Search

A 22-year-old woman presented with hemoptysis for three days, averaging 150 ml of blood per day. She had no history of childhood chest disease. On admission, a chest scan suggested a potential lung infection, and laboratory results showed no significant abnormalities. Despite continuous infusion of posterior pituitary hormone, her symptoms persisted. We performed bronchial arteriography and embolization using 150–350 μm microsphere particles. During the procedure, the patient developed chest pain. An electrocardiogram (ECG) showed abnormal Q-waves and ST-T elevation, with vital signs indicating hypotension and elevated myocardial enzymes suggesting acute myocardial infarction (AMI). Repeated arteriography revealed a bronchial artery-right coronary artery fistula, likely worsened by a dislodged gelatin sponge blocking coronary microvessels. The embolization was halted, and treatment with low molecular weight heparin and aspirin was initiated. By the fifth postoperative day, the patient's ECG indicated an abnormal Q wave in the inferior leads, and myocardial enzymes were gradually returning to normal. One week later, coronary angiography revealed no blockage, and the patient was discharged after stabilization. The cardiovascular magnetic resonance (CMR) indicated myocardial necrosis and edema in the inferior wall of the heart. During subsequent follow-up, the patient reported no significant chest pain or recurrence of hemoptysis. [ABSTRACT FROM AUTHOR]

Massive hemoptysis is a time critical airway emergency in the perioperative setting, with an associated mortality exceeding 50%. Causes of hemoptysis in the perioperative setting include procedural complication, coagulopathy, malignancy, chronic lung disease, infection, left-sided cardiac disease, pulmonary vascular disease and autoimmune disease. A rapid and coordinated multidisciplinary response is required to secure the airway, isolate the lung, ensure adequate oxygenation and ventilation, identify the underlying cause and initiate specific systemic, bronchoscopic, endovascular, or surgical treatment. This review examines the etiology, pathophysiology, as well as approach to management and interventions in perioperative massive hemoptysis. [ABSTRACT FROM AUTHOR]

Abstract A 22-year-old woman presented with hemoptysis for three days, averaging 150 ml of blood per day. She had no history of childhood chest disease. On admission, a chest scan suggested a potential lung infection, and laboratory results showed no significant abnormalities. Despite continuous infusion of posterior pituitary hormone, her symptoms persisted. We performed bronchial arteriography and embolization using 150–350 μm microsphere particles. During the procedure, the patient developed chest pain. An electrocardiogram (ECG) showed abnormal Q-waves and ST-T elevation, with vital signs indicating hypotension and elevated myocardial enzymes suggesting acute myocardial infarction (AMI). Repeated arteriography revealed a bronchial artery-right coronary artery fistula, likely worsened by a dislodged gelatin sponge blocking coronary microvessels. The embolization was halted, and treatment with low molecular weight heparin and aspirin was initiated. By the fifth postoperative day, the patient’s ECG indicated an abnormal Q wave in the inferior leads, and myocardial enzymes were gradually returning to normal. One week later, coronary angiography revealed no blockage, and the patient was discharged after stabilization. The cardiovascular magnetic resonance (CMR) indicated myocardial necrosis and edema in the inferior wall of the heart. During subsequent follow-up, the patient reported no significant chest pain or recurrence of hemoptysis.

Primary racemose hemangioma of the bronchial artery (RHBA) is a rare congenital condition characterized by enlarged and convoluted bronchial arteries, often forming fistulas between the pulmonary artery or vein. Herein, we report a case of balloon-assisted embolization using N-butyl-2-cyanoacrylate (NBCA) performed for a primary RHBA in an asymptomatic 57-year-old woman. There were 2 tortuous and dilated branches of the right bronchial artery (RBA) (arising from the left subclavian artery and the descending thoracic aorta) which merged in the right pulmonary hilar region, forming multiple aneurysms that short-circuited the right pulmonary artery. Embolization was performed via the RBA arising from the subclavian artery using a triaxial system (a 5-Fr guiding catheter, a 2.7-Fr microballoon catheter, and a 1.9-Fr microcatheter). The guiding catheter was inserted into the peripheral side of the RBA using the microballoon catheter as an anchor; the balloon was slightly inflated and advanced further into the peripheral side using blood flow. The microcatheter was inserted as close to the aneurysms as possible and embolization was done using an NBCA-iodized oil mixture under blood flow control by the microballoon catheter. Bronchial artery embolization is the treatment of choice for primary RHBA because of the risk of rupture, and balloon-assisted techniques can help guide the catheter distally while also controlling blood flow.

Abstract Background Bronchial artery embolization (BAE) is currently an important treatment for hemoptysis. However, there is no consensus in the efficacy and safety of BAE compared to conservative treatment for hemoptysis, which limits the widespread use of BAE in hemoptysis. The objective was to assess the clinical benefit of BAE versus conservative treatment in patients with hemoptysis. Methods A systematic search was conducted on the PubMed, Embase, ScienceDirect, CochraneLibrary, and ClinicalTrials up to March 2023. Both randomized controlled trials (RCTs) and cohort studies reporting rates of recurrent hemoptysis, clinical success, mortality, and complication by BAE and conservative treatment alone for hemoptysis were included. Data were pooled and compared by the use of odds ratio (OR) and 95% confidence interval (CI). Results Twelve studies (three RCTs, nine cohorts) involving 1231 patients met the eligibility criteria. Patients treated with BAE had lower recurrence rates of hemoptysis (26.5% vs. 34.6%; OR 0.37, 95% CI 0.14–0.98), higher clinical success rates (92.2% vs. 80.9%; OR 2.77, 95% CI 1.66–4.61), and lower hemoptysis-related mortality (0.8% vs. 3.2%; OR 0.20, 95% CI 0.05–0.84) compared with conservative treatment alone. There was no significant difference in all-cause mortality between the two groups. In terms of security, the incidence of major complications and minor complications in patients undergoing BAE treatment was 0.2% (1/422) and 15.6%, respectively. Conclusions BAE was more effective than conservative treatment alone in controlling hemoptysis, reducing recurrence, and decreasing hemoptysis-related mortality, with an almost negligible risk of major complications.

