Management of massive hemoptysis and application experience of computer tomography in vascular intervention of hemoptysis_West China Medical Journal

Authors：

LI Shanshan ¹ , LI Haiming ¹ , LI Peijun ² ,  WANG Ye ^1,2

1. Intensive Care Unit, People’s Hospital of Karamay City, Karamay, Xinjiang, 834000, P. R. China;
2. Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

WANG Ye, Email: doctordream0630@163.com

Keywords：

Hemoptysis; Interventional therapy; Computed tomography

DOI：

10.7507/1002-0179.202012107

Video：

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Hemoptysis is a common respiratory emergency, and severe cases can lead to death. Patients with massive hemoptysis need emergency management at the bedside, and fully evaluation for indications and timing of tracheal intubation and transtracheal intervention. When a relatively stable state is achieved, emergency vascular intervention is performed to stop bleeding. CT plays an important role in the risk assessment and interventional treatment of hemoptysis, and it is worthy of clinical promotion and more exploratory research. This article introduces the emergency treatment for massive hemoptysis, the vascular interventional procedure, the exploration of clinical application of preoperative CT, and the clinical application value of CT for hemoptysis risk assessment. It aims to provide a better way to deal with massive hemoptysis and to apply CT to the interventional treatment of hemoptysis more reasonably for clinicians.

Citation： LI Shanshan, LI Haiming, LI Peijun, WANG Ye. Management of massive hemoptysis and application experience of computer tomography in vascular intervention of hemoptysis. West China Medical Journal, 2021, 36(1): 97-101. doi: 10.7507/1002-0179.202012107 Copy

