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MDCTA Identifies Hemoptysis of Pulmonary Arterial Origin

February 6, 2008
Written by: , Filed in: Chest Radiology
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The objective of a recent study was to evaluate the role of multidetector row CT angiography (MDCTA) in evaluating patients with hemoptysis of pulmonary arterial origin.

The study has concluded that MDCTA can determine that the cause of massive hemoptysis may be of pulmonary arterial origin.

Participants
272 patients who had severe hemoptysis, including 189 patients who underwent endovascular treatment participated in this retrospective study.

Methodology
All patients underwent chest radiography, bronchoscopy, and MDCTA. The etiology of hemoptysis was determined from history, physical examination, chest radiography, bronchoscopy, MDCTA, microbiology, histology, and outcome. CTs were performed with a 16-slice MDCT scanner with IV contrast. Pulmonary parenchymal consolidation and ground-glass opacity was considered the site of bleeding.

Signs that the hemoptysis was of pulmonary arterial origin were the presence of a pulmonary artery aneurysm (PAA), a pulmonary artery pseudoaneurysm (PAPA), an air bubble within a PAA, or a pulmonary artery in the inner aspect of the wall of a cavity in the site of pulmonary parenchymal hemorrhage.

A pulmonary artery in the inner aspect of a wall of a cavity was considered the cause of hemoptysis if there was extravasation of contrast during invasive pulmonary angiography, if there was recurrent hemoptysis despite embolization of systemic arteries, and/or if there was pathologic confirmation.

A PAA was considered present if there was focal dilatation of the pulmonary artery without adjacent lung or tumor necrosis. A PAPA was considered present if there was focal dilatation of the pulmonary artery within an area of lung or tumor necrosis. Bronchial arteries were considered dilated if they measured >1.5 mm in diameter.

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Results of the Study
13 patients had hemoptysis of pulmonary arterial origin. Signs of pulmonary arterial origin as seen on MDCTA included PAPA (n=5), pulmonary artery seen in the inner aspect of the wall of a cavity (n=5), and PAA (n=3).

Of the three patients with PAA, two also had an air bubble within the PAA. Seven of 13 patients also had hypertrophy of the bronchial arteries. Signs of pulmonary arterial origin associated with bronchial artery hypertrophy predicted the need for both pulmonary artery and bronchial artery endovascular treatment.

Conclusions
MDCTA can correctly identify whether hemoptysis is of pulmonary arterial origin and can help guide therapy.

Reviewer’s Comments
The authors have demonstrated that MDCTA is very helpful in evaluating patients with massive hemoptysis due to its potential to identify the arterial source of bleeding.

Author: Vineet R. Jain, MD

Reference:
Khalil A, Parrot A, et al. Severe Hemoptysis of Pulmonary Arterial Origin: Signs and Role of Multidetector Row CT Angiography.
Chest; 2008; 133 (January): 212-219

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