Abstract Background Massive hemoptysis is characterized by its life-threatening nature, potentially leading to airway obstruction and asphyxia. The objective of this study was to evaluate the clinical effectiveness of combining endobronchial tamponade with bronchial artery embolization (BAE) in the treatment of massive hemoptysis. Methods Between March 2018 and March 2022, a total of 67 patients with massive hemoptysis who underwent BAE were divided into two groups: the combination group (n = 26) and the BAE group (n = 41). Technical and clinical success rates were assessed, and adverse events were monitored following the treatment. Blood gas analysis and coagulation function indicators were collected before and after the treatment, and recurrence and survival rates were recorded during the follow-up period. Results All patients achieved technical success. There were no significant differences in the clinical success rate, recurrence rates at 3 and 6 months, and mortality rates at 3 months, 6 months, and 1 year between the combination group and the BAE group. However, the hemoptysis recurrence rate at 1 year was significantly lower in the combination group compared to the BAE group (15.4% vs. 39.0%, P = 0.039). No serious adverse events were reported in either group. After treatment, the combination group showed higher levels of arterial partial pressure of oxygen (PaO2), oxygenation index (PaO2/FiO2), fibrinogen (FIB), and D-dimer (D-D) compared to the BAE group (P

Background: Bronchial artery embolization (BAE) is currently an important treatment for hemoptysis. However, there is no consensus in the efficacy and safety of BAE compared to conservative treatment for hemoptysis, which limits the widespread use of BAE in hemoptysis. The objective was to assess the clinical benefit of BAE versus conservative treatment in patients with hemoptysis. Methods: A systematic search was conducted on the PubMed, Embase, ScienceDirect, CochraneLibrary, and ClinicalTrials up to March 2023. Both randomized controlled trials (RCTs) and cohort studies reporting rates of recurrent hemoptysis, clinical success, mortality, and complication by BAE and conservative treatment alone for hemoptysis were included. Data were pooled and compared by the use of odds ratio (OR) and 95% confidence interval (CI). Results: Twelve studies (three RCTs, nine cohorts) involving 1231 patients met the eligibility criteria. Patients treated with BAE had lower recurrence rates of hemoptysis (26.5% vs. 34.6%; OR 0.37, 95% CI 0.14–0.98), higher clinical success rates (92.2% vs. 80.9%; OR 2.77, 95% CI 1.66–4.61), and lower hemoptysis-related mortality (0.8% vs. 3.2%; OR 0.20, 95% CI 0.05–0.84) compared with conservative treatment alone. There was no significant difference in all-cause mortality between the two groups. In terms of security, the incidence of major complications and minor complications in patients undergoing BAE treatment was 0.2% (1/422) and 15.6%, respectively. Conclusions: BAE was more effective than conservative treatment alone in controlling hemoptysis, reducing recurrence, and decreasing hemoptysis-related mortality, with an almost negligible risk of major complications. [ABSTRACT FROM AUTHOR]

Background: Massive hemoptysis is characterized by its life-threatening nature, potentially leading to airway obstruction and asphyxia. The objective of this study was to evaluate the clinical effectiveness of combining endobronchial tamponade with bronchial artery embolization (BAE) in the treatment of massive hemoptysis. Methods: Between March 2018 and March 2022, a total of 67 patients with massive hemoptysis who underwent BAE were divided into two groups: the combination group (n = 26) and the BAE group (n = 41). Technical and clinical success rates were assessed, and adverse events were monitored following the treatment. Blood gas analysis and coagulation function indicators were collected before and after the treatment, and recurrence and survival rates were recorded during the follow-up period. Results: All patients achieved technical success. There were no significant differences in the clinical success rate, recurrence rates at 3 and 6 months, and mortality rates at 3 months, 6 months, and 1 year between the combination group and the BAE group. However, the hemoptysis recurrence rate at 1 year was significantly lower in the combination group compared to the BAE group (15.4% vs. 39.0%, P = 0.039). No serious adverse events were reported in either group. After treatment, the combination group showed higher levels of arterial partial pressure of oxygen (PaO2), oxygenation index (PaO2/FiO2), fibrinogen (FIB), and D-dimer (D-D) compared to the BAE group (P < 0.05). Multivariate regression analysis demonstrated a significant correlation between combined therapy and hemoptysis-free survival. Conclusion: Combination therapy, compared to embolization alone, exhibits superior efficacy in improving respiratory function, correcting hypoxia, stopping bleeding, and preventing recurrence. It is considered an effective and safe treatment for massive hemoptysis. [ABSTRACT FROM AUTHOR]

The introduction of CFTR modulator drugs like elexacaftor-tezacaftor-ivacaftor (ETI) has transformed the management of cystic fibrosis (CF), significantly improving symptoms, lung function, and quality of life, while reducing reliance on intravenous antibiotics. However, respiratory exacerbations in the CFTR modulators era remain poorly understood from both pathophysiological and clinical perspectives.We present the case of a 20-year-old Caucasian woman with CF (F508del/L1077P) who, after three years of ETI treatment, experienced a severe episode of hemoptysis, despite being almost asymptomatic in the weeks leading up to admission, requiring bronchial artery embolization. Following ETI treatment, auscultatory findings and FEV1 changes may be less significant, making the detection of respiratory exacerbation more challenging. This highlights the need for heightened vigilance in managing such cases and underscores the challenge of diagnosing and managing exacerbations in the era of modulators. Long term real-world studies are essential to comprehend the evolving course of the disease during ETI treatment.

Abstract Background Tracheobronchial injuries generally occur due to iatrogenic or traumatic causes. Although bronchial rupture due to teratoma and germ cell tumors has been reported in the literature, no cases related to lung cancer have been determined. Our case is presented because of the refusal to be examined for the mass in the lung and the detection of bronchial rupture afterward when he presented with massive hemoptysis. Case presentation A 65-year-old male patient was admitted to the emergency department with the complaint of massive hemoptysis. Six months ago, bronchoscopy was recommended due to the 8 × 7 cm cavitary lesion obliterating the bronchus in the anterior upper lobe of the right lung on chest computed tomography, but the patient refused. The sputum sample, requested 3 times, was negative for acid-resistant bacteria, and no growth was detected in the mycobacterial culture. In the new pulmonary CT angiography, a progressive cavitary lesion invading the right main bronchus, carina, and vena cava superior was observed. Following tranexamic acid treatment and bronchial artery embolization, hemoptysis significantly decreased in the follow-up. In the flexible bronchoscopy performed for diagnostic purposes, the carina was pushed to the left and invaded, and there was damage to the right main bronchus. A biopsy was not performed due to the risk of bleeding, and lavage was performed. Lavage was negative for ARB, there was no growth in the mycobacteria culture, and cytology did not reveal malignant cells. The patient, diagnosed with right main bronchial rupture, was considered inoperable and died 1 month later due to respiratory failure. Conclusions Examinations should be initiated as soon as malignancy is suspected. When diagnosis and treatment are delayed, complications that would be challenging to intervene may develop.

