Localization of bleeding sites in patients with hemoptysis based on their chest computed tomography findings: a retrospective cohort study
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Published on: May 4, 2022
Hyun Ju Seon1, Yun-Hyeon Kim1, Yong-Soo Kwon2
1Department of Radiology, Chonnam National University Medical School, 42 Jebongro, Donggu, Gwangju, 61469, South Korea.
Insights
This study proposes a chest CT scan strategy to pinpoint bleeding sites in hemoptysis patients. The strategy accurately identifies bleeding locations using ground glass attenuation, lung cancer, and fungus balls.
Area of Science:
- Radiology
- Pulmonology
- Medical Imaging
Background:
- Hemoptysis, or coughing up blood, poses diagnostic challenges.
- Accurate localization of bleeding sites is crucial for effective treatment.
Purpose of the Study:
- To develop and validate a localization strategy for bleeding sites in hemoptysis patients.
- To assess the utility of chest computed tomography (CT) findings in localizing hemorrhage sources.
Main Methods:
- Retrospective review of chest CT findings in 161 hemoptysis patients.
- Analysis of ground glass attenuation (GGA) and specific lesions for hemorrhage potential.
- Comparison with fibre optic bronchoscopy (FOB) findings as the gold standard.
Main Results:
- The most prominent GGA showed higher concordance with FOB findings (k=0.751) than specific lesions (k=0.448).
- High concordance was observed for lung cancer (100%) and fungus balls (89%) with FOB findings.
- The proposed CT-based localization strategy demonstrated almost perfect agreement with FOB (k=0.904).
Conclusions:
- Chest CT findings, including prominent GGA, malignancy, and fungus balls, can effectively localize bleeding sites in hemoptysis.
- This strategy aids in guiding treatment decisions for patients with hemoptysis.
Background:
The aim of this study was to propose a localization strategy for bleeding sites in hemoptysis patients using their chest computed tomography (CT) findings.
Methods:
Between January 2005 and July 2009, the chest CT findings of 161 hemoptysis patients were retrospectively reviewed. Following chest CT, the lobe with the most prominent ground glass attenuation (GGA) or specific lesions with the potential to cause pulmonary hemorrhage were analysed to develop a localization strategy for bleeding sites. Fibre optic bronchoscopy (FOB) findings of active bleeding were used as the standard reference for the bleeding sites.
Results:
The concordance rate between the most prominent GGA and FOB findings was higher than that between specific lesions and FOB findings (Kappa value [k] = 0.751 vs. 0.448, p < 0.001). Among the specific lesions, there were high concordance rates between lung cancer and FOB findings (3/3, 100%) and fungus balls and FOB findings (8/9, 89%). The agreement of localization of the bleeding site between FOB findings and the localization strategy based on chest CT findings including the most prominent GGA, lung cancer and fungus balls, showed almost perfect (k = 0.904).
Conclusions:
The localization of bleeding sites in hemoptysis patients could be determined by chest CT findings such as the most prominent GGA, malignancy and fungus ball.
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