肺部疾病的支气管动脉与肺外体循环动脉CTA分析

目的:利用CT血管造影对支气管动脉与肺外体循环动脉进行肺供血研究。材料和方法:回顾性分析16层CT胸部增强发现肺外体循环动脉参与供血的不同肺疾病患者39例(男性24例,女性15例,平均年龄63.4岁;范围,20-82岁),采用容积显示(VR)、多平面重建(MPR)、最大强度投影(MIP)进行支气管动脉与肺外体循环动脉进行重建,分析其供血特征。结果:39例病人中共显示支气管动脉128支,肺外体循环动脉42支,其中内乳动脉19支,锁骨下动脉8支,膈下动脉8支,肋间动脉5支,甲状颈干与腹腔干各1支。35支肺外体循环动脉扩张迂曲进入肺内。5例支气管扩张和1例肺癌中扩张迂曲的支气管动脉与肺外体循环动脉形成明显的交通吻合成网状,7例支气管扩张中支气管动脉、肺外体循环动脉与肺动脉间形成吻合。除1例肺隔离症没有伴明显胸膜增厚外,其余肺外体循环动脉穿过胸壁进入肺内均伴有明显的胸膜增厚。结论:CTA并三维重建技术能清晰显示支气管动脉肺外体循环动脉的起源、分布等解剖特征,为介入术提供明确路径,有利于疾病的诊断与治疗。     

Bronchial and nonbronchial systemic arteries at multi-detector row CT angiography: comparison with conventional angiography

PURPOSE: To retrospectively evaluate bronchial and nonbronchial systemic arteries at multi-detector row helical computed tomography (CT) compared with conventional angiography in patients undergoing endovascular treatment of hemoptysis. MATERIALS AND METHODS: Neither institutional board approval nor informed consent was required. Forty-eight consecutive patients (39 men, nine women; mean age, 55.7 years; range, 20-82 years) with hemoptysis of bronchial and nonbronchial systemic artery origin underwent multi-detector row helical CT angiography of the thorax with use of a four-detector row (n = 31) or 16-detector row (n = 17) scanner prior to embolization. Findings on CT angiograms, including CT scans, maximum intensity projections, and three-dimensional volume-rendered images, were used to evaluate the depiction of bronchial and nonbronchial systemic arteries. Retrospective analysis of the ostium and the course of bronchial and/or nonbronchial systemic arteries on CT angiograms enabled evaluation of the accuracy of this technique in identification of the relevant vasculature. RESULTS: Among the 46 patients initially treated with bronchial artery embolization, 58 bronchial arteries were identified at CT and/or angiography. In 50 (86%) cases, concordant findings were observed with both modalities. In five (9%) cases, CT could not be used to identify the ostia of bronchial arteries. In three (5%) cases, CT depicted bronchial arteries that could not be selectively catheterized. Three-dimensional images were found to be superior to transverse CT scans in depicting the ectopic origin of the bronchial arteries, which enabled the interventional radiologists to perform successful embolization after direct catherization of the ectopic vessel in every case. In five (11%) patients, the nonbronchial systemic origin of bronchial bleeding was identified on CT angiograms. CONCLUSION: Multi-detector row helical CT angiography provides more precise depiction of bronchial and nonbronchial systemic arteries than does conventional angiography.     

Hemoptysis: bronchial and nonbronchial systemic arteries at 16-detector row CT

PURPOSE: To retrospectively evaluate 16-detector row computed tomography (CT) compared with conventional angiography in depiction of bronchial and nonbronchial systemic arteries in patients with hemoptysis. MATERIALS AND METHODS: Institutional review board approval was obtained, and informed consent was not required. Sixteen-detector row helical CT and conventional angiography of the thorax were performed in 22 patients (16 men, six women; age range, 18-75 years; mean age, 50 years) with hemoptysis. Three observers in consensus analyzed retrospectively transverse, multiplanar reconstruction, or three-dimensional CT images for visibility, traceability of bronchial arteries from their origin at the aorta or aortic branches to the hilum, and presence of nonbronchial systemic arteries. CT and angiographic findings of bronchial and nonbronchial systemic arteries causing hemoptysis were compared by two radiologists in consensus. Differences in visibility, traceability, and diameter of bronchial arteries causing and those not causing hemoptysis were tested by using generalized estimating equation method or the mixed model. RESULTS: Fifty-two (30 right and 22 left) bronchial arteries and 33 nonbronchial systemic arteries were visible at CT. Thirty-four (20 right and 14 left) of 52 bronchial arteries were traceable from their origins to the hilum. Thirty-one (16 right and 15 left) of 46 (27 right and 19 left) bronchial arteries and 26 of 64 nonbronchial systemic arteries evaluated at angiography were causing hemoptysis. Forty (87%, 23 right and 17 left) of 46 bronchial arteries seen at angiography were also detected at CT. All 31 bronchial arteries and sixteen (62%) of 26 nonbronchial systemic arteries causing hemoptysis were detected at CT. Twenty-three (74%) of 31 bronchial arteries causing hemoptysis were traceable from their origins to the hilum, and one (11%) of nine bronchial arteries not causing hemoptysis was traceable (P = .002). CONCLUSION: Sixteen-detector row CT provides depiction and traceability of the bronchial arteries in patients with hemoptysis, and in most patients it enables detection of the bronchial and nonbronchial arteries causing hemoptysis.     