Background: Tracheobronchial injuries generally occur due to iatrogenic or traumatic causes. Although bronchial rupture due to teratoma and germ cell tumors has been reported in the literature, no cases related to lung cancer have been determined. Our case is presented because of the refusal to be examined for the mass in the lung and the detection of bronchial rupture afterward when he presented with massive hemoptysis. Case presentation: A 65-year-old male patient was admitted to the emergency department with the complaint of massive hemoptysis. Six months ago, bronchoscopy was recommended due to the 8 × 7 cm cavitary lesion obliterating the bronchus in the anterior upper lobe of the right lung on chest computed tomography, but the patient refused. The sputum sample, requested 3 times, was negative for acid-resistant bacteria, and no growth was detected in the mycobacterial culture. In the new pulmonary CT angiography, a progressive cavitary lesion invading the right main bronchus, carina, and vena cava superior was observed. Following tranexamic acid treatment and bronchial artery embolization, hemoptysis significantly decreased in the follow-up. In the flexible bronchoscopy performed for diagnostic purposes, the carina was pushed to the left and invaded, and there was damage to the right main bronchus. A biopsy was not performed due to the risk of bleeding, and lavage was performed. Lavage was negative for ARB, there was no growth in the mycobacteria culture, and cytology did not reveal malignant cells. The patient, diagnosed with right main bronchial rupture, was considered inoperable and died 1 month later due to respiratory failure. Conclusions: Examinations should be initiated as soon as malignancy is suspected. When diagnosis and treatment are delayed, complications that would be challenging to intervene may develop. [ABSTRACT FROM AUTHOR]

Lung cancer continues to be the third leading cause of cancer and the leading cause of cancer deaths. As the field of interventional oncology continues to grow, interventional radiologists are increasingly treating lung cancer patients. Involvement begins with tissue diagnosis for which biomarkers and immunohistochemistry are used to guide selective and advanced medical therapies. An interventional radiologist must be aware of the rationale behind tissue diagnosis and techniques to minimize biopsy complications. Staging is an important part of tumor board conversations and drives treatment pathways. Surgical therapy remains the gold standard for early-stage disease but with an aging population the need for less invasive treatments such as radiation therapy and ablation continue to grow. The interventionalist must be aware of the indications, techniques, and pre- and posttherapy managements for percutaneous ablation. Endovascular therapy is broadly divided into therapeutic treatment of lung cancer, which is gaining traction, and treatment of lung cancer complications such as hemoptysis. This review aims to provide a good basis for interventional radiologists treating lung cancer patients. [ABSTRACT FROM AUTHOR]

Bronchial artery embolization (BAE) is currently the first-line treatment for massive hemoptysis. Previous studies have proven its safety and efficacy, with mild, transient, and reversible complications. This case described a patient with congenital multiple bronchopulmonary fistulas who underwent BAE due to massive hemoptysis. However, due to an overlooked and misdiagnosed atypical fistula, the patient experienced an ectopic pulmonary embolism and subsequently secondary pulmonary infarction. He eventually exhibited a full postoperative recovery following percutaneous catheter-directed embolectomy. This case revealed a type of occult fistula masked by multiple bronchial artery branches, which may be a potential risk factor for an ectopic pulmonary embolism during BAE. We propose that it is crucial to identify abnormal anastomosis, especially atypical fistula, and select appropriate embolization materials during BAE.

Background: This study was designed to study the frequency distribution of etiology of various grades of severity of hemoptysis and to determine the influence of underlying etiology on the type of treatment modalities selected. Materials and Methods: Adult patients presenting with hemoptysis at a tertiary care hospital over 18 months were included in the study. Detailed analysis of their clinical profile, underlying etiologies as well as management, modalities, and a 6-month follow-up was done. Results: One hundred and five patients were included in the final analysis. Pulmonary tuberculosis (PTB) sequelae were the most common etiology of hemoptysis across all grades of severity. Active PTB was the second leading cause. Chronic cavitary pulmonary aspergillosis (CCPA) was diagnosed in 6.6% of patients who mostly presented with massive hemoptysis. Bronchial artery embolization (BAE) was done in 15 patients. Most of the patients undergoing BAE had old PTB (53%) and CCPA (33%) with moderate-to-massive hemoptysis. Conclusions: Tuberculosis and its sequelae continue to be the most common etiology of hemoptysis in India. CCPA is a significant predictor of “moderate and massive” hemoptysis (5 out of 7 patients of CCPA) and these patients had recurrence of hemoptysis even after BAE. BAE is successful in decreasing the severity of hemoptysis and has a high utility in developing countries like India.

Abstract Background Bronchial artery aneurysm (BAA) is a rare vascular anomaly with the potential for serious complications, such as rupture leading to hemothorax or hemoptysis. Although bronchial artery embolization (BAE) is recognized as an effective intervention for ruptured BAA, video-assisted thoracoscopic surgery (VATS) is a minimally invasive approach for the treatment of associated hemothorax. Case presentation A 73-year-old woman presented with a mediastinal hematoma from a ruptured BAA, causing bilateral hemothorax. Emergency angiography revealed a saccular BAA that was successfully embolized using a microcatheter and coil. Subsequent computed tomography revealed an expanding hemothorax managed by VATS, with 1400 mL of blood drained. During VATS, thoracoscopy revealed pulmonary ligament rupture, which was attributed to increased intramediastinal pressure. The patient was discharged eight days postoperatively with no complications. This case highlights the use of BAE and VATS in the management of mediastinal BAA rupture and massive hemothorax. Conclusions BAE proved to be an effective strategy for the management of ruptured mediastinal BAAs. VATS is a valuable standby procedure for hematoma removal, but the indication should be carefully determined because of the risk of BAA re-rupture.

41-year-old lady, known case of Takayasu arteritis with pulmonary arterial involvement, presented with multiple episodes of haemoptysis (maximum 50 mL) in a week. She had undergone descending thoracic aorta angioplasty and stenting 3 years ago due to uncontrolled hypertension, left ventricular systolic dysfunction and approximately 70% stenosis of descending thoracic aorta. This lady was treated with embolization of hypertrophied bronchial artery as well as left internal mammary artery branch for management of haemoptysis. Embolization of hypertrophied bronchial artery in the setting of Takayasu arteritis with pulmonary arterial involvement presenting with haemoptysis is rare. Hypertrophied bronchial artery detected in post stenting computed tomography raises suspicion whether descending thoracic aorta stenting promotes the hypertrophy of bronchial artery. Literature of bronchial artery embolization in the setting of Takayasu with post DTA stenting is scarce. [ABSTRACT FROM AUTHOR]

