The largest study to date isolating patients with massive hemoptysis due to a pulmonary arterial source identified 24 patients from a cohort of 712 patients presenting with massive hemoptysis [26]. This study reported an 88% pulmonary artery embolization success rate. Overall, BAE is now universally accepted as a safe and effective intervention for the treatment of massive hemoptysis. CT Chest with IV Contrast The utility of CT in determining the cause for hemoptysis was first established in the late 1990s. Naidich et al [27] reported CT-bronchoscopic correlations of 58 patients with hemoptysis (severity not specified), showing CT was superior to bronchoscopy in both the diagnosis of lung cancer (17 CT positive versus 15 bronchoscopy positive) and definitive staging of lung cancer (48% versus 14%, respectively). They also established that CT was superior to radiography. Of the 23 normal chest radiographs, subsequent CT provided a definitive cause in 9 patients. Revel et al [28] published data from 80 patients with massive hemoptysis demonstrating CT was more efficient than the previous reference standard of bronchoscopy in identifying the etiology of hemoptysis (77% versus 8%, respectively; P < . 001). Based on these studies, CT can facilitate BAE planning by potentially identifying a specific lesion or isolating the bleeding artery based on increased arterial diameter and wall irregularity in a high percentage of cases. CT Chest without IV Contrast Several early studies have established the use of CT in the diagnosis of hemoptysis used high-resolution CT (HRCT). For example, Tsoumakidou et al [32] followed 184 patients with varying degrees of hemoptysis, demonstrating that HRCT identified a cause in 41% of patients with a normal chest radiograph. In 2008, Khalil et al [25] reported on the utility of performing HRCT in the emergent management of hemoptysis in the intensive care unit.
Hemoptysis. The largest study to date isolating patients with massive hemoptysis due to a pulmonary arterial source identified 24 patients from a cohort of 712 patients presenting with massive hemoptysis [26]. This study reported an 88% pulmonary artery embolization success rate. Overall, BAE is now universally accepted as a safe and effective intervention for the treatment of massive hemoptysis. CT Chest with IV Contrast The utility of CT in determining the cause for hemoptysis was first established in the late 1990s. Naidich et al [27] reported CT-bronchoscopic correlations of 58 patients with hemoptysis (severity not specified), showing CT was superior to bronchoscopy in both the diagnosis of lung cancer (17 CT positive versus 15 bronchoscopy positive) and definitive staging of lung cancer (48% versus 14%, respectively). They also established that CT was superior to radiography. Of the 23 normal chest radiographs, subsequent CT provided a definitive cause in 9 patients. Revel et al [28] published data from 80 patients with massive hemoptysis demonstrating CT was more efficient than the previous reference standard of bronchoscopy in identifying the etiology of hemoptysis (77% versus 8%, respectively; P < . 001). Based on these studies, CT can facilitate BAE planning by potentially identifying a specific lesion or isolating the bleeding artery based on increased arterial diameter and wall irregularity in a high percentage of cases. CT Chest without IV Contrast Several early studies have established the use of CT in the diagnosis of hemoptysis used high-resolution CT (HRCT). For example, Tsoumakidou et al [32] followed 184 patients with varying degrees of hemoptysis, demonstrating that HRCT identified a cause in 41% of patients with a normal chest radiograph. In 2008, Khalil et al [25] reported on the utility of performing HRCT in the emergent management of hemoptysis in the intensive care unit.