Causes for hemoptysis

Chronic inflammations
Infections
Tuberculosis
Fungal infections (e.g., aspergillosis)
Abscess
Pneumonia
Inflammatory states
Sarcoidosis
Wegener granulomatosis
Cystic fibrosis
Bronchiectasis
Pulmonary artery causes
Pulmonary artery stenosis/occlusions: congenital or acquired
Pulmonary arteriovenous malformation
Pulmonary artery pseudoaneurysm
Neoplasms 2
 Noninvasive imaging
Multidetector (MDCT) angiography is an important potential diagnostic modality for the accurate and
prompt diagnosis of the underlying vascular disorder because it provides a map of these vascular
structures.
In adults, the normal diameter of bronchial arteries is less than 1.5 mm at their origin and 0.5 mm at the
point of entry into the bronchopulmonary segment. Arteries that are 2 mm and larger in diameter on a CT
scan are considered to be abnormal.
Alternative arterial supply of the lung from Non-bronchial systemic arteries (NBSAs). They are
differentiated by their courses. NBSAs enter the pulmonary parenchyma through adherent pleura or via
the pulmonary ligament, and their course is not parallel to the bronchi.
Non-bronchial systemic arterial supply to the lung must be kept in mind when the pleural thickness is
greater than 3 mm and when enlarged and tortuous enhancing arteries are detected within the
extrapleural fat.

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Noninvasive imaging

Multidetector CT of bronchial and non-bronchial systemic arteries, Diagn Interv Radiol 2011; 17:1017 4
Branching pattern / Cauldwell/

Type 1 , two bronchial arteries on the left and one bronchial artery on the right that present as an
intercostobronchial trunk (ICBT) (40.6%).
Type 2 , one bronchial artery on the left and one ICBT on the right (21%).
Type 3 , two bronchial arteries on the left and two bronchial arteries on the right (one ICBT and one
bronchialartery) (20%).
Type 4 , one bronchial artery on the left and two bronchial arteries on the right (one ICBT and one
bronchial artery) (9.7%).
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 Technique
Ideally, distal embolization should be performed but should not affect the capillary bed of the bronchus.
Particles greater than 200 to 250 mm should be used to avoid tissue ischemia and neurologic damage.
Currently, polyvinyl alcohol (PVA) particles in the size range of 300 to 500 mm are commonly used with
good results.
Other embolic agents used include Gelfoam (Upjohn, alamazoo, MI) pledgets (1 to 2 mm), Gelfoam
slurry, thrombin, and glue.
The authors believe the recently approved embospheres and spherical PVA also will be effective in this
application.
Proximal occlusion with large particles or coils should be avoided if possible. Proximal occlusion affords
only very temporary relief because collateral pathways readily develop.
Very small particles (less than 200 mm) or liquid embolic agents should always be avoided because
these cause tissue infarction.

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Case 1
8-year-old girl
Admitted with hemoptysis and nose bleeding
Evaluated by ORL and prescribed therapy at home
Readmitted the day after with massive hemoptysis
No prior history of pulmonary or cardiac disorders.
Normal gastrointestinal tract endoscopy with no clear bleeding source
Aspiration of blood from the intubation tube
Anterior and posterior tamponade was placed

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Case1 / Medical status
Intubated patient
Febrile
Skin : reduced elasticity without rashes
Lymph nodes : NAD
Cardiovascular system : NAD , rhythmic heartbeat, clear heart tones without murmurs
Respiratory system : symmetrical chest , vesicular breathing strongly reduced to
absent in the right side.
Gastrointestinal system : NAD
Genitourinary system : NAD
Blood pressure : 140/80

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Case1 / Chest X-ray

day of admission Right basal consolidation 2 days after embolization

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Case 1 / Diagnostic angiography

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Case1 / Embolization PAV particles 700 m

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Postprocedure chest X-ray

The procedure was well tolerated

and, as a result, high clinical
success was achieved in localizing
and managing the bleeding.

The patient was discharged with no

further complications with
recommendations for reduced
physical effort.

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Case 2
Male, 18 Y old
03.2014 febrile with body temperature - 39,2
Progressing astenoadynamy
Th / BSAnts for 7 days
Addmited in 10 days
LAB - anemia, thrombocytopnenia, hepatosplenomegaly

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Case 2

In 2 days massive hemoptysis

Respiratory rate -50/min , HR
-120/min
Intubated

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Case 2

Embolization / gelspon particles + contrast

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Case 2

Day after embolization In 2 weeks

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Case 2

Final Dg: Hepatosplenic gamma-delta T-cell lymphoma

Splenectomy - 12.05.2014
Hyper CVAD x 2
Progressing hepatomegaly
Died in 4 months 07.2014

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 Conclusions
Major hemoptysis is a frightening and potentially fatal complication of a
variety of chronic inflammatory conditions of the lung.
Bronchial artery embolization is a well-established and well-tolerated
procedure. It comes with a better outcome than conservative, surgical, or
bronchoscopic techniques, especially when facing an acute massive
hemoptysis .
It is a lifesaving procedure performed on emergency medical situations.
Recurrent hemoptysis also can be successfully controlled with
embolization. Therefore, despite a prior history of bleeding and prior
embolization procedures, no patient should be denied the opportunity for
additional transcatheter therapy.

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Thank you for you attention!

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