Abstract
Hemoptysis can be a life-threatening respiratory emergency and indicates potentially serious underlying intrathoracic disease. Large-volume hemoptysis carries significant mortality and warrants urgent investigation and intervention. Initial assessment by chest radiography, bronchoscopy, and computed tomography (CT) is useful in localizing the bleeding site and identifying the underlying cause. Multidetector CT angiography is a relatively new imaging technique that allows delineation of abnormal bronchial and nonbronchial arteries using reformatted images in multiple projections, which can be used to guide therapeutic arterial embolization procedures. Bronchial artery embolization (BAE) is now considered to be the most effective procedure for the management of massive and recurrent hemoptysis, either as a first-line therapy or as an adjunct to elective surgery. It is a safe technique in the hands of an experienced operator with knowledge of bronchial artery anatomy and the potential pitfalls of the procedure. Recurrent bleeding is not uncommon, especially if there is progression of the underlying disease process. Prompt repeat embolization is advised in patients with recurrent hemoptysis in order to identify nonbronchial systemic and pulmonary arterial sources of bleeding. This article reviews the pathophysiology and causes of hemoptysis, diagnostic imaging and therapeutic options, and technique and outcomes of BAE.
Similar content being viewed by others
References
Haponik EF, Fein A, Chin R (2000) Managing life-threatening hemoptysis: has anything really changed? Chest 118:1431–1435
Crocco JA, Rooney JJ, Fankushen DS et al (1968) Massive hemoptysis. Arch Intern Med 121:495–498
Najarian KE, Morris CS (1998) Arterial embolization in the chest. J Thorac Imaging 13:93–104
Fernando HC, Stein M, Benfield JR et al (1998) Role of bronchial artery embolization in the management of hemoptysis. Arch Surg 133:862–866
Pump K (1972) Distribution of bronchial arteries in human lung. Chest 62:447–451
Deffebach ME, Charan NB, Lakshminarayan S et al (1987) The bronchial circulation: small but a vital attribute to the lung. Am Rev Respir Dis 135:463–481
Malik AB, Tracy SE (1980) Bronchovascular adjustments after pulmonary embolism. J Appl Physiol 49:476–481
Ferris EJ (1981) Pulmonary hemorrhage. Vascular evaluation and interventional therapy. Chest 80:710–714
Marshall TJ, Jackson JE (1997) Vascular intervention in the thorax: bronchial artery embolization for haemoptysis. Eur Radiol 7:1221–1227
McDonald DM (2001) Angiogenesis and remodeling of airway vasculature in chronic inflammation. Am J Respir Crit Care Med 164:S39–S45
Yoon W, Kim JK, Kim YH et al (2002) Bronchial and nonbronchial systemic artery embolization for life-threatening hemoptysis: a comprehensive review. Radiographics 22:1395–1409
Jean–Baptiste E (2000) Clinical assessment and management of massive hemoptysis. Crit Care Med 28:1642–1647
Hirshberg B, Biran I, Glazer M et al (1997) Hemoptysis: etiology, evaluation and outcome in a tertiary referral hospital. Chest 112:440–444
Hiyama J, Horita N, Shiota Y et al (2002) Cryptogenic hemoptysis and smoking. Chest 121:1375–1376
Bruzzi JF, Rémy-Jardin M, Delhaye D et al (2006) Multi-detector row CT of hemoptysis. Radiographics 26:3–22
Dweik RA, Stoller JK (1999) Role of bronchoscopy in massive hemoptysis. Clin Chest Med 20:89–105
Hsiao EI, Kirsch CM, Kagawa FT et al (2001) Utility of fibre-optic bronchoscopy before bronchial artery embolization for massive hemoptysis. AJR 177:861–867
Herth F, Ernst A, Becker HD (2001) Long-term outcome and lung cancer incidence in patients with hemoptysis of unknown origin. Chest 120:1592–1594
Abal AT, Nair PC, Cherian J (2001) Haemoptsis: aetiology, evaluation and outcome—a prospective study in a third world country. Respir Med 95:548–552
Song JW, Im JG, Shim YS et al (1998) Hypertrophied bronchial artery at thin-section CT in patients with bronchiectasis: correlation with CT angiographic findings. Radiology 208:187–191
Do KH, Goo JM, Im JG et al (2001) Systemic arterial supply to the lungs in adults: spiral CT findings. Radiographics 21:387–402
Yoon W, Kim YH, Kim JK et al (2003) Massive hemoptysis: prediction of nonbronchial systemic arterial supply with chest CT. Radiology 227:232–238
Remy-Jardin M, Bouaziz N, Dumont P et al (2004) Bronchial and nonbronchial systemic arteries at multi-detector row CT angiography: comparison with conventional angiography. Radiology 233:741–749
