, Volume 190, Issue 2, pp 221–225 | Cite as

Preprocedural Planning with Prospectively Triggered Multidetector Row CT Angiography Prior to Bronchial Artery Embolization in Cystic Fibrosis Patients with Massive Hemoptysis

  • Don HayesJr.Email author
  • Michael A. Winkler
  • Stephen Kirkby
  • Patrizio Capasso
  • Heidi M. Mansour
  • Anil K. Attili


Study Objectives

The aim of this study was to determine if electrocardiographically synchronized, prospectively triggered multidetector row computed tomography (ECG-MDR-CT) angiography of the aorta can accurately predict the location of ectopic bronchial arteries in patients with cystic fibrosis (CF) with massive hemoptysis prior to bronchial artery embolization (BAE).

Design and Setting

The study was a prospective, observational study from September 1, 2009 to June 30, 2011, conducted at a university hospital with an adult CF center.


The study included adult CF patients with massive hemoptysis.


A total of four adult patients (mean [± SD] age = 31.5 ± 7.9 years) with CF and massive hemoptysis underwent ECG-MDR-CT angiography. The location of the bleeding source was predicted in each case based on lung pathology observed on ECG-MDR-CT angiography. All four patients eventually required BAE without the need for conventional aortograms since the locations of the bronchial arteries were determined prior to the procedure. Review of lung pathology and arterial networks from the ECG-MDR-CT angiography data limited the number of selective catheterizations necessary to complete the procedures. BAE resulted in complete resolution of hemoptysis in three patients and successful mitigation of the bleeding in the fourth patient until lung transplantation was performed 1 week later.


ECG-MDR-CT angiography accurately depicted bronchial artery anatomy in CF patients with massive hemoptysis and provided excellent preprocedural planning for BAE. The information provided by ECG-MDR-CT angiography of the aorta prior to conventional angiography decreased the BAE radiation dose and contrast volume and likely reduced table time.


Angiography Prospectively triggered Multidetector row Computed tomography Cystic fibrosis Hemoptysis 



There are no conflicts of interest for any of the authors with any companies/organizations whose products/services are discussed in this article.


