CT血管成像对严重咯血急诊处理的应用价值

陈莹; 王客非; 王志伟; 刘长柱; 金征宇

doi:10.24920/003482

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CT血管成像对严重咯血急诊处理的应用价值

中国医学科学杂志（英文版） 2019年34卷第3期页码：194-198

Original Article | Updated：2024-04-10

- CT血管成像对严重咯血急诊处理的应用价值
- Affiliations：
  
  1. 1 Department of Radiology, Peking the 6th Hospital, Beijing 100007, China
  2. 2 Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China
- Author bio：
  
  *Tel: 86-10-69155444, Fax: 86-10-69155441, E-mail: zhiweiwang1981@sina.com
- Funds：
  
  the National Public Welfare Basic Scientific Research Program of Chinese Academy of Medical Sciences(2018PT32003);the National Public Welfare Basic Scientific Research Program of Chinese Academy of Medical Sciences(2017PT32004)
- DOI：10.24920/003482
  中图分类号：
- 收稿日期：2018-09-30，
  
  网络出版日期：2019-07-02，
  
  纸质出版日期：2019-07-02
- Accepted：
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陈莹, 王客非, 王志伟, 等. CT血管成像对严重咯血急诊处理的应用价值[J]. 中国医学科学杂志（英文版）, 2019,34(3):194-198.

Chen Ying, Wang Kefei, Wang Zhiwei, et al. Value of CT-Angiography in the Emergency Management of Severe Hemoptysis[J]. Chinese medical sciences journal, 2019, 34(3): 194-198.
陈莹, 王客非, 王志伟, 等. CT血管成像对严重咯血急诊处理的应用价值[J]. 中国医学科学杂志（英文版）, 2019,34(3):194-198. DOI： 10.24920/003482.

Chen Ying, Wang Kefei, Wang Zhiwei, et al. Value of CT-Angiography in the Emergency Management of Severe Hemoptysis[J]. Chinese medical sciences journal, 2019, 34(3): 194-198. DOI： 10.24920/003482.

摘要

目的

探讨急诊咯血患者支气管动脉的多排CT血管成像的影像解剖特点

并评估其对急诊咯血患者处理的应用价值。

方法

回顾性分析2013年1月1日至2015年12月31日急诊就诊的严重咯血患者（24小史咯血量≥100 ml）的临床与影像数据。讨论这些患者的多排CT血管成像图像特点、治疗方法和结局。

结果

共108例患者进行了多排CT血管成像检查。引起咯血病因主要为支气管扩张（44%）、结核（26%）和肿瘤（18%）。多排CT血管成像能显示197条支气管动脉和相关的35条非支气管体部动脉。位于纵膈气管分叉水平的支气管动脉的平均直径为2.8±1.2 mm。接受保守治疗的52例患者的支气管动脉的平均直径为2.9±1.1 mm

与56例接受栓塞治疗患者的支气管动脉平均直径无显著性差异（2.7±1.1 mm

=0.94）。栓塞治疗的技术成功率为95%（53/56）。随访患者的临床治愈率为94%（50/53）。

结论

对于严重咯血患者

多排CT血管成像能显示出血相关支气管动脉和非支气管体部动脉的解剖特点。然而

通过多排CT血管成像测量的支气管动脉直径不能作为患者是否需要支气管动脉栓塞治疗的指征。

Abstract

Objective

To depict imaging anatomy of bronchial artery (BA) using multidetector CT-angiography (MDCTA) and evaluate the value of MDCTA for management of hemoptysis patients requiring admission to emergency room.

Methods

We retrospectively studied the clinical and radiological data of patients with severe hemoptysis (≥100 ml of expectorated blood in a 24-hour period) requiring admission to emergency room from Jan 1

2013 to Dec 31

2015. Patients’ images of MDCTA

treatment modalities

and outcome were discussed.

Results

A total of 108 patients underwent MDCTA scans. Etiology of hemoptysis was mainly bronchiectasis (44%)

tuberculosis sequelae (26%) and tumor (18%). MDCTA visualized 197 traceable BAs and also suggested the involvement of 35 nonbronchial systemic arteries. The mean diameter of BAs

measured at the level of the bronchial bifurcation in the mediastinum

was 2.8±1.2 mm. The mean diameter of BAs

for 52 patients who only received conservative treatment

was 2.9±1.1 mm

and was not significantly larger than that of BAs for 56 patients who underwent bronchial artery embolization (BAE) for continued bleeding which did not resolve after conservative treatment (2.7±1.1 mm

= 0.94). The technical success rate of embolization was 95% (53/56). Clinical success rate during follow-up was achieved in 50 (94%) of 53 patients who had undergone embolization.

Conclusions

MDCTA provides useful information for identifying the anatomical characteristics of bleeding-related BAs and nonbronchial systemic arteries for the management of patients with severe hemoptysis. However

MDCTA could not determine the individuals who need BAE through measuring diameter of BAs.