Life-threatening hemoptysis (formerly called massive hemoptysis), though relatively uncommon, imposes significant mortality risks. This article discusses the etiology, clinical presentation, assessment, treatment, and nursing interventions to promote effective clinical management of patients with this condition. [ABSTRACT FROM AUTHOR]

Scimitar syndrome is a rare condition characterized by partial or complete anomalous pulmonary venous drainage of the lung to the inferior vena cava, right lung hypoplasia and dextroposition of the heart. Haemoptysis is uncommon in adults, although the clinical spectrum is wide. We report a case of a 38-year-old male with scimitar syndrome who had low grade haemoptysis persisting over several years secondary to bronchiectatic changes in his hypoplastic right lung. Conservative measures to manage haemoptysis were unsuccessful and the patient proceeded to bronchial artery embolization. The post-procedure course was complicated by lung infarction and the patient ultimately required pneumonectomy. Deformities of the blood vessels and lungs are complex in scimitar syndrome. Bronchial artery embolization should be approached cautiously to protect pulmonary perfusion. [ABSTRACT FROM AUTHOR]

The recommendations from the Society of Chest Imaging and Interventions expert group comprehensively cover all the aspects of management of hemoptysis, highlighting the role of diagnostic and interventional radiology. The diversity existing in etiopathology, imaging findings, and management of hemoptysis has been addressed. The management algorithm recommends the options for effective treatment while minimizing the chances of recurrence, based on the best evidence available and opinion from the experts.

Abstract Bronchial artery embolization is a feasible option for treating hemoptysis caused by foreign objects in patients who are not candidates for surgery.

Abstract Scimitar syndrome is a rare condition characterized by partial or complete anomalous pulmonary venous drainage of the lung to the inferior vena cava, right lung hypoplasia and dextroposition of the heart. Haemoptysis is uncommon in adults, although the clinical spectrum is wide. We report a case of a 38‐year‐old male with scimitar syndrome who had low grade haemoptysis persisting over several years secondary to bronchiectatic changes in his hypoplastic right lung. Conservative measures to manage haemoptysis were unsuccessful and the patient proceeded to bronchial artery embolization. The post‐procedure course was complicated by lung infarction and the patient ultimately required pneumonectomy. Deformities of the blood vessels and lungs are complex in scimitar syndrome. Bronchial artery embolization should be approached cautiously to protect pulmonary perfusion.

Introduction: Hemoptysis is one of the most common symptoms of respiratory system diseases. Common causes include bronchiectasis, tumors, tuberculosis, aspergilloma, and cystic fibrosis. The severity of hemoptysis varies from mild to moderate to massive hemoptysis and can easily lead to hemodynamic instability and death from suffocation or shock. Nevertheless, the most threatening hemoptysis that is presented to the emergency department and requires hospitalization is the massive one. In these cases, today, the most common way to manage hemoptysis is bronchial artery embolization (BAE). Methods: A systematic literature search was conducted in PubMed and Scopus from January 2017 (with the aim of selecting the newest possible reports in the literature) until May 2023 for studies reporting massive hemoptysis. All studies that included technical and clinical success rates of hemoptysis management, as well as rebleeding and mortality rates, were included. A proportional meta-analysis was conducted using a random-effects model. Results: Of the 30 studies included in this systematic review, 26 used bronchial artery embolization as a means of treating hemoptysis, with very high levels of both technical and clinical success (greater than 73.7% and 84.2%, respectively). However, in cases where it was not possible to use bronchial artery embolization, alternative methods were used, such as dual-vessel intervention (80% technical success rate and 66.7% clinical success rate), customized endobronchial silicone blockers (92.3% technical success rate and 92.3% clinical success rate), antifibrinolytic agents (50% clinical success rate), and percutaneous transthoracic embolization (93.1% technical success rate and 88.9% clinical success rate), which all had high success rates apart from antifibrinolytic agents. Of the 2467 patients included in these studies, 341 experienced rebleeding during the follow-up period, while 354 other complications occurred, including chest discomfort, fever, dysphagia, and paresis. A total of 89 patients died after an episode of massive hemoptysis or during the follow-up period. The results of the meta-analysis showed a pooled technical success of bronchial artery embolization equal to 97.22% and a pooled clinical success equal to 92.46%. The pooled recurrence was calculated to be 21.46%, while the mortality was 3.5%. These results confirm the ability of bronchial artery embolization in the treatment of massive hemoptysis but also emphasize the high rate of recurrence following the intervention, as well as the risk of death. Conclusion: In conclusion, massive hemoptysis can be treated with great clinical and technical success using bronchial artery embolization, reducing mortality. Mortality has now been reduced to a small percentage of cases. [ABSTRACT FROM AUTHOR]

Background: Asymptomatic bronchial artery aneurysms (BAA) could be underdiagnosed, and the precise prevalence is unknown. Bronchial artery angiography revealed that this rare disease in about 1% of patients. BAA is fatal if ruptured since there is no correlation between the diameter and symptoms of the aneurysm and the risk of rupture. Early treatment on diagnosis is desirable. Bronchial artery embolization (BAE) is the first choice for treatment because of its minimally invasive nature. Case presentation: A 74-year-old man was referred to our department and pointed out a tumor-like lesion under the aortic arch on a contrast-enhanced computed tomography (CECT). We diagnosed it as a mediastinal BAA, and BAE was planned. The bronchial artery arising from the aorta showed strong atherosclerotic meanders and was difficult to engage, resulting in iatrogenic acute aortic dissection (AAD). Urgent thoracic endovascular aortic repair (TEVAR) was performed. There was no contrast effect of the aneurysm on a postoperative CECT, indicating thrombotic occlusion. Conclusions: We were preparing a system that could convert to surgery or TEVAR, in case of difficult to treat with BAE or ruptured aneurysm during BAE, so we were able to respond quickly to aortic dissection caused by BAE and obtain a good result of both BAA and aortic dissection. TEVAR would be considered a treatment of BAA, in cases such as the present case, where engagement is difficult, where the length of the inflow artery is short, or where the inflow artery is tortuous. [ABSTRACT FROM AUTHOR]

