Hemoptysis: contribution of the Computed tomography (CT)

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El kacemi, I. El hardouni, S.Bouklata -Department of emergency radiology

UHC IBN SINA RABAT MOROCCO

PLAN

INTRODUCTION AND GENERALITIES AIMS OF THE STUDYMATERIALS AND METHODS RESULTS CONCLUSION

INTRODUCTION AND GENERALITIES

Hemoptysis is the spitting of blood that originated in the lungs or bronchial tubes, a result of pulmonary or bronchial hemorrhage.

Hemoptysis is classified as nonmassiveor massive based on the volume of blood

loss

Gravity depends on the abundance of the hemoptisis .

•The hemoptysis can be a life-threatening respiratory emergency and indicates potentially serious underlying intrathoracic disease.

•The Initial assessment by chest angio CT scan is useful for:

- for localizing the bleeding site - identifying the underlying cause.  - Direct the endovascular treatment

OBJECTIVES

To point out the physiopathology of hemoptysis. To show the advantages of the CT scan for the diagnosis and rule out the etiology of the

hemoptysis.To orient therapeutic decisions

MATERIALS AND METHODS site: departement of emergency radiology CHU ibn SINA

Rabat.

We retrospectively reviewed 40 patients files and radiological findings with particular focus on the chest angio CT scan .

We analyzed the age, sex, history of tobacco , bleeding, chest radiography, chest computed tomography

Protocol of the CT :–Scan (64 cuts).–Flow: 2cc/s.–Fine cuts: 0,6 -1mm–Single acquisition.–Late passage if suspicion of extravasation

•The angio CT-scan multi-cuts permitted to specify:

-Localization. -The mechanism. -The cause. -To assess the locoregional extension in

case of bronchopulmonary neoplasy.

RESULTS: •The mean age was : 58 years ( 30 – 86).• 32males and 8 females•71% smokers

RESULTS

•ETIOLOGY:- Neoplasy: 25%- Pulmonary embolism : 5%- tuberculosis: 37,5%- Aspergillosis : 5%- Bronchogenic cyst : 2,5%- Pulmonary artery aneurysm : 2,5%- Bronchial dilatation : 22,5%

ETIOLOGY:

• the chest radiography was normal in 10% and the CT was diagnostic in 77%, including 4 cases with a normal chest radiography.

•When the chest radiography was unspecific (28%), CT was diagnostic in 40% and localized the site of bleeding in 60% CT .

Bronchopulmonary tumor

Bilateral pulmonary artery aneurysm in the context of Behcet’s disease

Bronchial dilatation

Active tuberculosis

Sequelea of tuberculosis

Bronchogenic cyst

Aspergillosis

DISCUSSION•After a careful history and examination, a

chest radiography should be obtained- If a diagnosis remains unclear, further

imaging with chest computed tomography (CT) or direct visualization with bronchoscopy

often is indicated.

•High-resolution CT has become increasinglyuseful in the initial evaluation of hemoptysis and is

preferred if parenchymaldisease is suspected.

• Its role in hemoptysis continues to evolve, and further studies are needed to evaluate its effect on patient management and outcome

•High-resolution CT is indicated when clinical suspicion for malignancy exists and sputum and bronchoscopy do not yield any pathology.

•High-resolution CT also is indicated when chest radiography reveals peripheral or other parenchymal disease

CONCLUSION•  Large-volume hemoptysis carries significant

mortality and warrants urgent investigation and intervention

•The endovascular treatment in urgency of the massive hemoptysis depend of on the site and the mechanism.

REFERENCE:• 1 Carette MF, Parrot A, Khalil A (2004). Hémoptysies:

principales étiologies et conduite à tenir. EMC-pneumologie

• 2 Revel MP, Fournier LS, Hennebicque AS, Cuenod CA, Meyer G, Reynaud P, Frija G (2002) Can CT replace bronchoscopy in the detection of the site and cause of bleeding in patients with large or massive hemoptysis? AJR 179:1217-1224.

• 3 Hsiao EI, Kirsch CM, Kagawa FT, Wehner JH, Jensen WA, Baxter RB (2001) Utility of fiberoptic bronchoscopy before bronchial artery embolization for massive hemoptysis. AJR 177:861-867.

• 4 Hakanson E, Konstantinov IE, Fransson SG, Svedjeholm R (2002) Management of life-threatening haemoptysis. Br J