1.	Crocco JA, Rooney JJ, Fankushen DS, et al. Massive hemoptysis. Arch Intern Med, 1968, 121(6): 495-498.
2.	Davidson K, Shojaee S. Managing Massive Hemoptysis. Chest, 2020, 157(1): 77-88.
3.	Lin Y, Chen Z, Yang X, et al. Bronchial and non-bronchial systemic arteries: value of multidetector CT angiography in diagnosis and angiographic embolisation feasibility analysis. J Med Imaging Radiat Oncol, 2013, 57(6): 644-651.
4.	Gupta M, Srivastava DN, Seith A, et al. Clinical impact of multidetector row computed tomography before bronchial artery embolization in patients with hemoptysis: a prospective study. Can Assoc Radiol J, 2013, 64(1): 61-73.
5.	Chalumeau-Lemoine L, Khalil A, Prigent H, et al. Impact of multidetector CT-angiography on the emergency management of severe hemoptysis. Eur J Radiol, 2013, 82(11): e742-e747.
6.	Abdulmalak C, Cottenet J, Beltramo G, et al. Haemoptysis in adults: a 5-year study using the French nationwide hospital administrative database. Eur Respir J, 2015, 46(2): 503-511.
7.	Ittrich H, Bockhorn M, Klose, et al. The diagnosis and treatment of hemoptysis. Dtsch Arztebl Int, 2017, 114(21): 371-381.
8.	Hetzel J, Maldonado F, Ravaglia C, et al. Transbronchial cryobiopsies for the diagnosis of diffuse parenchymal lung diseases: expert statement from the Cryobiopsy Working Group on safety and utility and a call for standardization of the procedure. Respiration, 2018, 95(3): 188-200.
9.	Panda A, Bhalla AS, Goyal A. Bronchial artery embolization in hemoptysis: a systematic review. Diagn Interv Radiol, 2017, 23(4): 307-317.
10.	Corey R, Hla KM. Major and massive hemoptysis: reassessment of conservative management. Am J Med Sci, 1987, 294(5): 301-309.
11.	Ibrahim WH. Massive haemoptysis: the definition should be revised. Eur Respir J, 2008, 32(4): 1131-1132.
12.	Deshwal H, Sinha A, Mehta AC. Life-threatening hemoptysis. (2020-08-30)[2021-01-15]. https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0040-1714386.
13.	Patwa A, Shah A. Anatomy and physiology of respiratory system relevant to anaesthesia. Indian J Anaesth, 2015, 59(9): 533-541.
14.	Kathuria H, Hollingsworth HM, Vilvendhan R, et al. Management of life-threatening hemoptysis. J Intensive Care, 2020, 8: 23.
15.	Gagnon S, Quigley N, Dutau H, et al. Approach to hemoptysis in the modern era. Can Respir J, 2017, 2017: 1565030.
16.	Radchenko C, Alraiyes AH, Shojaee S. A systematic approach to the management of massive hemoptysis. J Thorac Dis, 2017, 9(Suppl 10): S1069-S1086.
17.	Sehgal IS, Dhooria S, Agarwal R, et al. Use of a flexible cryoprobe for removal of tracheobronchial blood clots. Respir Care, 2015, 60(7): e128-e131.
18.	Campos JH. An update on bronchial blockers during lung separation techniques in adults. Anesth Analg, 2003, 97(5): 1266-1274.
19.	Haponik EF, Fein A, Chin R. Managing life-threatening hemoptysis: has anything really changed?. Chest, 2000, 118(5): 1431-1435.
20.	Campos JH, Hallam EA, Van Natta T, et al. Devices for lung isolation used by anesthesiologists with limited thoracic experience: comparison of double-lumen endotracheal tube, Univent torque control blocker, and Arndt wire-guided endobronchial blocker. Anesthesiology, 2006, 104(2): 261-266, discussion 5A.
21.	Yun JS, Song SY, Na KJ, et al. Surgery for hemoptysis in patients with benign lung disease. J Thorac Dis, 2018, 10(6): 3532-3538.
22.	Fei QL, Zhou YY, Yuan YX, et al. An applied anatomical study of bronchial artery. Surg Radiol Anat, 2018, 40(1): 55-61.
23.	Cauldwell EW, Siekert RG. The bronchial arteries; an anatomic study of 150 human cadavers. Surg Gynecol Obstet, 1948, 86(4): 395-412.
24.	Sancho C, Escalante E, Domínguez J, et al. Embolization of bronchial arteries of anomalous origin. Cardiovasc Intervent Radiol, 1998, 21: 300-304.
25.	Cohen AM, Doershuk CF, Stern RC. Bronchial artery embolization to control hemoptysis in cystic fibrosis. Radiology, 1990, 175(2): 401-405.
26.	Zhao T, Wang S, Zheng L, et al. The value of 320-row multidetector ct bronchial arteriography in recurrent hemoptysis after failed transcatheter arterial embolization. J Vasc Interv Radiol, 2017, 28(4): 533-541.e1.
27.	Abdul Jabbar A, Patel A, Marzlin N, et al. Internal mammary artery-to-pulmonary vasculature fistula: systematic review of case reports. Vasc Med, 2017, 22(5): 426-431.
28.	Han K, Yoon KW, Kim JH, et al. Bronchial artery embolization for hemoptysis in primary lung cancer: a retrospective review of 84 patients. J Vasc Interv Radiol, 2019, 30(3): 428-434.
29.	Li PJ, Yu H, Wang Y, et al. Multidetector computed tomography angiography prior to bronchial artery embolization helps detect culprit ectopic bronchial arteries and non-bronchial systemic arteries originating from subclavian and internal mammary arteries and improve hemoptysis-free early survival rate in patients with hemoptysis. Eur Radiol, 2019, 29(4): 1950-1958.

