvement of the non-bronchial systemic artery was significantly greater in the non-cryptogenic hemoptysis group than in the cryptogenic hemoptysis group.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey.

ABSTRACT
Management of cryptogenic massive hemoptysis is difficult, and conservative treatment may be inadequate to stop the hemorrhage. Surgery is not a reasonable option because there is no underlying identifiable pathology. This study aimed to investigate the radiologic findings and bronchial artery embolization outcomes in cryptogenic hemoptysis, and to compare the results with non-cryptogenic hemoptysis. We evaluated 26 patients with cryptogenic hemoptysis and 152 patients with non-cryptogenic hemoptysis. A comparison of the bronchial artery abnormalities between the cryptogenic and non-cryptogenic hemoptysis groups showed that only extravasation was more statistically significant in the cryptogenic hemoptysis group than in the non-cryptogenic hemoptysis group, while the other bronchial artery abnormalities, such as bronchial artery dilatation, hypervascularity, and bronchial-to-pulmonary shunting, showed no significant difference between groups. Involvement of the non-bronchial systemic artery was significantly greater in the non-cryptogenic hemoptysis group than in the cryptogenic hemoptysis group. While 69.2% of patients with cryptogenic hemoptysis also had hypervascularity in the contralateral bronchial arteries and/or ipsilateral bronchial artery branches other than the bleeding lobar branches, this finding was not detected in non-cryptogenic hemoptysis. Embolization was performed on all patients using polyvinyl alcohol particles of 355-500 µm. Hemoptysis ceased in all patients immediately after embolization. While recurrence of hemoptysis showed no statistically significant difference between the cryptogenic and non-cryptogenic hemoptysis groups, it was mild in cryptogenic hemoptysis in contrast to mostly severe in non-cryptogenic hemoptysis. Transarterial embolization is a safe and effective technique to manage cryptogenic hemoptysis.

No MeSH data available.


Related in: MedlinePlus

Images of a patient by CT scan and angiography. (A) Axial CT scan obtained with parenchymal lung window demonstrates hazy consolidation at left upper lobe. (B) Left second intercostal arteriography demonstrates dilatation and hypervascularity. (C) Bronchial arteriography shows combined right and left bronchial trunk with hypervascularity, more prominent in the left upper lobe. (D) CT scan obtained 10 months after embolization demonstrates normal lung parenchyma.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4414643&req=5

Figure 2: Images of a patient by CT scan and angiography. (A) Axial CT scan obtained with parenchymal lung window demonstrates hazy consolidation at left upper lobe. (B) Left second intercostal arteriography demonstrates dilatation and hypervascularity. (C) Bronchial arteriography shows combined right and left bronchial trunk with hypervascularity, more prominent in the left upper lobe. (D) CT scan obtained 10 months after embolization demonstrates normal lung parenchyma.

Mentions: Diagnostic angiography revealed abnormalities in all patients. While all patients had bronchial artery abnormalities, 4 patients (15.4%) also had systemic artery abnormalities, including 3 patients (11.5%) who had intercostal artery abnormalities and 1 patient (3.8%) who had abnormalities of 1 lateral thoracic artery and 2 intercostal arteries (Fig. 2). The most commonly detected abnormalities of bronchial artery were dilatation in 18 patients (69.2%) and hypervascularity in 25 patients (96.2%) (Fig. 3). Four patients (15.4%) had bronchial-to-pulmonary shunting while 4 patients (15.4%) had extravasation into the bronchial lumen. In addition to bleeding bronchial artery branches, 18 patients (69.2%) exhibited hypervascularities in contralateral bronchial arteries and/or ipsilateral bronchial artery branches other than bleeding lobar branches (Fig. 3, 4). Intercostal and lateral thoracic arteries abnormalities were also dilatation and hypervascularity.


Radiological findings and outcomes of bronchial artery embolization in cryptogenic hemoptysis.

