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Hemoptysis: contribution of the
Computed tomography (CT)

El kacemi, I. El hardouni, S.Bouklata


-Department of emergency radiology UHC IBN
SINA RABAT MOROCCO
PLAN

 INTRODUCTION AND GENERALITIES


 AIMS OF THE STUDY
MATERIALS AND METHODS
 RESULTS
 CONCLUSION
INTRODUCTION AND GENERALITIES

Hemoptysis is the spitting of blood that


originated in the lungs or bronchial tubes, a
result of pulmonary or bronchial hemorrhage.

 Hemoptysis is classified as nonmassive


or massive based on the volume of blood loss

Gravity depends on the abundance of the


hemoptisis .
• The hemoptysis can be a life-threatening
respiratory emergency and indicates potentially
serious underlying intrathoracic disease.

• The Initial assessment by chest angio CT


scan is useful for:
- for localizing the bleeding site
- identifying the underlying cause.
- Direct the endovascular treatment
OBJECTIVES

To point out the physiopathology of hemoptysis.


To show the advantages of the CT scan
for the diagnosis and rule out the etiology of the
hemoptysis.
To orient therapeutic decisions
MATERIALS AND METHODS
 site: departement of emergency radiology CHU ibn
SINA Rabat.

 We retrospectively reviewed 40 patients files and


radiological findings with particular focus on the chest
angio CT scan .
 We analyzed the age, sex, history of tobacco , bleeding,
chest radiography, chest computed tomography

 Protocol of the CT :
–Scan (64 cuts).
–Flow: 2cc/s.
–Fine cuts: 0,6 -1mm
–Single acquisition.
–Late passage if suspicion of extravasation
• The angio CT-scan multi-cuts permitted to
specify:
-Localization.
-The mechanism.
-The cause.
-To assess the locoregional extension in
case of bronchopulmonary neoplasy.
RESULTS:
• The mean age was : 58 years ( 30 – 86).
• 32males and 8 females
• 71% smokers
RESULTS

• ETIOLOGY:
- Neoplasy: 25%
- Pulmonary embolism : 5%
- tuberculosis: 37,5%
- Aspergillosis : 5%
- Bronchogenic cyst : 2,5%
- Pulmonary artery aneurysm : 2,5%
- Bronchial dilatation : 22,5%
ETIOLOGY:
• the chest radiography was normal in 10% and
the CT was diagnostic in 77%, including 4
cases with a normal chest radiography.

• When the chest radiography was unspecific


(28%), CT was diagnostic in 40% and localized
the site of bleeding in 60% CT .
Bronchopulmonary tumor
Bilateral pulmonary artery aneurysm in the context
of Behcet’s disease
Bronchial dilatation
Active tuberculosis
Sequelea of tuberculosis
Bronchogenic cyst
Aspergillosis
DISCUSSION
• After a careful history and examination, a chest
radiography should be obtained
- If a diagnosis remains unclear, further imaging
with chest computed tomography (CT) or direct
visualization with bronchoscopy
often is indicated.
• High-resolution CT has become increasingly
useful in the initial evaluation of hemoptysis and is
preferred if parenchymaldisease is suspected.

• Its role in hemoptysis continues to evolve, and


further studies are needed to evaluate its effect
on patient management and outcome
• High-resolution CT is indicated when clinical
suspicion for malignancy exists and sputum and
bronchoscopy do not yield any pathology.

• High-resolution CT also is indicated when chest


radiography reveals peripheral or other
parenchymal disease
CONCLUSION
• Large-volume hemoptysis carries significant
mortality and warrants urgent investigation and
intervention
• The endovascular treatment in urgency of the
massive hemoptysis depend of on the site and
the mechanism.
REFERENCE:
• 1 Carette MF, Parrot A, Khalil A (2004). Hémoptysies: principales
étiologies et conduite à tenir. EMC-pneumologie

• 2 Revel MP, Fournier LS, Hennebicque AS, Cuenod CA, Meyer G,


Reynaud P, Frija G (2002) Can CT replace bronchoscopy in the
detection of the site and cause of bleeding in patients with large or
massive hemoptysis? AJR 179:1217-1224.

• 3 Hsiao EI, Kirsch CM, Kagawa FT, Wehner JH, Jensen WA, Baxter
RB (2001) Utility of fiberoptic bronchoscopy before bronchial artery
embolization for massive hemoptysis. AJR 177:861-867.

• 4 Hakanson E, Konstantinov IE, Fransson SG, Svedjeholm R (2002)


Management of life-threatening haemoptysis. Br J

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