Objective To explore the efficacy and safety of CalliSpheres® drug-eluting beads trans-bronchial artery chemoembolization (DEB-BACE) . Methods A retrospective analysis was conducted on 45 patients with advanced primary lung cancer complicated with massive hemoptysis treated in Linyi Cancer Hospital from December 2019 to December 2021. All patients received bronchial artery embolization (BAE) and were divided into observation group (n=24) and control group (n=21) according to different embolization materials. DEB-BACE using CalliSpheres® drug-eluting beads loading 40-60 mg of epirubicin was performed in observation group, and BACE with 8Spheres® blank microspheres was given in control group. The control of hemoptysis, tumor response, the survival time and the related adverse reactions were observed and compared between two groups. Results There was no significant difference in hemostatic success rate between observation group and control group (87.5% vs 85.7%, P＞0.05) . The median duration of nonmassive hemoptysis in observation group was statistically longer than that in control group (96 days vs 50 days, P＜0.01) . At two months after embolization therapy, the objective response rate (83.3% vs 38.1%) in observation group were significantly higher than those in control group (P＜0.05) . The fever, chest tightness and chest pain related to the embolization treatment disappeared after symptomatic treatment in two groups, and there was no statistical difference in adverse reactions between two groups (P＞0.05) . No serious complications such as spinal cord injury and cerebral embolism occurred in two groups. By the end of September 30, 2022, the median overall survival in observation group (10 months) was statistically higher than that in control group (6 months) (P＜0.01) at a follow-up of 2-25 (9.97±5.41) month. Conclusion In the treatment of advanced lung cancer with massive hemoptysis, DEB-BACE can achieve higher tumor response rate, longer survival time without hemoptysis and total survival time compared with conventional BAE.

Haemoptysis is a frequently encountered presentation in thoracic surgery practice. Most of the patients present with chronic haemoptysis while 5% of them will present with life-threatening acute haemoptysis. Emergency surgery used to be the first-line management in acute life-threatening haemoptysis which resulted in significant morbidity and mortality. With advancements in interventional procedures, most of these acute presentations are now being managed conservatively by interventionists. In a country like India with a high incidence of tuberculosis and other infectious diseases of the lungs, haemoptysis is even more common. While interventional procedures help to tide over the crisis and earn valuable time to stabilise a haemorrhaging patient, surgical resection is the definitive management most of the time. This review will endeavour to establish the definition, aetiology, emergency, and definitive management of a patient who presents with haemoptysis. [ABSTRACT FROM AUTHOR]

To investigate whether pre-procedure Computed Tomography Angiography (CTA) improves radiation exposure, procedure complexity, and symptom recurrence after bronchial embolization for massive hemoptysis. A single-center retrospective review of bronchial artery embolization (BAE) for massive hemoptysis was performed for procedures between 2008 and 2019. Multi-variate analysis was performed to determine the significance of pre-procedure CTA and etiology of hemoptysis on patient radiation exposure (reference point air kerma, RPAK) and rate of recurrent hemoptysis. There were 61 patients (mean age 52.5 years; SD = 19.2 years, and 57.3% male) and CTA was obtained for 42.6% (26/61). Number of vessels selected was a mean of 7.2 (SD = 3.4) in those without CTA and 7.4 (SD = 3.4) in those with CTA (p = 0.923). Mean procedure duration was 1.8 h (SD = 1.6 h) in those without CTA and 1.3 h (SD = 1.0 h) in those with CTA (p = 0.466). Mean fluoroscopy time and RPAK per procedure were 34.9 min (SD = 21.5 min) and 1091.7 mGy (SD = 1316.6 mGy) for those without a CTA and 30.7 min (SD = 30.7 min) and 771.5 mGy (SD = 590.0 mGy) for those with a CTA (p = 0.523, and p = 0.879, respectively). Mean total iodine given was 49.2 g (SD = 31.9 g) for those without a CTA and 70.6 g (SD = 24.9 g) for those with a CTA (p = 0.001). Ongoing hemoptysis at last clinical follow up was 13/35 (37.1%) in those without CTA and 9/26 (34.6%) in those with CTA (p = 0.794). Pre-procedure CTA did not improve radiation effective dose and symptom recurrence after BAE and is associated with significant increases in total iodine dose. • Bronchial artery embolization can be performed without pre-procedure cross-sectional imaging. • Computed tomography angiography does not add significant radiation effective dose. • Cases with an otherwise suspected bleeding site should proceed directly to interventional treatment. [ABSTRACT FROM AUTHOR]

The recommendations from the Society of Chest Imaging and Interventions expert group comprehensively cover all the aspects of management of hemoptysis, highlighting the role of diagnostic and interventional radiology. The diversity existing in etiopathology, imaging findings, and management of hemoptysis has been addressed. The management algorithm recommends the options for effective treatment while minimizing the chances of recurrence, based on the best evidence available and opinion from the experts. [ABSTRACT FROM AUTHOR]

Abstract Background Massive hemoptysis is a life-threatening condition that requires immediate treatment. This study aimed to retrospectively analyze the outcome of bronchial artery embolization (BAE) for massive hemoptysis, as well as potential factors that may contribute to the recurrence of hemoptysis after BAE. Methods A total of 105 patients with massive hemoptysis treated with BAE were analyzed. Results The immediate control rate of bleeding was 84.8% (67/79); however, during the 36-month follow-up, 45.3% (29 out of 64) of the patients had recurrent hemoptysis after BAE. Comorbidities, pituitary hormone treatment, the angiographic appearance of artery dilation and hypertrophy, and the materials used for BAE were significantly correlated with the success rate of the BAE, while lack of pituitary hormone treatment and existence of arterio-arterial or arteriovenous fistula were risk factors for the recurrence of hemoptysis after BAE. Only a small proportion of patients (9/105, 8.6%) had mild complications after BAE treatment. Conclusion Findings suggest that BAE continues to be an effective treatment for massive hemoptysis in emergency settings. Moreover, the treatment of underlying pulmonary diseases and comorbidities is important to increase BAE’s success rate of BAE and decrease the risk of recurrent hemoptysis after BAE.

Objectives This article evaluates the immediate success, recurrence rate, complications, and the culprit vessel of bronchial artery embolization (BAE) in patients presenting with hemoptysis. Materials and Methods All patients who underwent BAE from July 1, 2018 to August 31, 2021 were included. BAE was done for moderate to severe hemoptysis or for mild hemoptysis which was recurrent and not controlled by medical management. Patients referred for surgical intervention and hemoptysis controlled on medical management were excluded. Results One hundred and thirty patients underwent BAE in the study period. Mean age was 41.5 years and majority (73.1%) was male. Forty-three (33.1%) patients had mild, 46 (35.4%) had moderate, and 41 (31.5%) with the duration of symptoms ranging from 3 days to 25 years. Most common culprit vessel was posterior intercostal artery closely followed by the intercostobronchial artery. Hypervascularity was the most common angiographic abnormality encountered. On an average, 2.75 vessels were embolized per BAE with a wide range of 1 to 8 vessels. Hemoptysis control was seen in 96.1% patients immediately, 90.7 % at 1 month, 82.3 % at 3 months, and 66.9 % at 6 months. Overall recurrence was seen in 43 patients (33.1%). Chest pain was the most common minor side effect occurring in 77.1% cases. Conclusion BAE is a safe and effective procedure that can be performed routinely in patients presenting with moderate to massive hemoptysis or with mild hemoptysis refractory to medical management.