  1. 1.
    Schidlow DV, Taussig LM, Knowles MR (1993) Cystic Fibrosis Foundation consensus conference report on pulmonary complications of cystic fibrosis. Pediatr Pulmonol 15:187–198PubMedCrossRefGoogle Scholar
  2. 2.
    Dweik RA, Stoller JK (1999) Role of bronchoscopy in massive hemoptysis. Clin Chest Med 20:89–105PubMedCrossRefGoogle Scholar
  3. 3.
    Flume PA, Mogayzel PJ Jr, Robinson KA, Rosenblatt RL, Quittell L, Marshall BC, Clinical Practice Guidelines for Pulmonary Therapies Committee; Cystic Fibrosis Foundation Pulmonary Therapies Committee (2010) Cystic fibrosis pulmonary guidelines: pulmonary complications: hemoptysis and pneumothorax. Am J Respir Crit Care Med 182:298–306PubMedCrossRefGoogle Scholar
  4. 4.
    Gong H Jr, Salvatierra C (1981) Clinical efficacy of early and delayed fiberoptic bronchoscopy in patients with hemoptysis. Am Rev Respir Dis 124:221–225PubMedGoogle Scholar
  5. 5.
    Saumench J, Escarrabill J, Padró L, Montañá J, Clariana A, Cantó A (1989) Value of fiberoptic bronchoscopy and angiography for diagnosis of the bleeding site in hemoptysis. Ann Thorac Surg 48:272–274PubMedCrossRefGoogle Scholar
  6. 6.
    Remy-Jardin M, Bouaziz N, Dumont P, Brillet PY, Bruzzi J, Remy J (2004) Bronchial and nonbronchial systemic arteries at multi-detector row CT angiography: comparison with conventional angiography. Radiology 233:741–749PubMedCrossRefGoogle Scholar
  7. 7.
    Yoon YC, Lee KS, Jeong YJ, Shin SW, Chung MJ, Kwon OJ (2005) Hemoptysis: bronchial and nonbronchial systemic arteries at 16-detector row CT. Radiology 234:292–298PubMedCrossRefGoogle Scholar
  8. 8.
    Hartmann IJ, Remy-Jardin M, Menchini L, Teisseire A, Khalil C, Remy J (2007) Ectopic origin of bronchial arteries: assessment with multidetector helical CT angiography. Eur Radiol 17(8):1943–1953PubMedCrossRefGoogle Scholar
  9. 9.
    Khalil A, Fartoukh M, Tassart M, Parrot A, Marsault C, Carette MF (2007) Role of MDCT in identification of the bleeding site and the vessels causing hemoptysis. AJR Am J Roentgenol 188:W117–W125PubMedCrossRefGoogle Scholar
  10. 10.
    Yu H, Liu SY, Li HM, Xiao XS, Dong WH (2010) Empirical description of bronchial and nonbronchial arteries with MDCT. Eur J Radiol 75:147–153PubMedCrossRefGoogle Scholar
  11. 11.
    Mundo-Sagardia JA, Januzzi JL, Cury RC (2007) Hypertrophied bronchial artery in cystic fibrosis diagnosed by computed tomography angiography. J Cardiovasc Comput Tomogr 1:110–111PubMedCrossRefGoogle Scholar
  12. 12.
    Brinson GM, Noone PG, Mauro MA, Knowles MR, Yankaskas JR, Sandhu JS, Jaques PF (1998) Bronchial artery embolization for the treatment of hemoptysis in patients with cystic fibrosis. Am J Respir Crit Care Med 157:1951–1958PubMedGoogle Scholar
  13. 13.
    Barben JU, Ditchfield M, Carlin JB, Robertson CF, Robinson PJ, Olinsky A (2003) Major haemoptysis in children with cystic fibrosis: a 20-year retrospective study. J Cyst Fibros 2:105–111PubMedCrossRefGoogle Scholar
  14. 14.
    Flume PA, Yankaskas JR, Ebeling M, Hulsey T, Clark LL (2005) Massive hemoptysis in cystic fibrosis. Chest 128:729–738PubMedCrossRefGoogle Scholar
  15. 15.
    Lordan JL, Gascoigne A, Corris PA (2003) The pulmonary physician in critical care * Illustrative case 7: assessment and management of massive haemoptysis. Thorax 58:814–819PubMedCrossRefGoogle Scholar
  16. 16.
    de Gracia J, de la Rosa D, Catalán E, Alvarez A, Bravo C, Morell F (2003) Use of endoscopic fibrinogen-thrombin in the treatment of severe hemoptysis. Respir Med 97:790–795PubMedCrossRefGoogle Scholar
  17. 17.
    Rémy J, Arnaud A, Fardou H, Giraud R, Voisin C (1977) Treatment of hemoptysis by embolization of bronchial arteries. Radiology 122:33–37PubMedGoogle Scholar
  18. 18.
    Swanson KL, Johnson CM, Prakash UB, McKusick MA, Andrews JC, Stanson AW (2002) Bronchial artery embolization: experience with 54 patients. Chest 121:789–795PubMedCrossRefGoogle Scholar
  19. 19.
    Chun JY, Belli AM (2010) Immediate and long-term outcomes of bronchial and non-bronchial systemic artery embolisation for the management of haemoptysis. Eur Radiol 20:558–565PubMedCrossRefGoogle Scholar
  20. 20.
    Sidhu M, Wieseler K, Burdick TR, Shaw DW (2008) Bronchial artery embolization for hemoptysis. Semin Intervent Radiol 25:310–318PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Don HayesJr.
    • 1
    Email author
  • Michael A. Winkler
    • 2
  • Stephen Kirkby
    • 1
  • Patrizio Capasso
    • 2
  • Heidi M. Mansour
    • 3
  • Anil K. Attili
    • 2
  1. 1.Departments of Pediatrics and Internal MedicineThe Ohio State University College of MedicineColumbusUSA
  2. 2.Department of RadiologyUniversity of Kentucky College of MedicineLexingtonUSA
  3. 3.Department of Pharmaceutical SciencesUniversity of Kentucky College of PharmacyLexingtonUSA

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