Hemoptysis CT chest without IV contrast for the evaluation of hemoptysis did not differentiate between massive versus nonmassive quantities of hemoptysis. CT Chest without and with IV Contrast Although very early publications studying the utility of CT in patients presenting with nonmassive hemoptysis performed chest protocols including acquisitions both without IV contrast followed by acquisitions with IV contrast, there are no data to support that there is any added value of CT chest without IV contrast prior to the administration of IV contrast in the diagnosis of nonmassive hemoptysis or in the preprocedural planning of BAE. CTA Chest There are no recent studies comparing the benefits of a routine chest CT with IV contrast to CTA in patients with nonmassive hemoptysis. As previously discussed, preprocedural CTA or routine CT with IV contrast has become the standard of care for arterial planning of BAE. In a recent study reporting the outcomes of BAE in patients with primarily nonmassive hemoptysis, all 489 noncancer patients underwent a CTA prior to embolization [47]. The authors noted that conventional aortography previously used to detect origins of the bleeding bronchial arteries was effectively replaced by arterial mapping information provided by CTA. Radiography Chest Chest radiographs continue to be a reasonable initial imaging choice in patients with nonmassive hemoptysis, especially when used to confirm a clinical diagnosis for benign disease such as acute bronchitis or pneumonia. There are no recent studies comparing the utility of chest radiographs with other imaging modalities. Variant 3: Recurrent hemoptysis. Initial imaging. Recurrent hemoptysis is a new variant for this update. It is defined as repeated episodes of hemoptysis following initial treatment with either medical therapy or BAE. Typically, the etiology of recurrent hemoptysis is known and usually not life threatening, although there is a wide range of hemoptysis severity.
Hemoptysis. Hemoptysis CT chest without IV contrast for the evaluation of hemoptysis did not differentiate between massive versus nonmassive quantities of hemoptysis. CT Chest without and with IV Contrast Although very early publications studying the utility of CT in patients presenting with nonmassive hemoptysis performed chest protocols including acquisitions both without IV contrast followed by acquisitions with IV contrast, there are no data to support that there is any added value of CT chest without IV contrast prior to the administration of IV contrast in the diagnosis of nonmassive hemoptysis or in the preprocedural planning of BAE. CTA Chest There are no recent studies comparing the benefits of a routine chest CT with IV contrast to CTA in patients with nonmassive hemoptysis. As previously discussed, preprocedural CTA or routine CT with IV contrast has become the standard of care for arterial planning of BAE. In a recent study reporting the outcomes of BAE in patients with primarily nonmassive hemoptysis, all 489 noncancer patients underwent a CTA prior to embolization [47]. The authors noted that conventional aortography previously used to detect origins of the bleeding bronchial arteries was effectively replaced by arterial mapping information provided by CTA. Radiography Chest Chest radiographs continue to be a reasonable initial imaging choice in patients with nonmassive hemoptysis, especially when used to confirm a clinical diagnosis for benign disease such as acute bronchitis or pneumonia. There are no recent studies comparing the utility of chest radiographs with other imaging modalities. Variant 3: Recurrent hemoptysis. Initial imaging. Recurrent hemoptysis is a new variant for this update. It is defined as repeated episodes of hemoptysis following initial treatment with either medical therapy or BAE. Typically, the etiology of recurrent hemoptysis is known and usually not life threatening, although there is a wide range of hemoptysis severity.