Kervancioglu S, Bayram N, Gelebek Yilmaz F, Sanli M, Sirikci A - J. Korean Med. Sci. (2015)

Images of a patient by CT scan and angiography. (A) Axial CT scan obtained with parenchymal lung window demonstrates hazy consolidation at left upper lobe. (B) Left second intercostal arteriography demonstrates dilatation and hypervascularity. (C) Bronchial arteriography shows combined right and left bronchial trunk with hypervascularity, more prominent in the left upper lobe. (D) CT scan obtained 10 months after embolization demonstrates normal lung parenchyma.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4414643&req=5

Figure 2: Images of a patient by CT scan and angiography. (A) Axial CT scan obtained with parenchymal lung window demonstrates hazy consolidation at left upper lobe. (B) Left second intercostal arteriography demonstrates dilatation and hypervascularity. (C) Bronchial arteriography shows combined right and left bronchial trunk with hypervascularity, more prominent in the left upper lobe. (D) CT scan obtained 10 months after embolization demonstrates normal lung parenchyma.
Mentions: Diagnostic angiography revealed abnormalities in all patients. While all patients had bronchial artery abnormalities, 4 patients (15.4%) also had systemic artery abnormalities, including 3 patients (11.5%) who had intercostal artery abnormalities and 1 patient (3.8%) who had abnormalities of 1 lateral thoracic artery and 2 intercostal arteries (Fig. 2). The most commonly detected abnormalities of bronchial artery were dilatation in 18 patients (69.2%) and hypervascularity in 25 patients (96.2%) (Fig. 3). Four patients (15.4%) had bronchial-to-pulmonary shunting while 4 patients (15.4%) had extravasation into the bronchial lumen. In addition to bleeding bronchial artery branches, 18 patients (69.2%) exhibited hypervascularities in contralateral bronchial arteries and/or ipsilateral bronchial artery branches other than bleeding lobar branches (Fig. 3, 4). Intercostal and lateral thoracic arteries abnormalities were also dilatation and hypervascularity.

Bottom Line: Surgery is not a reasonable option because there is no underlying identifiable pathology.A comparison of the bronchial artery abnormalities between the cryptogenic and non-cryptogenic hemoptysis groups showed that only extravasation was more statistically significant in the cryptogenic hemoptysis group than in the non-cryptogenic hemoptysis group, while the other bronchial artery abnormalities, such as bronchial artery dilatation, hypervascularity, and bronchial-to-pulmonary shunting, showed no significant difference between groups.Involvement of the non-bronchial systemic artery was significantly greater in the non-cryptogenic hemoptysis group than in the cryptogenic hemoptysis group.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey.

ABSTRACT
Management of cryptogenic massive hemoptysis is difficult, and conservative treatment may be inadequate to stop the hemorrhage. Surgery is not a reasonable option because there is no underlying identifiable pathology. This study aimed to investigate the radiologic findings and bronchial artery embolization outcomes in cryptogenic hemoptysis, and to compare the results with non-cryptogenic hemoptysis. We evaluated 26 patients with cryptogenic hemoptysis and 152 patients with non-cryptogenic hemoptysis. A comparison of the bronchial artery abnormalities between the cryptogenic and non-cryptogenic hemoptysis groups showed that only extravasation was more statistically significant in the cryptogenic hemoptysis group than in the non-cryptogenic hemoptysis group, while the other bronchial artery abnormalities, such as bronchial artery dilatation, hypervascularity, and bronchial-to-pulmonary shunting, showed no significant difference between groups. Involvement of the non-bronchial systemic artery was significantly greater in the non-cryptogenic hemoptysis group than in the cryptogenic hemoptysis group. While 69.2% of patients with cryptogenic hemoptysis also had hypervascularity in the contralateral bronchial arteries and/or ipsilateral bronchial artery branches other than the bleeding lobar branches, this finding was not detected in non-cryptogenic hemoptysis. Embolization was performed on all patients using polyvinyl alcohol particles of 355-500 µm. Hemoptysis ceased in all patients immediately after embolization. While recurrence of hemoptysis showed no statistically significant difference between the cryptogenic and non-cryptogenic hemoptysis groups, it was mild in cryptogenic hemoptysis in contrast to mostly severe in non-cryptogenic hemoptysis. Transarterial embolization is a safe and effective technique to manage cryptogenic hemoptysis.

No MeSH data available.


Related in: MedlinePlus