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ACR Appropriateness Criteria® Hemoptysis
, Kathryn M Olsen1, Shawdi Manouchehr-Pour2
1Radiology Imaging Associates, Englewood, Colorado.
Summary
This review highlights imaging and treatment guidelines for hemoptysis (coughing up blood). Chest imaging and CT angiography are recommended, with bronchial artery embolization increasingly used for severe or recurrent cases.
Area of Science:
- Pulmonology and Radiology
- Evidence-based Medicine
Background:
- Hemoptysis, or coughing up blood, presents in nonmassive, massive, and recurrent forms.
- Current literature guides the diagnosis and management of hemoptysis.
Framework:
- Imaging recommendations for massive hemoptysis include chest radiograph and CT with contrast or CT angiography (CTA) with contrast.
- For nonmassive hemoptysis, similar imaging is advised, with bronchial artery embolization used post-medical therapy failure.
- Recurrent hemoptysis management involves reassessment with chest imaging and CTA, with embolization as a preferred treatment, barring infectious etiologies like cystic fibrosis.
Implementation:
- The American College of Radiology Appropriateness Criteria provide evidence-based guidelines.
- Guidelines are developed and revised annually by multidisciplinary expert panels.
- Methodologies like RAND/UCLA and GRADE are used to assess imaging and treatment appropriateness.
Implications:
- These guidelines aim to standardize and optimize the diagnostic and therapeutic approach to hemoptysis.
- Expert opinion supplements evidence where data is lacking or equivocal.
- The review emphasizes the growing role of bronchial artery embolization in managing hemoptysis.
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