1. Crocco JA, Rooney JJ, Fankushen DS, et al. Massive hemoptysis. Arch Intern Med, 1968, 121(6): 495-498.
2. Davidson K, Shojaee S. Managing Massive Hemoptysis. Chest, 2020, 157(1): 77-88.
3. Lin Y, Chen Z, Yang X, et al. Bronchial and non-bronchial systemic arteries: value of multidetector CT angiography in diagnosis and angiographic embolisation feasibility analysis. J Med Imaging Radiat Oncol, 2013, 57(6): 644-651.
4. Gupta M, Srivastava DN, Seith A, et al. Clinical impact of multidetector row computed tomography before bronchial artery embolization in patients with hemoptysis: a prospective study. Can Assoc Radiol J, 2013, 64(1): 61-73.
5. Chalumeau-Lemoine L, Khalil A, Prigent H, et al. Impact of multidetector CT-angiography on the emergency management of severe hemoptysis. Eur J Radiol, 2013, 82(11): e742-e747.
6. Abdulmalak C, Cottenet J, Beltramo G, et al. Haemoptysis in adults: a 5-year study using the French nationwide hospital administrative database. Eur Respir J, 2015, 46(2): 503-511.
7. Ittrich H, Bockhorn M, Klose, et al. The diagnosis and treatment of hemoptysis. Dtsch Arztebl Int, 2017, 114(21): 371-381.
8. Hetzel J, Maldonado F, Ravaglia C, et al. Transbronchial cryobiopsies for the diagnosis of diffuse parenchymal lung diseases: expert statement from the Cryobiopsy Working Group on safety and utility and a call for standardization of the procedure. Respiration, 2018, 95(3): 188-200.
9. Panda A, Bhalla AS, Goyal A. Bronchial artery embolization in hemoptysis: a systematic review. Diagn Interv Radiol, 2017, 23(4): 307-317.
10. Corey R, Hla KM. Major and massive hemoptysis: reassessment of conservative management. Am J Med Sci, 1987, 294(5): 301-309.
11. Ibrahim WH. Massive haemoptysis: the definition should be revised. Eur Respir J, 2008, 32(4): 1131-1132.
12. Deshwal H, Sinha A, Mehta AC. Life-threatening hemoptysis. (2020-08-30)[2021-01-15]. https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0040-1714386.
13. Patwa A, Shah A. Anatomy and physiology of respiratory system relevant to anaesthesia. Indian J Anaesth, 2015, 59(9): 533-541.
14. Kathuria H, Hollingsworth HM, Vilvendhan R, et al. Management of life-threatening hemoptysis. J Intensive Care, 2020, 8: 23.
15. Gagnon S, Quigley N, Dutau H, et al. Approach to hemoptysis in the modern era. Can Respir J, 2017, 2017: 1565030.
16. Radchenko C, Alraiyes AH, Shojaee S. A systematic approach to the management of massive hemoptysis. J Thorac Dis, 2017, 9(Suppl 10): S1069-S1086.
17. Sehgal IS, Dhooria S, Agarwal R, et al. Use of a flexible cryoprobe for removal of tracheobronchial blood clots. Respir Care, 2015, 60(7): e128-e131.
18. Campos JH. An update on bronchial blockers during lung separation techniques in adults. Anesth Analg, 2003, 97(5): 1266-1274.
19. Haponik EF, Fein A, Chin R. Managing life-threatening hemoptysis: has anything really changed?. Chest, 2000, 118(5): 1431-1435.
20. Campos JH, Hallam EA, Van Natta T, et al. Devices for lung isolation used by anesthesiologists with limited thoracic experience: comparison of double-lumen endotracheal tube, Univent torque control blocker, and Arndt wire-guided endobronchial blocker. Anesthesiology, 2006, 104(2): 261-266, discussion 5A.
21. Yun JS, Song SY, Na KJ, et al. Surgery for hemoptysis in patients with benign lung disease. J Thorac Dis, 2018, 10(6): 3532-3538.
22. Fei QL, Zhou YY, Yuan YX, et al. An applied anatomical study of bronchial artery. Surg Radiol Anat, 2018, 40(1): 55-61.
23. Cauldwell EW, Siekert RG. The bronchial arteries; an anatomic study of 150 human cadavers. Surg Gynecol Obstet, 1948, 86(4): 395-412.
24. Sancho C, Escalante E, Domínguez J, et al. Embolization of bronchial arteries of anomalous origin. Cardiovasc Intervent Radiol, 1998, 21: 300-304.
25. Cohen AM, Doershuk CF, Stern RC. Bronchial artery embolization to control hemoptysis in cystic fibrosis. Radiology, 1990, 175(2): 401-405.
26. Zhao T, Wang S, Zheng L, et al. The value of 320-row multidetector ct bronchial arteriography in recurrent hemoptysis after failed transcatheter arterial embolization. J Vasc Interv Radiol, 2017, 28(4): 533-541.e1.
27. Abdul Jabbar A, Patel A, Marzlin N, et al. Internal mammary artery-to-pulmonary vasculature fistula: systematic review of case reports. Vasc Med, 2017, 22(5): 426-431.
28. Han K, Yoon KW, Kim JH, et al. Bronchial artery embolization for hemoptysis in primary lung cancer: a retrospective review of 84 patients. J Vasc Interv Radiol, 2019, 30(3): 428-434.
29. Li PJ, Yu H, Wang Y, et al. Multidetector computed tomography angiography prior to bronchial artery embolization helps detect culprit ectopic bronchial arteries and non-bronchial systemic arteries originating from subclavian and internal mammary arteries and improve hemoptysis-free early survival rate in patients with hemoptysis. Eur Radiol, 2019, 29(4): 1950-1958.

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