Clinical Impact of Multidetector Row Computed Tomography Before Bronchial Artery Embolization in Patients With Hemoptysis: A Prospective Study

Purpose

To evaluate prospectively the role and impact of multidetector row computed tomography (MDCT) before bronchial artery embolization (BAE) in patients with hemoptysis.

Methods

MDCT of the thorax was performed in 27 patients (21 men, 6 women; age range, 22-70 years; mean, 39 years) with hemoptysis who were referred for BAE. Transverse, multiplanar reconstruction, and 3-dimensional reconstruction (maximum intensity projection and volume rendered) images were analysed to identify the abnormal hypertrophied bronchial and nonbronchial systemic arteries causing hemoptysis, their origin and course were noted. Digital subtraction angiography was performed with the knowledge of findings of MDCT. Selective arteriogram of abnormal bronchial as well as nonbronchial arteries was performed. Embolization was attempted in 25 of these patients (92.6%) by using polyvinyl alcohol particles (350-500 μm), Gelfoam or Embospheres (400-700 μm). Follow-up was done for a mean period of 20.5 months.

Results

Based on MDCT, 2 of 27 patients were found unsuitable for BAE. On computed tomography, 38 arteries (27 bronchial and 11 nonbronchial systemic arteries) were identified as abnormal hypertrophied vessels. On angiography, 34 of these arteries (25 bronchial and 9 nonbronchial systemic arteries) were found to be responsible for hemoptysis. Three of these arteries could not be evaluated during angiography, and 1 artery that was identified as abnormal on computed tomography was found normal on angiography. All 25 bronchial and 9 nonbronchial systemic arteries that cause hemoptysis were detected at MDCT. Embolization was successful in 23 of 25 patients.

Conclusion

MDCT enables detection and depiction of all bronchial and nonbronchial systemic arteries causing hemoptysis.     

Role of MDCT in identification of the bleeding site and the vessels causing hemoptysis

OBJECTIVE: MDCT has improved the management of hemoptysis by providing more precise depiction of bronchial and nonbronchial systemic arteries than conventional CT. The purpose of this article is to review the role of MDCT in the identification of the bleeding site and the vessels causing hemoptysis. CONCLUSION: Identification of the origin of the involved systemic arteries (bronchial and nonbronchial) or involved pulmonary artery on MDCT enables the interventional radiologist to treat them, especially in elderly patients with a tortuous aorta and atheroma.     

咯血的多层螺旋CT血管成像诊断

目的 评价64层MSCT血管成像对咯血的诊断及指导治疗作用.方法 22例因反复大量咯血的患者行胸部64层MSCT血管成像.结果 咯血相关血管表现为无支气管动脉供血型3例、单支或多支支气管动脉供血型15例、支气管动脉与非支气管动脉共同供血型3例以及直接异常体循环动脉供血型1例.结论 64层MSCT血管成像对支气管动脉DSA插管及栓塞治疗大咯血有明显的指导作用.

Abstract：

Objective To evaluate the nse of CT angiography in the diagnosis of hemoptysis and guiding the treatment of it with 64-slice spiral CT.Methods Twenty-two patients with repeated and massive hemoptysis underwent chest CT angiography.Results The blood supply of hemoptysis was nonbronchial systemic arteries in 3 patients,single or multiple bronchial arteries in 15 patients,mixed arteries of nonbronchial systemic and bronchial arteries in 3 patients and abnormal systemic arteries in 1 patient.Conclusion With 64-slice spiral CT,CT angiography provided useful information for the treatment of hemoptysis by guiding bronchial arterial embolization.     