A 58-year-old woman with bronchiectasis presented with massive hemoptysis and severe respiratory failure, which required long-term extracorporeal membrane oxygenation with continuous heparin infusion. Bronchial artery embolization using hydrogel coils, which provide a greater volume occlusion than bare platinum coils, was performed; hemoptysis stopped and she fully recovered. No recanalization was observed on follow-up computed tomography angiography 2 months postbronchial artery embolization, and there had been no recurrence of bleeding at the time of this report (at least 6 months). Although continuous anticoagulation during extracorporeal membrane oxygenation might hinder complete vessel occlusion by metallic coils or induce early recanalization (because the homeostatic mechanism of coils depends on the patient's coagulability), our experience showed that bronchial artery embolization using hydrogel coils was effective and safe. Additionally, this case presents a successful example of anticoagulation management for patients with hemoptysis on extracorporeal membrane oxygenation who undergo bronchial artery embolization using coils.

Haemoptysis occurs in up to 25 % of young people with Cystic fibrosis (CF) [1]. We undertook a literature review and described the management approach to haemoptysis in CF between 2010 and 2020 at an Australian tertiary paediatric centre, The Children's Hospital Westmead, Sydney, New South Wales, using a retrospective review of the medical records which identified 67 episodes. Sixty episodes met inclusion criteria, including 31 patients. Using the US CF Foundation guidelines, episodes were classified as scant (53.3 %), moderate (38.3 %) or massive (8.3 %). Fifty-two percent of patients were female, mean age at presentation was 15.4 years (SD+/- 2.4) and 58 % were homozygous for the Fdel508 genotype. Twelve episodes (9 patients) required bronchial artery embolization (BAE). BAE was used in all cases of massive haemoptysis 5/5 (100 %), 6/23 (22 %) episodes of moderate and 1/32 (3 %) episode of scant haemoptysis as an elective procedure for recurrent haemoptysis. Our literature review and institutional experience highlights the need for up-to-date management guidelines in the management of haemoptysis in Cystic Fibrosis. Based on our experience, we provide a proposed algorithm to help guide the management of haemoptysis in CF. [ABSTRACT FROM AUTHOR]

Background: We investigated the efficacy and safety of bronchial artery embolization (BAE) using a 5F JL4 catheter in patients with hemoptysis and a bronchial artery opening in the inferior wall of the aortic arch. Methods: This was a single-center retrospective study. Seventeen patients underwent BAE using 5F JL4. We then evaluated technical success (TS), clinical success (CS), incidence of complications, and hemoptysis recurrence rate (RR). Results: The TS rate of microcatheter superselective catheterization and CS rate after surgery were 100%, and the incidence of severe complications and postoperative RR were 17.6%. Conclusions: Bronchial artery embolization for hemoptysis with a BA opening in the inferior wall of the aortic arch using the 5F JL4 catheter could be a safe method. The short- and medium-term results were excellent. [ABSTRACT FROM AUTHOR]

Bronchial artery embolization is minimally invasive, has a low complication rate, and achieves good hemorrhage control. It is the first-line treatment in hemoptysis patients whom medications are ineffective. Cerebral infarction is a rare complication of bronchial artery embolization, with posterior circulation infarcts being the most common. Possible mechanisms include a neurotoxic reaction to the contrast medium used, bronchial artery-pulmonary shunt, embolus formation, fistula formation between the bronchial artery and the cerebral artery, and so on. To the best of our knowledge, there have been relatively few reports regarding posterior circulation infarcts after BAE, including 14 cases shown in Table 1. 11 patients recovered well after medical treatment, while the other patients did not survive. We report a case of a patient with a large posterior circulation infarct post bronchial artery embolization who developed severe neurological symptoms and died after 3 months of medication. Conclusion: Posterior circulation infarction is a rare but severe complication of bronchial artery embolization, and measures should be taken to prevent its occurrence. [ABSTRACT FROM AUTHOR]

Background: Hemoptysis is a severe complication of cystic fibrosis (CF) for which bronchial artery embolization (BAE) is an efficient primary therapeutic option. However, recurrence is more frequent than for other etiologies of hemoptysis. Purpose: To assess the safety and efficacy of BAE in patients with CF and hemoptysis and predictive factors for recurrent hemoptysis Material and Methods: This retrospective study reviewed all adult patients with CF treated by BAE for hemoptysis in our center from 2004 to 2021. The primary endpoint was the recurrence of hemoptysis after bronchial artery embolization. Secondary endpoints were overall survival and complications. We introduced the vascular burden (VB) defined as the sum of all bronchial artery diameters measured on pre-procedural enhanced computed tomography (CT) scans. Results: A total of 48 BAE were performed in 31 patients. A total of 19 recurrences occurred with a median recurrence-free survival of 3.9 years. In univariate analyzes, percentage of unembolized VB (%UVB) (hazard ratio [HR] = 1.034, 95% confidence interval [CI=1.016–1.052; P < 0.001) and %UVB vascularizing the suspected bleeding lung (%UVB-lat) (HR = 1.024, 95% CI=1.012–1.037; P < 0.001) were associated with recurrence. In multivariate analyzes, only %UVB-lat remained significantly associated with recurrence (HR = 1.020, 95% CI=1.002–1.038; P = 0.030). One patient died during follow-up. No complication of grade 3 or higher was reported according to the CIRSE classification system for complications. Conclusion: When possible, unilateral BAE seems sufficient in patients with CF with hemoptysis even in such a diffuse disease involving both lungs. The efficiency of BAE could be improved by thoroughly targeting all arteries vascularizing the bleeding lung. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this retrospective study was to evaluate the added value of pre-procedural computed tomography angiography (CTA) prior to bronchial artery embolization for patients presenting with hemoptysis. Materials and Methods: In this retrospective study, we evaluated patients admitted for hemoptysis from 2010 to 2021 and treated by catheter-directed embolization. After establishing quality criteria for pre-procedural computed tomography (CT), patients were divided into two groups depending on their pre-procedural imaging assessment: Quality CT-angiography (QCTA group) and suboptimal pre-procedural imaging (suboptimal CTA, unenhanced or no CT evaluation; control group). Groups were compared based on radiological success, procedure-related complications, and clinical success, including cessation of hemoptysis, recurrence rates, and overall mortality. Results: We included 31 patients in the QCTA group, and 35 in the control group. Clinical success was n = 24/31 (77.4%) in the QCTA group and n = 27/35 (77.1%) in the control group (p = 0.979). Technical success was n = 37/42 (88.1%) in the QCTA group and n = 39/42 (92.86%) in the control group (p = 0.820). Overall recurrence was 10.6%. Minor complications occurred in 27.3%, and one major complication was reported. The concordance between the affected bleeding lung and the identification of pathological arteries during angiography was better in the QCTA group (p = 0.045). The average number of culprit arteries (bronchial, non-bronchial systemic arteries [NBSA] or pulmonary) in the QCTA group was not significantly higher than that in the control group. Conclusions: Preprocedural QCTA better identifies the affected bleeding lung and bleeding vessels compared to direct angiography. No difference in clinical success, complications, recurrence rates, or mortality was observed.

