PURPOSE: Hemoptysis is a life-threatening complication of cystic fibrosis (CF). Electrocardiographically (ECG) synchronized prospectively triggered multi-detector row CT angiography (CTA) was used to evaluate its role in depicting bronchial artery anatomy, predicting the location of bronchial arterial bleeding, and facilitating a focused plan for bronchial artery embolization (BAE) in CF patients with acute massive hemopytsis.
METHODS: A prospective cohort study was performed in hemodynamically stable CF patients, with massive hemoptysis as defined by > 240 mL of blood in 24 hours, to investigate the effectiveness of CTA for preprocedural planning prior to BAE. The CTA was performed with a dual source 32 detector row Z-flying focal spot scanner (Somatom Definition, Siemens, Germany), using prospective ECG triggering and a single breath hold technique.
RESULTS: Five adult (mean age 31.5 ± 7.9 years) CF patients (3 male, 2 female) presented with massive hemoptysis and underwent CTA between 9/09 and 3/11. The location of the bleeding source was predicted in each case based on lung pathology on CTA. Hypertrophied and tortuous orthotopic bronchial arteries were found in all patients. The anatomy delineated included their origin, mediastinal and parenchymal course, as well as caliber. Ectopic bronchial artery collaterals arising from the subclavian arteries and their branches were also well delineated in all patients. Three of the 5 patients required BAE. Conventional aortograms were not necessary because the sites of origin of the bronchial arteries were known prior to the procedure. Review of the CTA data allowed for selection for arterial site access (brachial vs. femoral), limited search time, and limited the number of selective catheterizations necessary to complete the procedures. The findings of CTA and conventional angiography were concordant in all 3 cases. BAE resulted in successful outcome in 2 patients without complications. BAE was successful in averting hemoptysis in the third patient until urgent lung transplantation was performed.
CONCLUSIONS: CTA was well tolerated and accurately depicted bronchial artery anatomy in CF patients with acute massive hemoptysis while allowing for preprocedural preparation for BAE. CTA prior to conventional angiography decreased BAE radiation dose, table time, and contrast volume with excellent outcomes.
CLINICAL IMPLICATIONS: CTA should be considered in the initial evaluation of a CF patient with massive hemoptysis.
DISCLOSURE: The following authors have nothing to disclose: Don Hayes, Jr., Michael Winkler, Stephen Kirkby, Anil Attili
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