Empirical description of bronchial and nonbronchial arteries with MDCT

Purpose

We aimed to retrospectively evaluate bronchial and nonbronchial systemic arteries using multi-detector row helical computed tomographic (MDCT) angiography in patients with pulmonary disorders.

Materials and Methods

Thirty-nine patients (24 men, 15 women; mean age, 63.4 years; range, 20-82 years) with congenital and acquired pulmonary disorders of the bronchial and nonbronchial systemic arteries underwent multi-detector row helical computed tomographic angiography of the thorax using a 16-detector row scanner. Each of these patients had experienced an episode of hemoptysis. Computed tomographic angiogram data, which included maximum intensity projections, multiplanar reconstruction, and three-dimensional volume-rendered images, were used to retrospectively analyse the characteristics of the bronchial and nonbronchial systemic arteries.

Results

We identified a total of 128 bronchial arteries (76 on the right side and 52 on the left) in 39 patients. We detected 42 nonbronchial systemic artery branches, including 19 internal mammary artery branches, 8 subclavian artery branches, 8 inferior phrenic artery branches, 5 intercostal artery branches, 1 thyrocervical trunk branch, and 1 celiac trunk branch. Thirty-five dilated and tortuous nonbronchial systemic arteries entered into the lung parenchyma and extended down to the lesions. Every case, except the one case of sequestration, was associated with pleural thickening where the vascular structures passed through the extrapleural fat.

Conclusions

The variations in both the bronchial artery anatomy and the location and type of the nonbronchial arteries were great. Nonbronchial arteries may be a significant source of hemoptysis. MDCT angiography can be used to detect detailed anatomical information about the origins and courses of bronchial and nonbronchial systemic arteries and their pathophysiologic features.     

Systemic collateral supply in patients with chronic thromboembolic and primary pulmonary hypertension: assessment with multi-detector row helical CT angiography

PURPOSE: To compare retrospectively the frequency of systemic collateral supply in patients who have chronic thromboembolic pulmonary hypertension with the frequency of systemic collateral supply in patients who have primary pulmonary hypertension by using multi-detector row helical computed tomographic (CT) angiography. MATERIALS AND METHODS: For this review, neither institutional board approval nor informed consent was required. Thirty-six consecutive patients, including 22 patients (four men, 18 women; mean age, 46.0 years) with chronic thromboembolic pulmonary hypertension (group 1) and 14 patients (five men, nine women; mean age, 63.0 years) with primary pulmonary hypertension (group 2), underwent multisection spiral CT angiography of the pulmonary and systemic circulations with a four- (n = 17) or 16- (n = 19) detector row scanner. CT angiograms were assessed for the presence of abnormal bronchial and/or nonbronchial systemic arteries, CT features of pulmonary hypertension, and right ventricular dysfunction. Vascular and parenchymal signs of chronic pulmonary embolism were specifically analyzed on CT angiograms of group 1 patients. Comparative analyses were performed by using the chi(2) or the Fisher exact test for categoric data. An unpaired bilateral Wilcoxon rank sum test was used for continuous data. A chi(2) goodness-of-fit test was used to compare observed proportions with equal proportions. RESULTS: The degree of pulmonary hypertension was comparable in groups 1 and 2. Abnormally enlarged systemic arteries were identified in 16 (73%) of 22 patients from group 1 and in two (14%) of 14 patients from group 2 (P = .002). The systemic collateral supply in group 1 comprised enlargement of both bronchial and nonbronchial systemic arteries in nine (56%) of the 16 patients; the remaining seven patients had an exclusive enlargement of bronchial systemic arteries (n = 6, 38%) or nonbronchial (n = 1, 6%) systemic arteries. A total of 31 enlarged nonbronchial systemic arteries were depicted, including 13 inferior phrenic arteries, 10 intercostal arteries, seven internal mammary arteries, and one lateral thoracic artery. The mean +/- standard deviation of abnormal nonbronchial systemic arteries per patient was 1.4 +/- 1.9. No relationship was found between the mean number of abnormally enlarged nonbronchial systemic arteries and the CT angiographic features of chronic pulmonary embolism. CONCLUSION: These results demonstrate the higher frequency of abnormally enlarged bronchial and nonbronchial systemic arteries in patients who have chronic thromboembolic pulmonary hypertension compared with patients who have primary pulmonary hypertension; this finding could help distinguish these two entities on CT angiograms.     

