Standard CTs with contrast also include timing issues and recons/reformats. Only in CTA, however, is 3-D rendering a required element. This corresponds to the definitions that CMS has applied to the Current Procedural Terminology codes. Massive hemoptysis due to an unknown cause (ie, cryptogenic hemoptysis) has similar BAE outcomes compared with hemoptysis from a known cause. An early study treating cryptogenic hemoptysis with BAE was published in 2010 [22]. In this study, 39 patients with cryptogenic hemoptysis who presented with varying severity of hemorrhage were all treated medically. Hemoptysis remained uncontrolled in 21 patients, who subsequently underwent successful BAE; 2 patients had recurrent hemoptysis. A second retrospective review compared BAE outcomes of 26 patients with cryptogenic hemoptysis to 152 patients with a known cause of hemoptysis over the same interval. Both groups showed a 100% immediate success rate following BAE, and both groups demonstrated similar recurrence rates (12% versus 25%, respectively, which was not statistically different) [8]. Over 90% of massive hemoptysis is due to a systemic arterial supply, and therefore conventional pulmonary arteriography is rarely performed. An early study documenting this was authored by Sbano et al [23], reporting a pulmonary arterial bleeding origin in 8 of 76 patients with massive hemoptysis. Although all of these patients were initially treated with BAE, 7 out of 8 patients required additional pulmonary artery embolization. Shin et al [24] identified 10 patients with pulmonary artery pseudoaneurysms (PAPs) out of 286 patients presenting with massive hemoptysis undergoing BAE. These authors reported a pulmonary artery embolization success rate above 90%. Khalil et al [25] retrospectively reviewed 272 patients, 13 of whom had bleeding from a pulmonary artery origin. Of these 13 patients, 11 underwent pulmonary artery embolization, all of which were successful.
Hemoptysis. Standard CTs with contrast also include timing issues and recons/reformats. Only in CTA, however, is 3-D rendering a required element. This corresponds to the definitions that CMS has applied to the Current Procedural Terminology codes. Massive hemoptysis due to an unknown cause (ie, cryptogenic hemoptysis) has similar BAE outcomes compared with hemoptysis from a known cause. An early study treating cryptogenic hemoptysis with BAE was published in 2010 [22]. In this study, 39 patients with cryptogenic hemoptysis who presented with varying severity of hemorrhage were all treated medically. Hemoptysis remained uncontrolled in 21 patients, who subsequently underwent successful BAE; 2 patients had recurrent hemoptysis. A second retrospective review compared BAE outcomes of 26 patients with cryptogenic hemoptysis to 152 patients with a known cause of hemoptysis over the same interval. Both groups showed a 100% immediate success rate following BAE, and both groups demonstrated similar recurrence rates (12% versus 25%, respectively, which was not statistically different) [8]. Over 90% of massive hemoptysis is due to a systemic arterial supply, and therefore conventional pulmonary arteriography is rarely performed. An early study documenting this was authored by Sbano et al [23], reporting a pulmonary arterial bleeding origin in 8 of 76 patients with massive hemoptysis. Although all of these patients were initially treated with BAE, 7 out of 8 patients required additional pulmonary artery embolization. Shin et al [24] identified 10 patients with pulmonary artery pseudoaneurysms (PAPs) out of 286 patients presenting with massive hemoptysis undergoing BAE. These authors reported a pulmonary artery embolization success rate above 90%. Khalil et al [25] retrospectively reviewed 272 patients, 13 of whom had bleeding from a pulmonary artery origin. Of these 13 patients, 11 underwent pulmonary artery embolization, all of which were successful.