Chest Imaging

Haemoptysis, endovascular treatment

Technique for treatment of bronchial bleeding that is indicated in patients after failure of medical treatment and where there is a temporary or absolute contraindication to surgery (see embolization bronchial arteries). Haemoptysis suitable for embolization can be classified into three categories:

  • life-threatening bleeding;

  • repeated haemoptysis in patients with a poor respiratory function and in patients unable to tolerate the vasoconstrictive therapy; and

  • minimal haemoptysis which can turn out to be a "sentinel" bleeding and may be followed by a grace period of hours to days before exsanguinating bleeding occurs. Such bleeding is encountered in patients with cavitary tuberculosis, invasive mycosis, lung abscess, excavated carcinoma, and any bronchoinvasive and angioinvasive diseases of the lung.

    The single most important contraindication to endovascular treatment is the risk of spinal cord injury which may occur during selective catheterization of the intercostobronchial trunk or intercostal arteries. Such a risk can be avoided by the registration of somatosensory evoked potentials during the procedure. In patients with previously unknown chronic thromboembolic disease, embolization of the systemic collateral supply may be responsible for an aseptic pulmonary infarct. Approximately 5% of bronchial bleeding are of pulmonary arterial origin. In these cases, the pulmonary artery is vaso-occluded with coils or balloons. Bronchial wall injury after bronchial artery embolization is exceptional. Myocardial ischaemia can occur after inadvertent embolization of the coronary circulation through the bronchial arteries. Pulmonary infarction has already been mentioned. Intercostal and paraspinal muscle infarction and necrosis of the oesophagus, mediastinal lymph nodes and pulmonary artery are due to inadequate embolization techniques.

    JR - MRJ