Prediction of recurrent hemoptysis with MDCT angiography

OBJECTIVE: To identify the computed tomography (CT) findings to predict recurrent bleeding in patients with massive hemoptysis. METHODS: Fifty-eight patients with massive hemoptysis underwent both CT and conventional bronchial angiography for bronchial artery embolization. Retrospective analysis was done to analyze the statistical differences in the initial CT findings between the nonrecurrent and recurrent hemoptysis groups using the Mann-Whitney U test and the chi or Fisher exact test. Stepwise logistic regression analysis was used to find predictive variables for the recurrence of hemoptysis. RESULTS: After embolization, recurrence of hemoptysis was observed in 15 of 58 patients (26%). The diameter of bronchial (P = 0.001) and nonbronchial systemic arteries (P < 0.05), total number of dilated bronchial and nonbronchial systemic arteries (P = 0.001), pleural thickening (P = 0.01), extrapleural fat thickening (P = 0.004), and enhancing vascular structures within the extrapleural fat layer (P = 0.04) were significantly different in the nonrecurrent and recurrent hemoptysis groups. Stepwise logistic regression analysis showed that the total number of dilated bronchial and nonbronchial systemic arteries (odds ratio, 3.540; 95% confidence interval: 1.175, 10.662; P = 0.025) was a significant CT variable associated with the recurrence of hemoptysis. CONCLUSIONS: CT bronchial angiography may help in the prediction of recurrent bleeding in patients with massive hemoptysis.     

La tomografía computarizada multidetector en la hemoptisis amenazante

Life-threatening hemoptysis is a severe condition that requires rapid diagnosis and treatment. One of the treatments of choice is embolization. The initial assessment aims to locate the origin and cause of bleeding. The technological advance of the development of multidetector computed tomography (MDCT) has changed the management of patients with life-threatening hemoptysis. MDCT angiography makes it possible to evaluate the cause of bleeding and locate the vessels involved both rapidly and noninvasively; it is particularly useful for detecting ectopic bronchial arteries, nonbronchial systemic arteries, and pulmonary pseudoaneurysms. Performing MDCT angiography systematically before embolization enables better treatment planning. In this article, we review the pathophysiology and causes of life-threatening hemoptysis (including cryptogenic hemoptysis) and the MDCT angiography technique, and we review how to systematically evaluate the images (lung parenchyma, airways, and vascular structures).     

Peripheral pulmonary artery pseudoaneurysms and massive hemoptysis

OBJECTIVE: The aim of this study was to determine the incidence and etiology of pulmonary artery pseudoaneurysms in patients undergoing bronchial angiography for massive hemoptysis and to assess patient outcome after the embolization of these pseudoaneurysms. CONCLUSION: Peripheral pulmonary artery pseudoaneurysms occur in up to 11% of patients undergoing bronchial angiography for hemoptysis. These are often most easily appreciated on bronchial and/or nonbronchial systemic arterial angiograms because of complete reversal of flow in pulmonary artery branches in the diseased lung. Embolization of bronchial and nonbronchial systemic arteries alone may not be sufficient therapy to control hemoptysis, and occlusion of the pseudoaneurysm itself via a pulmonary artery approach is recommended.     

64-detector row CT evaluation of bronchial and non-bronchialsystemic arteries in life-threatening haemoptysis

Objective To retrospectively evaluate the depiction of bronchial and non-bronchial systemic arteries with 64-detector row CT in patients undergoing endovascular treatment for life-threatening haemoptysis. Methods 64-detector row helical CT and conventional angiography of the thorax were performed in 28 patients (25 males, 3 females; age range, 18-65 years; mean age, 40 years) with life-threatening haemoptysis. CT images were analysed to identify abnormal bronchial and non-bronchial systemic arteries and also to localise them in two planes. Results Using multidetector CT (MDCT), 43 bronchial arteries were identified on the right side and 46 on the left side. 89% of the right bronchial arteries originated from the right intercostobronchial arteries. A common trunk of origin of the right and left bronchial artery was noted in 46% of cases. 23 non-bronchial systemic arteries were noted on the right side and 41 on the left side. Pleural thickening >3 mm was confirmed to be a good predictor of non-bronchial systemic supply. An internal mammary artery diameter of >3 mm and an inferior phrenic artery diameter of >2 mm were sensitive indicators for non-bronchial systemic supply. Conclusion MDCT is a good investigation tool for evaluating life-threatening haemoptysis as it confirms the disease process, identifies the origin and ostial position of bronchial arteries, detects non-bronchial systemic arteries and acts as a roadmap for percutaneous transcatheter embolisation.     