Hartmann IJ, Remy-Jardin M, Menchini L et al (2007) Ectopic origin of bronchial arteries: assessment with multidetector helical CT angiography. Eur Radiol 17:1943–1953
Chung MJ, Lee JH, Lee KS et al (2006) Bronchial and nonbronchial systemic arteries in patients with hemoptysis: depiction on MDCT angiography. AJR 186:649–655
Yoon YC, Lee KS, Jeong YJ et al (2005) Hemoptysis: bronchial and nonbronchial systemic arteries at 16-detector row CT. Radiology 234:292–298
Khalil A, Fartoukh M, Tassart M et al (2007) Role of MDCT in identification of the bleeding site and the vessels causing hemoptysis. AJR 188:W117–W125
Garzon AA, Gourin A (1978) Surgical management of massive hemoptysis: a ten-year experience. Ann Surg 187:267–271
Garzon AA, Cerruti M, Gourin A et al (1970) Pulmonary resection for massive hemoptysis. Surgery 67:633–638
Shigemura N, Wan IY, Yu SC et al (2009) Multidisciplinary management of life–threatening massive hemoptysis: a 10-year experience. Ann Thorac Surg 87:849–853
Remy J, Arnaud A, Fardou H et al (1977) Treatment of hemoptysis by embolization of bronchial arteries. Radiology 122:33–37
Uflacker R, Kaemmerer A, Picon PD et al (1985) Bronchial artery embolization in the management of hemoptysis: technical aspects and long-term results. Radiology 157:637–644
Rabkin JE, Astafjev VI, Gothman LN et al (1987) Transcatheter embolization in the management of pulmonary hemorrhage. Radiology 163:361–365
Katoh O, Kishikawa T, Yamada H et al (1990) Recurrent bleeding after arterial embolization in patients with hemoptysis. Chest 97:541–546
Hayakawa K, Tanaka F, Torizuka T et al (1992) Bronchial artery embolization for hemoptysis: immediate and long-term results. CardioVasc Interv Radiol 15:154–158
Ramakantan R, Bandekar VG, Gandhi MS et al (1996) Massive hemoptysis due to pulmonary tuberculosis: control with bronchial artery embolization. Radiology 200:694
Mal H, Rullon I, Mellot F et al (1999) Immediate and long-term results of bronchial artery embolization for life-threatening hemoptysis. Chest 115:996–1001
Swanson KL, Johnson M, Prakash UB et al (2002) Bronchial artery embolization: experience with 54 patients. Chest 121:789–795
Poyanli A, Acunas B, Rozanes I et al (2007) Endovascular therapy in the management of moderate and massive haemoptysis. Br J Radiol 80:331–336
Williams JR, Wilcox WC, Burns RR (1963) Angiography of the systemic pulmonary circulation. Am J Roentgenol AJR 90:614–627
Neyazaki T (1962) A method for arteriography of the bronchial artery. Jpn Heart J 3:523–536
Viamonte M Jr (1964) Selective bronchial arteriography in man: preliminary report. Radiology 83:830–839
Feigelson HH, Ravin HA (1965) Transverse myelitis following selective bronchial arteriography. Radiology 85:663–665
Kardjiev V, Symeonov A, Chankov I (1974) Etiology, pathogenesis and prevention of spinal cord lesions in selective angiography of the bronchial and intercostal arteries. Radiology 112:81–83
Di Chiro G (1974) Unintentional spinal cord arteriography: a warning. Radiology 112:231–233
Remy J, Voisin C, Dupuis C et al (1974) Traitement des hemoptysies par embolization de la circulation systemique. Ann Radiol (Paris) 17:5–16
Uflacker R, Kaemmerer A, Neves C et al (1983) Management of massive hemoptysis by bronchial artery embolization. Radiology 146:627–634
Brinson GM, Noone PG, Mauro MA et al (1998) Bronchial artery embolization for the treatment of hemoptysis in patients with cystic fibrosis. Am J Respir Crit Care Med 157:1951–1958
Yu-Tang Goh P, Lin M, Teo N et al (2002) Embolization for hemoptysis: a six-year review. CardioVasc Interv Radiol 25:17–25
Kato A, Kudo S, Matsumoto K et al (2000) Bronchial artery embolization for hemoptysis due to benign diseases: immediate and long-term results. CardioVasc Interv Radiol 23:351–357
Cauldwell EW, Siekert RG, Lininger RE et al (1948) The bronchial arteries: an anatomic study of 150 human cadavers. Surg Gynecol Obstet 86:395–412
Botenga AS (1968) The role of bronchopulmonary anastomoses in chronic inflammatory processes of the lung. Selective arteriographic investigation. Am J Roentgenol Radium Ther Nucl Med 104:829–837
Sancho C, Escalante E, Dominguez J et al (1998) Embolization of bronchial arteries of anomalous origin. CardioVasc Interv Radiol 21:300–304
Stoll JF, Bettmann MA (1988) Bronchial artery embolization to control hemoptysis: a review. CardioVasc Interv Radiol 11:263–269
Keller FS, Rosch J, Loflin TG et al (1987) Nonbronchial systemic collateral arteries: significance in percutaneous embolotherapy for hemoptysis. Radiology 164:692
Remy J, Lemaitre L, Lafitte JJ et al (1984) Massive hemoptysis of pulmonary arterial origin: diagnosis and treatment. AJR 143:963–969
