Imaging and interventional radiological treatment of hemoptysis

Abstract

Hemoptysis is coughing up blood originating from the lower respiratory tract. There are multiple causes of hemoptysis, from airway diseases, parenchymal diseases, cardiovascular diseases, and other causes. Hemoptysis may cease temporarily, but a possible life-threatening condition may still be present, requiring complete evaluation and probably treatment. Massive hemoptysis (>300 ml blood in 24 hours) seldom occurs but has high mortality. Diagnostic examinations include patient history, physical examination, bronchoscopy, laboratory tests, chest X-ray, computed tomography (CT) of the chest, pulmonary angiography, aortography, and angiography of the bronchials and other thoracic systemic arteries. Bronchoscopy together with clinical and radiological examinations indicates from which part of the lung the bleeding is occurring, yet the cause of hemoptysis cannot be determined in 20–30% of cases. One of the therapeutic measurements may be embolization of the bleeding vessel such as in pulmonary arteriovenous malformations or in bronchial or other systemic arterial branches supplying the bleeding lung segment. Systemic bronchial and non-bronchial collateral artery anatomy is very complex and variable, and it may be difficult to recognize how the systemic arteries or pulmonary arteries may be involved as a source of bleeding. Interventional treatments are effective and safe therapeutic methods which reduce the need for acute thoracic surgery. Embolization may be life saving, or it may postpone surgery and, in some situations, should be the treatment of choice.