Severe hemoptysis of pulmonary arterial origin: signs and role of multidetector row CT angiography |
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Authors: | Khalil Antoine Parrot Antoine Nedelcu Cosmina Fartoukh Muriel Marsault Claude Carette Marie-France |
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Affiliation: | 1. Radiology Department, Assistance Publique-Hôpitaux de Paris, Tenon Hospital, Paris, France;2. Respiratory Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Tenon Hospital, Paris, France.;1. Division of Cardiothoracic Surgery, The Children''s Hospital of Philadelphia, Philadelphia, Pennsylvania;2. Division of Cardiology, The Children''s Hospital of Philadelphia, Philadelphia, Pennsylvania;1. Institute of Interventional Radiology, West China Hospital, Sichuan University, Chengdu 610041, China;2. Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu 610041, China;3. Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China;1. Department of Thoracic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People''s Republic of China;2. Department of Pathology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People''s Republic of China;3. Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX;4. Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX;1. Hôpital de la Timone, 264 Rue Saint Pierre, 13005 Marseille, France;2. Hôpital Pellegrin, Bordeaux, France;3. Hôpital Nord, Marseille, France;4. Hôpital d''instruction des armées Laveran, Marseille, France;5. Institut Paoli Calmettes, Marseille, France;1. Department of diagnostic Radiology, Hospital Clínico San Carlos, Madrid, Spain;2. Department of Interventional Radiology, Hospital Clínico San Carlos, Madrid, Spain;1. Pediatric Heart Center, Children’s Hospital of Fudan University, 399 Wanyuan Rd., Minhang, Shanghai 201102, China;2. Respiratory Department, Children’s Hospital of Fudan University, 399 Wanyuan Rd., Minhang, Shanghai 201102, China;3. Department of Pediatric Cardiology, Royal Hospital for Children, Glasgow, Scotland |
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Abstract: | BACKGROUND: Hemoptysis of pulmonary arterial origin is a diagnostic challenge in patients admitted to a respiratory ICU (RICU) for treatment of hemoptysis. Its early accurate recognition and treatment reduce morbidity and prevent mortality. Multidetector row CT angiography (MDCTA) is an accurate method for imaging the systemic vascular network. Our aim was to assess the MDCTA signs and role in managing hemoptysis of pulmonary arterial origin. METHODS: We performed a retrospective clinical and radiologic analysis of all consecutive patients who were referred for severe hemoptysis to our RICU and were treated by endovascular means between January 2004 and December 2006. We reviewed all of those cases with hemoptysis of pulmonary arterial origin. RESULTS: Of 272 patients who were referred for severe hemoptysis to the RICU, 189 patients were treated by endovascular means. Thirteen patients (nine men, four women; mean age, 45 years) had hemoptysis of pulmonary arterial origin. Signs of pulmonary arterial hemoptysis seen on MDCTA were of the following three types: pseudoaneurysm (n = 5); aneurysm of the pulmonary artery (n = 3); or the presence of a pulmonary artery in the inner wall of a cavity (n = 5). Hypertrophy of the bronchial arteries seen on MDCTA associated with any of these signs predicted the necessity to treat both the bronchial and pulmonary arteries. Pulmonary artery vasoocclusion was performed as a first treatment in eight patients with such an association (n = 1) or without such an association (n = 7) along with bronchial artery embolization. The remaining five patients were treated with systemic artery embolization, followed by surgery (n = 1), pulmonary artery vasoocclusion (n = 3), and death from massive hemoptysis (n = 1). CONCLUSIONS: MDCTA performed prior to endovascular treatment allows the correct identification and early appropriate management of severe hemoptysis of pulmonary arterial origin. |
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Keywords: | Behçet disease CT scan hemoptysis pulmonary artery tuberculosis BAE" },{" #name" :" keyword" ," $" :{" id" :" cekeyw70" }," $$" :[{" #name" :" text" ," _" :" bronchial artery embolization MDCTA" },{" #name" :" keyword" ," $" :{" id" :" cekeyw90" }," $$" :[{" #name" :" text" ," _" :" multidetector CT angiography NBSA" },{" #name" :" keyword" ," $" :{" id" :" cekeyw110" }," $$" :[{" #name" :" text" ," _" :" nonbronchial systemic artery PAA" },{" #name" :" keyword" ," $" :{" id" :" cekeyw130" }," $$" :[{" #name" :" text" ," _" :" pulmonary artery aneurysm PAPA" },{" #name" :" keyword" ," $" :{" id" :" cekeyw150" }," $$" :[{" #name" :" text" ," _" :" pulmonary artery pseudoaneurysm RICU" },{" #name" :" keyword" ," $" :{" id" :" cekeyw170" }," $$" :[{" #name" :" text" ," _" :" respiratory ICU |
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