A study by Shin et al [24] also documented the importance of detecting a pulmonary artery source of hemoptysis prior to embolization. In his study of 286 patients presenting with massive hemoptysis, they used CTA to identify 10 patients for a total of 11 PAPs as the source of the massive hemoptysis by CTA prior to undergoing BAE. Of these 11 PAPs, 6 PAPs detected on CTA could not be detected prospectively on conventional pulmonary arteriography, but CTA guided subselection pulmonary arteriography and resulted in successful embolization of the bleeding artery. The authors reported a pulmonary artery embolization success rate of over 90%. A subsequent study by Shin et al [26] also identified patients presenting with massive hemoptysis due to a pulmonary arterial source. Out of 712 patients with massive hemoptysis, 24 patients demonstrated PAPs on their preprocedural CTA examination. Fifteen of these PAPs identified on CTA were also visualized on pulmonary arteriography, all of which were successfully embolized. The remaining 9 PAPs identified on CTA were not detectable on conventional pulmonary arteriography and were subsequently treated with bronchial and systemic nonbronchial embolization, resulting in a 33% rate of hemoptysis cessation. Persistently symptomatic PAPs were subsequently treated by percutaneous or surgical interventions based on CTA findings. There are no recent data comparing the diagnostic advantages between routine CT with IV contrast with CTA. However, CTA may offer a slight advantage over routine CT with IV contrast when the intention is to treat massive hemoptysis with BAE because CTA typically provides slightly better opacification of vessels, possibly improving detection of abnormal arteries potentially causing hemoptysis. At present, the vast majority of publications reporting BAE outcomes obtain CTA chest CTs prior to BAE for preprocedural planning.
Hemoptysis. A study by Shin et al [24] also documented the importance of detecting a pulmonary artery source of hemoptysis prior to embolization. In his study of 286 patients presenting with massive hemoptysis, they used CTA to identify 10 patients for a total of 11 PAPs as the source of the massive hemoptysis by CTA prior to undergoing BAE. Of these 11 PAPs, 6 PAPs detected on CTA could not be detected prospectively on conventional pulmonary arteriography, but CTA guided subselection pulmonary arteriography and resulted in successful embolization of the bleeding artery. The authors reported a pulmonary artery embolization success rate of over 90%. A subsequent study by Shin et al [26] also identified patients presenting with massive hemoptysis due to a pulmonary arterial source. Out of 712 patients with massive hemoptysis, 24 patients demonstrated PAPs on their preprocedural CTA examination. Fifteen of these PAPs identified on CTA were also visualized on pulmonary arteriography, all of which were successfully embolized. The remaining 9 PAPs identified on CTA were not detectable on conventional pulmonary arteriography and were subsequently treated with bronchial and systemic nonbronchial embolization, resulting in a 33% rate of hemoptysis cessation. Persistently symptomatic PAPs were subsequently treated by percutaneous or surgical interventions based on CTA findings. There are no recent data comparing the diagnostic advantages between routine CT with IV contrast with CTA. However, CTA may offer a slight advantage over routine CT with IV contrast when the intention is to treat massive hemoptysis with BAE because CTA typically provides slightly better opacification of vessels, possibly improving detection of abnormal arteries potentially causing hemoptysis. At present, the vast majority of publications reporting BAE outcomes obtain CTA chest CTs prior to BAE for preprocedural planning.