Radiologic Management of Haemoptysis: Diagnostic and Interventional Bronchial Arterial Embolisation

 

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Abstract

Hemoptysis can be a life-threatening pulmonary emergency with high mortality, is symptomatic of an underlying severe pulmonary disease and requires immediate diagnosis and treatment. Diagnostically, bronchoscopy, conventional chest x-ray and contrast-enhanced multislice computed tomography (MSCT) with CT angiography (CTA) provide information regarding the underlying pulmonary disease, bleeding site, the vascular anatomy of the bronchial arteries (BA) and extrabronchial branches, as well a basis for planning of endovascular intervention. Therapeutically, bronchial artery embolization (BAE) is a safe and effective technique in the hands of an experienced interventionist with profound knowledge of the BA anatomy and possible pitfalls as well as experience with first-line therapy of recurrent and massive hemoptysis or as an intervention prior to elective surgery. Recurrent episodes of hemoptysis are not uncommon and require a prompt repeat BAE after exclusion of extrabronchial systemic and pulmonary artery bleeding sources. This review article should give an overview of the history, anatomical and pathophysiological basics and the clinical context of hemoptysis and diagnosis, as well as a survey of management, treatment and results of BAE.

Key Points:

• Hemoptyses are life threatening and require urgent diagnostic and therapy.

• Chest x-ray, bronchoscopy, and contrast-enhanced MSCT with CTA should be carried out before therapeutic bronchial artery embolization (BAE).

• BAE for the treatment of massive and recurrent hemoptysis is safe and effective.

• False embolization in spinal branches of BA are the most serious complication of a BAE.

• Repeatedly BAE refractory cases should undergo elective surgery.

Citation Format:

• Ittrich H, Klose H, Adam G Radiologisches Management von Hämoptysen: Diagnostik und Interventionelle Bronchialarterienembolisation. Fortschr Röntgenstr 2015; 187: 248 – 259

Zusammenfassung

Hämoptysen stellen einen lebensbedrohlichen pulmonalen Notfall mit hoher Mortalität dar, sind meist Symptome einer schwerwiegenden pulmonalen Grunderkrankung und erfordern eine sofortige Diagnostik und Therapie. Diagnostisch liefern das konventionelle Thoraxröntgen, die kontrastmittelunterstütze Mehrschicht-Computertomografie (MSCT) mit CT-Angiografie (CTA) und die Bronchoskopie Informationen zur zugrundeliegenden pulmonalen Erkrankung, zur Seitenlokalisation, zur Gefäßanatomie der Bronchialarterien (BA) und extrabronchialer Äste sowie zur Planung des interventionell-endovaskulären Eingriffs. Therapeutisch hat sich die Bronchialarterienembolisation (BAE) bei Durchführung durch einen erfahrenen Interventionalisten mit Kenntnissen der BA-Anatomie und möglicher Fallstricke als sichere und effektive Technik bewährt und ist Erstlinientherapie bei massiven und rekurrierenden Hämoptysen sowie im Vorfeld einer elektiven Operation. Rezidivierende Hämoptysen sind nicht ungewöhnlich und erfordern nach Abklärung möglicher extrabronchialer, systemisch- und pulmonalarterieller Blutungsquellen eine erneute BAE. Diese Übersichtsarbeit soll einen Überblick zur Historie, zu anatomischen und pathophysiologischen Grundlagen und zum klinischen Hintergrund der Hämoptysen sowie zu Diagnostik, Management, Therapie und Ergebnissen der BAE geben.

Kernaussagen:

• Hämoptysen sind lebensbedrohlich und erfordern eine dringende Diagnostik und Therapie.

• Thorax-Röntgen, Bronchoskopie und eine Kontrastmittel-unterstützte MSCT mit CTA sollten vor therapeutischer Bronchialarterienembolisation (BAE) erfolgen.

• Die BAE zur Therapie von massiven und rezidivierenden Hämoptysen ist sicher und effektiv.

• Fehlembolisationen in spinal versorgende Äste von BA sind die schwerste Komplikation einer BAE.

• Wiederholt BAE-refraktäre Fälle wie Aspergillome sollten operativ saniert werden.

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