Sbano H, Mitchell AW, Ind PW et al (2005) Peripheral pulmonary artery pseudoaneurysms and massive hemoptysis. AJR 184:1253–1259
Muthuswamy PP, Akbik F, Franklin C et al (1987) Management of major or massive hemoptysis in active tuberculosis by bronchial artery embolization. Chest 92:77–82
Picard C, Parrot A, Boussard V et al (2003) Massive hemoptysis due to Rasmussen aneurysm: detection with helocoidal CT angiography and successful coil embolization. Intensive Care Med 29:1837–1839
Auerbach O (1939) Pathology and pathogenesis of pulmonary artery aneurysm in tuberculous cavity. Am Rev Tuberc 39:99–115
Ference BA, Shannon TM, White RI Jr et al (1994) Life-threatening pulmonary hemorrhage with pulmonary arteriovenous malformations and hereditary hemorrhagic telangectasia. Chest 106:1387–1390
White RI Jr, Pollak JS, Wirth JA (1996) Pulmonary arteriovenous malformations: diagnosis and transcatheter embolotherapy. J Vasc Interv Radiol 7:787–804
Pollak JS, Saluja S, Thabet A et al (2006) Clinical and anatomic outcomes after embolotherapy of pulmonary arteriovenous malformations. J Vasc Interv Radiol 17:35–44
Andersen PE (2006) Imaging and interventional radiological treatment of hemoptysis. Acta Radiol 47:780–792
Phillips S, Ruttley MS (2000) Bronchial artery embolization: the importance of preliminary thoracic angiography. Clin Radiol 55:317–319
Tanaka N, Yamakado K, Murashima S et al (1997) Superselective bronchial artery embolization for hemoptysis with a coaxial microcatheter system. J Vasc Interv Radiol 8:65–70
White RI Jr (1999) Bronchial artery embolotherapy for control of acute hemoptysis: analysis of outcome. Chest 115:912–915
Corr PD (2005) Bronchial artery embolization for life-threatening hemoptysis using tris-acryl microspheres: short-term result. Cardiovasc Interv Radiol 28:439–441
Baltacioglu F, Cimsit NC, Bostanci K, et al. (2008) Transarterial microcatheter glue embolization of the bronchial artery for life-threatening hemoptysis: technical and clinical results. Eur J Radiol [Epub ahead of print]
Chun JY, Belli AM (2009) Immediate and long-term outcomes of bronchial and non-bronchial systemic artery embolisation for the management of haemoptysis. Eur Radiol [Epub ahead of print]
Park HS, Kim YI, Kim HY et al (2007) Bronchial artery and systemic artery embolization in the management of primary lung cancer patients with hemoptysis. Cardiovasc Interv Radiol 30:638–643
Lee S, Chan JW, Chan SC et al (2008) Bronchial artery embolisation can be equally safe and effective in the management of chronic recurrent haemoptysis. Hong Kong Med J 14:14–20
Kim YG, Yoon HK, Ko GY et al (2006) Long-term effect of bronchial artery embolization in Korean patients with haemoptysis. Respirology 11:776–781
Osaki SI, Nakanishi Y, Wataya H et al (2000) Prognosis of bronchial artery embolization in the management of hemoptysis. Respiration 67:412–416
Tonkin IL, Hanissian AS, Boulden TF et al (1991) Bronchial arteriography and embolotherapy for hemoptysis in patients with cystic fibrosis. CardioVasc Interv Radiol 14:241–246
Cohen AM, Doershuk CF, Stern RC (1990) Bronchial artery embolization to control hemoptysis in cystic fibrosis. Radiology 175:401–405
Wong ML, Szkup P, Hopley MJ (2002) Percutaneous embolotherapy for life-threatening hemoptysis. Chest 121:95–102
Girard P, Baldeyrou P, Lemoine G et al (1990) Left mainstem bronchial artery stenosis complicating bronchial artery embolization. Chest 97:1246–1248
Lemoigne F, Rampal P, Petersen R (1983) Fatal ischaemic colitis after bronchial artery embolization. Presse Med 12:2056–2057
Munk PL, Morris DC, Nelems B (1990) Left main bronchial-esophageal fistula: a complication of bronchial artery embolization. Cardiovasc Interv Radiol 13:95–97
Liu SF, Lee TY, Wong SL et al (1998) Transient cortical blindness: a complication of bronchial artery embolization. Respir Med 92:983–986
Ivanick MJ, Thorwarth W, Donohue J et al (1983) Infarction of the left main-stem bronchus: a complication of bronchial artery embolization. AJR 141:535–537
Ackowledgment
We would like to thank Dr. Robin Swain for his assistance in the preparation of this manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Chun, JY., Morgan, R. & Belli, AM. Radiological Management of Hemoptysis: A Comprehensive Review of Diagnostic Imaging and Bronchial Arterial Embolization. Cardiovasc Intervent Radiol 33, 240–250 (2010). https://doi.org/10.1007/s00270-009-9788-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00270-009-9788-z