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Added benefit of thoracic aortography after transarterial embolization in patients with hemoptysis
Ho Jong Chun1, Jae Young Byun, Seung-Schik Yoo
1Department of Radiology, Kangnam St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505 Banpo-Dong, Seocho-Ku, Seoul 137-040, Korea.
Insights
Post-embolization thoracic aortography helps identify missed arteries causing hemoptysis. This imaging technique improves detection of bleeding sources, particularly inferior phrenic and intercostal arteries, in patients with hemoptysis.
Area of Science:
- Interventional Radiology
- Vascular Imaging
- Pulmonary Medicine
Background:
- Hemoptysis, or coughing up blood, can stem from various pulmonary and systemic arterial sources.
- Transarterial embolization is a common treatment for hemoptysis, but may not always identify all causative arteries.
- Identifying all bleeding arteries is crucial for effective hemoptysis management.
Purpose of the Study:
- To evaluate the utility of thoracic aortography after transarterial embolization in detecting additional arteries responsible for hemoptysis.
- To assess the contribution of postembolization aortography in identifying previously undetected bleeding sources.
Main Methods:
- Prospective study of 76 patients with hemoptysis between March 2000 and November 2001.
- Initial transarterial embolization targeting bronchial and systemic arteries, followed by thoracic aortography.
- Thoracic aortography performed with the catheter tip distal to the left subclavian artery origin.
Main Results:
- A total of 200 arteries were identified as sources of hemoptysis.
- Postembolization thoracic aortography identified 29 additional arteries (14.5%) missed during initial embolization.
- Specifically, inferior phrenic (n=8) and intercostal arteries (n=16) were frequently identified on postembolization aortography.
Conclusions:
- Inferior phrenic and intercostal arteries are often overlooked during routine transarterial embolization for hemoptysis.
- Postembolization thoracic aortography is valuable for assessing embolization effectiveness and enhancing the detection of hemoptysis-related arteries.
Objective:
The purpose of this study was to examine the usefulness of thoracic aortography performed after transarterial embolization in identifying additional arteries responsible for causing hemoptysis.
Subjects And Methods:
Between March 2000 and November 2001, we prospectively performed thoracic aortography after transarterial embolization in 76 patients with hemoptysis. Underlying diseases included tuberculosis (n = 34), bronchiectasis (n = 30), emphysema (n = 4), bronchitis (n = 4), aspergillosis (n = 3), and lung cancer (n = 1). Initially, angiography of bronchial and other systemic arteries possibly contributing to hemoptysis was performed with embolization. After completion of the embolization, thoracic aortography was performed, with the tip of the catheter located just distal to the origin of the left subclavian artery.
Results:
A total of 200 arteries (52 right bronchial, 40 left bronchial, six common bronchial, 76 intercostal, 11 inferior phrenic, six thoracodorsal, eight internal mammary, and one thyrocervical) were identified either at the initial embolization or on thoracic aortography as being responsible for causing hemoptysis. Among them, 29 arteries (14.5%) that were not included on the initial selection for embolization were later identified on postembolization thoracic aortography. There were two right bronchial, three left bronchial, eight inferior phrenic, and 16 intercostal arteries.
Conclusion:
The inferior phrenic and intercostal arteries were often missed on routine transarterial embolization in patients with hemoptysis. Postembolization thoracic aortography is useful for monitoring the effectiveness of embolization and for improving the detection of arteries contributing to hemoptysis.
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