Background: Massive hemoptysis is a life-threatening condition that requires immediate treatment. This study aimed to retrospectively analyze the outcome of bronchial artery embolization (BAE) for massive hemoptysis, as well as potential factors that may contribute to the recurrence of hemoptysis after BAE. Methods: A total of 105 patients with massive hemoptysis treated with BAE were analyzed. Results: The immediate control rate of bleeding was 84.8% (67/79); however, during the 36-month follow-up, 45.3% (29 out of 64) of the patients had recurrent hemoptysis after BAE. Comorbidities, pituitary hormone treatment, the angiographic appearance of artery dilation and hypertrophy, and the materials used for BAE were significantly correlated with the success rate of the BAE, while lack of pituitary hormone treatment and existence of arterio-arterial or arteriovenous fistula were risk factors for the recurrence of hemoptysis after BAE. Only a small proportion of patients (9/105, 8.6%) had mild complications after BAE treatment. Conclusion: Findings suggest that BAE continues to be an effective treatment for massive hemoptysis in emergency settings. Moreover, the treatment of underlying pulmonary diseases and comorbidities is important to increase BAE's success rate of BAE and decrease the risk of recurrent hemoptysis after BAE. [ABSTRACT FROM AUTHOR]

Objective: Bronchial artery embolization (BAE) now serves as the standard treatment for hemoptysis. The aim of this study was to determine the characteristics and outcomes of the patients who undergo BAE during the coronavirus disease-2019 pandemic period. Methods: We retrospectively investigated patients that presented to the hospital with hemoptysis and received bronchial arterial embolization treatment during the pandemic period. Age, gender, history of previous diseases, and related data were collected. Results: The study was conducted with 11 patients whose 18.18% (n=2) were female and 81.81% (n=9) were male. The mean age of the patients is 61.27±10.94 and they stayed in hospital 21.18±19.59 days on average. Infection and bronchiectasis were seen as the leading cause of hemorhagee. Also, alveolar hemorrhage seen 81.8% (n=9) of the patients. Dilated bronchial arteries were seen on 72.7% (n=8) of the patients. Although 54.5% (n=6) of the patients admitted to the intensive care unit after the procedure, no complication or mortality seen in any patient during the procedure. Conclusion: Bronchial arterial embolization is an effective minimally invasive technique for treating hemoptysis. This invasive procedure could be applied safely during the pandemic period. [ABSTRACT FROM AUTHOR]

Background: Embolization of the bronchial artery is one of the non-surgical successful measures to treat hemoptysis without surgery. Aim of the Work: To evaluate the technique, efficacy, and safety of Bronchial Artery Embolization (BAE) in patients with hemoptysis due to cavitary lung lesions. Patients and Methods: This study was a reconstructive (retrospective and prospective) cohort study and included 20 candidates who presented with hemoptysis due to cavitary lung lesions and were refractory to the supportive treatment measures during the period between March 2021 and September 2021. The study population was referred from the Chest Department to Interventional Radiology Unit, at Ain Shams University Hospitals. Results: Massive hemoptysis was seen in 15 patients and recurrent mild-moderate in 5 patients. On imaging, cavitary lesions were seen on the left side in 8 patients, the right side in 8 patients, and bilateral involvement in 4 patients. Bronchiectatic changes were the predominant pathology seen in 6 patients. Immediate success was achieved in 20 patients, while recurrence within one month was noted in 4 patients. 13 patients reported experiencing minor problems like chest pain, but no serious ones like spinal cord ischemia. Conclusion: When a patient has hemoptysis, BAE is a standard technique that is both safe and effective with a very low complication rate. [ABSTRACT FROM AUTHOR]

Objectives This article evaluates the immediate success, recurrence rate, complications, and the culprit vessel of bronchial artery embolization (BAE) in patients presenting with hemoptysis. Materials and Methods All patients who underwent BAE from July 1, 2018 to August 31, 2021 were included. BAE was done for moderate to severe hemoptysis or for mild hemoptysis which was recurrent and not controlled by medical management. Patients referred for surgical intervention and hemoptysis controlled on medical management were excluded. Results One hundred and thirty patients underwent BAE in the study period. Mean age was 41.5 years and majority (73.1%) was male. Forty-three (33.1%) patients had mild, 46 (35.4%) had moderate, and 41 (31.5%) with the duration of symptoms ranging from 3 days to 25 years. Most common culprit vessel was posterior intercostal artery closely followed by the intercostobronchial artery. Hypervascularity was the most common angiographic abnormality encountered. On an average, 2.75 vessels were embolized per BAE with a wide range of 1 to 8 vessels. Hemoptysis control was seen in 96.1% patients immediately, 90.7 % at 1 month, 82.3 % at 3 months, and 66.9 % at 6 months. Overall recurrence was seen in 43 patients (33.1%). Chest pain was the most common minor side effect occurring in 77.1% cases. Conclusion BAE is a safe and effective procedure that can be performed routinely in patients presenting with moderate to massive hemoptysis or with mild hemoptysis refractory to medical management. [ABSTRACT FROM AUTHOR]

A 72-year-old man visited the emergency department with chief complaints of dizziness and dysarthria. Initially, a stroke was strongly suspected and brain computed tomography (CT) and neck CT angiography were performed; however, a ruptured bronchial artery aneurysm (BAA) was observed. BAA is a rare disease and usually asymptomatic but can be life-threatening. Patients with a ruptured BAA may present with hypovolemic shock, causing symptoms such as suspected cerebrovascular disease due to decreased cerebral blood flow. • Bronchial artery aneurysm (BAA) is a rare and asymptomatic disease. • Depending on its location and size, symptoms can include dysphagia and chest pain. • BAA can be associated with both cardiopulmonary and neurological symptoms. • If the aneurysm ruptures, it can cause hemoptysis and hypovolemic shock. • Transcatheter bronchial artery embolization/surgery is performed if BAA ruptures. [ABSTRACT FROM AUTHOR]

