Endovascularly Treatable Causes of Hemoptysis: Guide for Emergency Radiologists

In the setting of hemoptysis in the emergency department, the initial step is to identify patients with a life-threatening condition. With endovascular therapy now established as the preferred approach for managing acute bleeding, one of the primary challenges is determining whether there is an underlying cause of hemoptysis associated with treatable vessels. CT angiography has become the diagnostic modality of choice because it provides a comprehensive vascular map in a single acquisition by enabling evaluation of the bronchial arteries, nonbronchial systemic arteries, and pulmonary arteries. The authors review the imaging features of various conditions associated with hemoptysis that are amenable to endovascular treatment, including bronchial and nonbronchial systemic artery hypertrophy, aneurysms and pseudoaneurysms, systemic-to-pulmonary artery shunts, aortobronchial fistulas, pulmonary arteriovenous malformations, systemic artery-to-pulmonary vein malformations and fistulas, and major aortopulmonary collateral arteries. A structured reporting approach is proposed to aid emergency radiologists in lesion characterization and accurate identification of patients suitable for endovascular treatment. ^©RSNA, 2025 Supplemental material is available for this article.