支气管动脉CT血管造影

支气管动脉起始、分布、走行等解剖变异较大,正常支气管动脉管径细小,疾病状态下支气管动脉发生解剖学重塑,并可与肺循环、肺外体循环等发生交通吻合.16层CT血管造影可以清晰显示支气管动脉的三维形态学特征,解释各种生理和病理状态.     

高流量对比剂注射速率下CTA对支气管动脉源性咯血栓塞治疗的价值

目的评价高流量对比剂注射流速下320排CT血管成像(CTA)对支气管动脉栓塞(BAE)治疗咯血的术前指导价值。方法纳入95例咯血患者,通过分析支气管动脉开口位置和起源,以及血管形态学等特征来评估行栓塞治疗的可行性,并根据CTA提供的相关血管解剖路径图,行选择性血管造影,一旦证实为异常即行栓塞治疗,评估BAE术后临床成功率及技术成功率。结果在95例咯血患者中,320排CTA检测到297根支气管动脉,其中右侧155根,左侧142根,根据CTA提供的支气管动脉解剖学信息,228根支气管动脉成功进行了选择性支气管动脉造影,支气管动脉CTA与数字减影血管造影(DSA)表现为高度一致性,其中90例患者中的132根支气管动脉经DSA证实为责任血管,5例患者中因5根异常的支气管动脉未能成功插管,故未进行BAE,其余异常血管均成功栓塞。4例患者BAE术后仍有少量咯血。临床成功率为95.6%(86/90),技术成功率为96.2%(127/132)。结论高流量对比剂注射速率下,320排CTA可以清晰的显示咯血的支气管动脉的解剖学信息,可为介入治疗提供重要的参考信息,从而获得较高的成功率。     

Radiological Management of Hemoptysis: A Comprehensive Review of Diagnostic Imaging and Bronchial Arterial Embolization

Hemoptysis can be a life-threatening respiratory emergency and indicates potentially serious underlying intrathoracic disease. Large-volume hemoptysis carries significant mortality and warrants urgent investigation and intervention. Initial assessment by chest radiography, bronchoscopy, and computed tomography (CT) is useful in localizing the bleeding site and identifying the underlying cause. Multidetector CT angiography is a relatively new imaging technique that allows delineation of abnormal bronchial and nonbronchial arteries using reformatted images in multiple projections, which can be used to guide therapeutic arterial embolization procedures. Bronchial artery embolization (BAE) is now considered to be the most effective procedure for the management of massive and recurrent hemoptysis, either as a first-line therapy or as an adjunct to elective surgery. It is a safe technique in the hands of an experienced operator with knowledge of bronchial artery anatomy and the potential pitfalls of the procedure. Recurrent bleeding is not uncommon, especially if there is progression of the underlying disease process. Prompt repeat embolization is advised in patients with recurrent hemoptysis in order to identify nonbronchial systemic and pulmonary arterial sources of bleeding. This article reviews the pathophysiology and causes of hemoptysis, diagnostic imaging and therapeutic options, and technique and outcomes of BAE.     

Pulmonary arteriovenous malformation treated with embolotherapy: systemic collateral supply at multidetector CT angiography after 2-20-year follow-up