• ETI therapy revolutionizes CF care with improved lung function and quality of life. • CF patients on ETI may show unusual symptoms during respiratory exacerbations. • Recognizing subtle symptoms is crucial for timely intervention. • Vigilance is essential in managing CF patients on ETI. • New diagnostic methods are needed to enhance care. The introduction of CFTR modulator drugs like elexacaftor-tezacaftor-ivacaftor (ETI) has transformed the management of cystic fibrosis (CF), significantly improving symptoms, lung function, and quality of life, while reducing reliance on intravenous antibiotics. However, respiratory exacerbations in the CFTR modulators era remain poorly understood from both pathophysiological and clinical perspectives. We present the case of a 20-year-old Caucasian woman with CF (F508del/L1077P) who, after three years of ETI treatment, experienced a severe episode of hemoptysis, despite being almost asymptomatic in the weeks leading up to admission, requiring bronchial artery embolization. Following ETI treatment, auscultatory findings and FEV 1 changes may be less significant, making the detection of respiratory exacerbation more challenging. This highlights the need for heightened vigilance in managing such cases and underscores the challenge of diagnosing and managing exacerbations in the era of modulators. Long term real-world studies are essential to comprehend the evolving course of the disease during ETI treatment. [ABSTRACT FROM AUTHOR]

Management of hemoptysis begins with an angio-CT to identify the location, the bleeding vessel, mapping of systemic arteries and the cause of the hemoptysis. Endovascular treatment is the first-line therapy, in 90% of cases by embolization of the systemic arteries and in 10% of cases by occlusion of the pulmonary arteries.

An otherwise healthy young man presented with massive hemoptysis 2 month following a mild coronavirus disease 2019 (COVID-19) and with no other identifiable cause of illness. The patient was successfully treated with bronchial artery embolization. We are strongly convinced that hemoptysis in this case was COVID-related. This unusual case of delayed COVID-related hemoptysis reveals new aspects in the understanding of mid-term and presumable auto-immune triggered effects in patients with initially only mild symptoms of the disease.

Introduction: Hemoptysis is an emergency condition with high morbidity and mortality which requires immediate treatment. Active tuberculosis (TB) and post-tubercular sequelae can result in hemoptysis with the most common source is from bronchial artery. Case: We reported a 22-year-old man who presented with shortness of breath and recurrent hemoptysis. A chest X-Ray showed total atelectasis right lung due to obstructive airway. After aspiration clotting blood in bronchus and instillation adrenalin with fiber optic bronchoscopy, the atelectasis totally disappeared. Computed tomography angiography (CTA) showed prominent vascular lesions from the apical right pulmonary artery, right brachialis artery, and branch of the posterior intercostal artery. The patient was referred to the interventional unit of the radiology department in Dr. Soetomo General Hospital and underwent bronchial artery embolization. After this procedure, his symptoms resolved completely and he was discharged after a week with 2nd category anti-tuberculosis drugs (ATD). 6 months of follow-up, he no longer experienced hemoptysis. Conclusion: Recurrent hemoptysis needs optimal management, including diagnostic with chest radiography, CT and bronchoscopy. Treatment with bronchoscopy and bronchial artery embolization will reduce mortality and morbidity in patients with hemoptysis.

Massive hemoptysis can lead to respiratory failure and life-threatening hypoxia in patients with underlying post-tubercular fibrocavitary disease. In the absence of urgent surgical interventions in a resource-poor country, interventional bronchoscopy and bronchial artery embolization (BAE) can be lifesaving in critical care management of such patients. We present a young male who required mechanical ventilation, emergency bronchoscopic intervention, and BAE, and showed recovery.

Hemoptysis is a common clinical emergency, bronchial arterial embolization is considered to be an effective treatment. The presence of coronary artery—bronchial artery fistula (CBF) may lead to recurrence of hemoptysis after treatment. It is necessary to investigate the imaging characteristics of a CBF and its correlation with the severity of pulmonary disease. With the development of multi-detector computed tomography, our study used the 320-slice CT bronchial artery angiography technology to observe and visualize blood vessels. The image and clinical data of 2015 hemoptysis patients with 320-slice CT bronchial artery angiography were retrospectively reviewed from January 2015 to December 2019. The axial and three-dimensional CT images were analyzed. The incidence, anatomical characteristics of CBF and pulmonary disease severity score were evaluated. A total of 12 CBF vessels were detected in 11 patients. We found that the incidence of CBF in this group was 0.55% (11/2015). Mean CBF diameter was 1.9 mm (1.2–2.5 mm). The course of CBF usually was relatively fixed. The proportions of CBF originated from the left circumflex artery, right coronary artery, and left anterior descending artery were 75%, 16.7% and 8.3%, respectively. Preliminarily analysis of the correlation between the trend of CBF and the pulmonary diseases severity score showed that CBF was more likely to communicate with a bronchial artery on the side with a higher severity score. CBF may occur in patients with chronic pulmonary disease and hemoptysis, and its origin, course and trend are characteristic. Detailed and comprehensive computed tomography angiography image analysis is helpful to improve the clinical treatment of hemoptysis with CBF. [ABSTRACT FROM AUTHOR]

Purpose: This pilot study was designed to assess the technical feasibility and safety of bronchial artery chemoembolization with radiopaque doxorubicin eluting beads (DEB-BACE) in patients with malignant hemoptysis from pulmonary metastasis. Materials & Methods: Four patients underwent DEB-BACE using 70-150 μm radiopaque DEB (LC Beads LUMI, Boston Scientific). Beads delivery and deposition were assessed under fluoroscopy and cone beam computed tomography (CT), respectively. Results: All 4 procedures were technically successful. Beads delivery and deposition were successfully visualized under fluoroscopy and cone beam CT guidance in all cases. Hemoptysis was resolved after embolization in all 4 patients. There were no adverse events or immediate or early complications after DEB-BACE. Two patients (50%) required repeat DEB-BACE within 1 week due to recurrent hemoptysis, and 1 patient had DEB-BACE 1.5 years later due to recurrent hemoptysis from the contralateral lung. All targeted lesions decreased in size in follow-up studies (mean 16 months, range 1-33 months). One patient died of progressive cancer disease invading the heart 1 month after DEB-BACE. Conclusions: DEB-BACE using radiopaque LC Beads LUMI loaded with doxorubicin is technically feasible and safe for controlling hemoptysis and cancer progression in patients with metastatic lung tumors. Visualization of beads delivery under fluoroscopy and deposition of beads under cone beam CT facilitate delivery of beads and embolization of bronchial arteries. [ABSTRACT FROM AUTHOR]