Localization of bleeding sites in patients with hemoptysis based on their chest computed tomography findings: a retrospective cohort study.

Hyun Ju Seon,Yong-Soo Kwon,Yun-Hyeon Kim

doi:10.1186/s12890-016-0322-1

Abstract

BackgroundThe aim of this study was to propose a localization strategy for bleeding sites in hemoptysis patients using their chest computed tomography (CT) findings.MethodsBetween January 2005 and July 2009, the chest CT findings of 161 hemoptysis patients were retrospectively reviewed. Following chest CT, the lobe with the most prominent ground glass attenuation (GGA) or specific lesions with the potential to cause pulmonary hemorrhage were analysed to develop a localization strategy for bleeding sites. Fibre optic bronchoscopy (FOB) findings of active bleeding were used as the standard reference for the bleeding sites.ResultsThe concordance rate between the most prominent GGA and FOB findings was higher than that between specific lesions and FOB findings (Kappa value [k] = 0.751 vs. 0.448, p < 0.001). Among the specific lesions, there were high concordance rates between lung cancer and FOB findings (3/3, 100%) and fungus balls and FOB findings (8/9, 89%). The agreement of localization of the bleeding site between FOB findings and the localization strategy based on chest CT findings including the most prominent GGA, lung cancer and fungus balls, showed almost perfect (k = 0.904).ConclusionsThe localization of bleeding sites in hemoptysis patients could be determined by chest CT findings such as the most prominent GGA, malignancy and fungus ball.

Highlights

The aim of this study was to propose a localization strategy for bleeding sites in hemoptysis patients using their chest computed tomography (CT) findings
We evaluated abnormal radiological findings in the CT images as follows: First, we evaluated the presence or absence of ground glass attenuation (GGA), which is the result of the alveolar lumen filling with blood [7]
This study directly compared between CT and Fibre optic bronchoscopy (FOB) findings in localization of bleeding sites, and active bleeding visualization by FOB were defined as standard reference of the bleeding sites

Summary

Introduction

The aim of this study was to propose a localization strategy for bleeding sites in hemoptysis patients using their chest computed tomography (CT) findings. Massive hemoptysis is one of the most dreaded conditions among all respiratory emergencies and can have a variety of underlying causes [1, 2]. Medical and surgical treatments have been tried for hemoptysis, the mortality rate increases significantly to about 40%, when surgery is undertaken as an emergency procedure [3, 4]. Localization of the specific artery could help to perform successful BAE and surgery. The rapid and exact identification of the site causing active bleeding is essential for the successful treatment of patients with hemoptysis.

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