PURPOSE: To retrospectively evaluate frequency of systemic arterial collateral supply to treated pulmonary arteriovenous malformations (PAVMs) in long-term follow-up with multi-detector row helical computed tomography (CT). MATERIALS AND METHODS: Institutional review board approval was obtained, with waiver of informed consent. Thirty-two patients (19 male, 13 female; mean age, 43 years) underwent follow-up multi-detector row helical CT angiography of the chest (collimation, 16x0.75 mm) 2 or more years after embolotherapy of PAVMs. The study group had a history of successful embolotherapy of 53 PAVMs and a mean of 9 years of follow-up (range, 2-20 years). A search for abnormal systemic arteries was based on analysis of thin-collimated contiguous transverse CT scans and two- and three-dimensional images including maximum intensity projections and volume-rendered images. Statistical comparison was performed with the Fisher exact test (categoric variables) and Wilcoxon rank sum test (continuous variables). RESULTS: At CT, 13 patients (group 1) had abnormally enlarged systemic arteries and 19 patients (group 2) had no abnormal arteries. In group 1, 32 abnormally enlarged arteries were seen-five bronchial and 27 nonbronchial arteries (14 inferior phrenic, six musculophrenic, five internal mammary, two intercostal). The degree of enlargement was moderate for 26 arteries and marked for six. There were no significant differences between groups for (a) clinical characteristics of patients, including history of surgery before or after embolotherapy (P=.7); (b) anatomic structures of treated PAVMs; and (c) embolization procedures and their effectiveness. The number of patients with features suggestive of lung infarction in the days or months after embolotherapy was significantly higher in group 1 (P=.04). On CT angiograms, the number of patients with features suggestive of sequelae of lung infarction was significantly higher in group 1 (P=.02). There were no symptomatic differences attributable to systemic collateral supply between groups; in particular, there was no hemoptysis in group 1. CONCLUSION: Abnormally enlarged systemic arteries were present in 13 of 32 patients, in whom there was a significantly higher frequency of clinical and/or radiographic features suggestive of lung infarction after embolotherapy.     

Pulmonary Artery Access Embolization in Patients with Massive Hemoptysis in Whom Bronchial and/or Nonbronchial Systemic Artery Embolization Is Contraindicated

The objective of this paper is to present an alternative therapeutic approach for the treatment of patients with massive hemoptysis in whom bronchial and/or nonbronchial systemic arterial embolization is not possible. We describe a percutaneous procedure for pulmonary segmental artery embolization. Between May 2000 and July 2006, 27 adult patients with hemoptysis underwent percutaneous treatment at our department; 20 of 27 patients were embolized via bronchial and or nonbronchial systemic arteries and 7 patients were embolized via pulmonary artery. Femoral arterial access for systemic artery catheterization and femoral vein access for pulmonary arterial catheterization were used. Gelfoam particles and coils were used for embolization. In this study, we report on three cases of massive hemoptysis from a systemic arterial source in whom bronchial and/or nonbronchial arteries embolization was not possible. Percutaneous embolization via the pulmonary artery access was successful in all three patients. In conclusion, embolization via pulmonary artery is presented as an alternative approach for the management of hemoptysis in patients in whom bronchial arterial embolization is not possible.     

MDCT angiography mapping of abnormal bronchopulmonary vasculature in patients with haemoptysis

Background

The systematic use of MDCT angiography in patients with haemoptysis is especially helpful to identify ectopic bronchial arteries, non-bronchial systemic arteries and pulmonary artery pseudoaneurysms.

Cobb综合征的临床表现和比较影像学分析(附4例报告并文献复习)

目的:分析Cobb综合征的临床和影像学表现,并进行影像学方法比较。方法:4例患者临床表现为双下肢无力或瘫痪,查体主要见下肢肌力减退和皮肤血管瘤。4例均行64排螺旋CT和DSA检查,其中3例行MRI检查。结果:CT增强扫描可显示病变相应节段的髓内、髓外椎管内、椎旁及肌肉和皮下软组织内的血管畸形。多排螺旋CT血管造影可显示畸形血管团及其主要供血动脉和引流静脉,并可立体观察畸形血管与邻近结构的关系。MRI平扫可见髓内异常信号,T1WI呈低或等信号,T2WI呈高信号,椎管内外可见大量流空信号,呈迂曲状;肌肉和皮下软组织内可见相似病灶,增强后病变明显强化。DSA行选择性双侧椎动脉、甲状颈干和/或相应节段的肋间动脉及腰动脉造影,可清楚显示病变节段内畸形血管团、增粗扩张的供血动脉和粗大的引流静脉。结论:多排螺旋CT血管造影和MRI能无创、准确地显示Cobb综合征髓内、椎管内外、椎体和软组织内病变的形态及范围,结合皮肤表现可对该病做出确定诊断。     

Percutaneous embolotherapy in life-threatening hemoptysis

Percutaneous embolization of the bronchial arteries to control massive or recurrent hemoptysis has become an accepted procedure, especially in treating patients with chronic pulmonary disease who are poor candidates for lung resection. Nonbronchial systemic collateral arteries and pulmonary arteries may contribute significantly to pulmonary hemorrhage, but embolization of these vessels has not been stressed in recent literature. When embolization of the bronchial artery fails to control hemoptysis, nonbronchial systemic collateral arteries should be embolized. If no systemic collaterals are present, then embolization of segmental pulmonary arteries may prove helpful.