Multidetector CT angiography (MDCTA) allows for appropriate endovascular treatment of severe hemoptysis of pulmonary arterial origin, according to a report in the January issue of Chest. by Will Boggs, MD

Multidetector CT angiography (MDCTA) allows for appropriate endovascular treatment of severe hemoptysis of pulmonary arterial origin, according to a report in the January issue of Chest.

"MDCTA helps to diagnose, to localize, and to plan" the treatment by interventional radiologists of such very ill patients, Dr. Antoine Khalil told Reuters Health.

Dr. Khalil from Tenon Hospital in Paris, France, and colleagues assessed the thoracic MDCTA signs and role in patients with severe hemoptysis of pulmonary arterial origin in 13 patients admitted to the ICU for bronchial artery embolization.

MDCTA signs of hemoptysis of pulmonary arterial origin included pulmonary artery pseudoaneurysms, pulmonary artery in the inner wall cavity, multiple pulmonary artery aneurysms associated with pulmonary artery occlusion due to systemic disease, and isolated pulmonary artery aneurysm in one patient with Behçet disease, the authors report.

Pulmonary artery vasoocclusion in patients with pulmonary artery aneurysm or pseudoaneurysm was performed with bronchial artery embolization in one patient and without bronchial artery embolization in five patients. Pulmonary artery vasoocclusion was also performed in three patients with a pulmonary artery in the wall of the cavity.

Isolated treatment by pulmonary artery vasoocclusion was effective in five patients, all of whom had a bronchial artery of normal size, the researchers note.

"In our institution, MDCTA is used routinely during the first hours after admittance to manage patients who have been referred to the RICU for treatment of hemoptysis," the investigators say. "In our series, MDCTA findings influenced disease management and spared patients from undergoing systematic bronchial arteriography."

"The MDCT provides a good compromise between spatial and time resolution and safety for patient management," Dr. Khalil explained. "The other modalities, including MRI or chest x-ray, are not specific or sensitive for severe hemoptysis of pulmonary arterial origin."

"MDCTA should be considered prior to endovascular treatment because it allows for the correct identification and early management of patients with hemoptysis of pulmonary origin," the authors conclude. "Furthermore, MDCTA guides endovascular treatment by showing the precise bleeding site for accurate superselective vasoocclusion."


Source: Reuters