关键词

Keywords

references

Cordovilla R , Bollo de Miguel E , Nuñez Ares A , et al . Diagnosis and treatment of hemoptysis . Arch Bronconeumol 2016 ; 52 ( 7 ): 368 - 77 . doi: 10.1016/j.arbres.2015.12.002 10.1016/j.arbres.2015.12.002 .

Larici AR , Franchi P , Occhipinti M , et al . Diagnosis and management of hemoptysis . Diagn Interv Radiol 2014 ; 20 ( 4 ): 299 - 309 . doi: 10.5152/dir.2014.13426 10.5152/dir.2014.13426 . DOI: 10.5152/dir.2014.13426 http://doi.org/10.5152/dir.2014.13426

Mori H , Ohno Y , Tsuge Y , et al . Use of multidetector row CT to evaluate the need for bronchial arterial embolization in hemoptysis patients . Respiration 2010 ; 80 ( 1 ): 24 - 31 . doi: 10.1159/000253882 10.1159/000253882 .

Ittrich H , Klose H , Adam G . Radiologic management of haemoptysis: diagnostic and interventional bronchial arterial embolisation . Rofo 2015 ; 187 ( 4 ): 248 - 59 . doi: 10.1055/s-0034-1385457 10.1055/s-0034-1385457 .

Khalil A , Fedida B , Parrot A , et al . Severe hemoptysis: from diagnosis to embolization . Diagn Interv Imaging 2015 ; 96 ( 7-8 ): 775 - 88 . doi: 10.1016/j.diii.2015.06.007 10.1016/j.diii.2015.06.007 .

Shin B , Koh WJ , Shin SW , et al . Outcomes of bronchial artery embolization for life-threatening hemoptysis in patients with chronic pulmonary aspergillosis . PLoS One 2016 ; 11 ( 12 ): e0168373 . doi: 10.1371/journal.pone.0168373 10.1371/journal.pone.0168373 .

Fujita T , Tanabe M , Moritani K , et al . Immediate and late outcomes of bronchial and systemic artery embolization for palliative treatment of patients with nonsmall-cell lung cancer having hemoptysis . Am J Hosp Palliat Care 2014 ; 31 ( 6 ): 602 - 7 . doi: 10.1177/1049909113499442 10.1177/1049909113499442 .

Tom LM , Palevsky HI , Holsclaw DS , et al . Recurrent bleeding, survival, and longitudinal pulmonary function following bronchial artery embolization for hemoptysis in a U.S. adult population . J Vasc Interv Radiol 2015 ; 26 ( 12 ): 1806 - 13 . doi: 10.1016/j.jvir.2015.08.019 10.1016/j.jvir.2015.08.019 .

Chun JY , Morgan R , Belli AM . Radiological management of hemoptysis: a comprehensive review of diagnostic imaging and bronchial arterial embolization . Cardiovasc Intervent Radiol 2010 ; 33 ( 2 ): 240 - 50 . doi: 10.1007/s00270-009-9788-z 10.1007/s00270-009-9788-z .

Fujii H , Fujita A , Nakamura H , et al . Endovascular embolization of an aberrant bronchial artery originating from the internal mammary artery in a patient with hemoptysis . Case Rep Radiol 2016 ; 2016 : 2707195 . doi: 10.1155/2016/2707195 10.1155/2016/2707195 .

Lin Y , Chen Z , Yang X , et al . Bronchial and non-bronchial systemic arteries: value of multidetector CT angiography in diagnosis and angiographic embolisation feasibility analysis . J Med Imaging Radiat Oncol 2013 ; 57 ( 6 ): 644 - 51 . doi: 10.1111/1754-9485 10.1111/1754-9485 .

Slattery MM , Keeling AN , Lee MJ . Outcome and complications of bronchial artery embolisation for life-threatening haemoptysis . Ir J Med Sci 2009 ; 178 ( 2 ): 155 - 9 . doi: 10.1007/s11845-008-0244-x 10.1007/s11845-008-0244-x .

Gupta M , Srivastava DN , Seith A , et al . Clinical impact of multidetector row computed tomography before bronchial artery embolization in patients with hemoptysis: a prospective study . Can Assoc Radiol J 2013 ; 64 ( 1 ): 61 - 73 . doi: 10.1016/j.carj.2011.08.002 10.1016/j.carj.2011.08.002 . DOI: 10.1016/j.carj.2011.08.002 http://doi.org/10.1016/j.carj.2011.08.002

Khalil A , Fartoukh M , Parrot A , et al . Impact of MDCT angiography on the management of patients with hemoptysis . AJR Am J Roentgenol 2010 ; 195 ( 3 ): 772 - 8 . doi: 10.2214/AJR.09.4161 10.2214/AJR.09.4161 .

Chalumeau-Lemoine L , Khalil A , Prigent H , et al . Impact of multidetector CT-angiography on the emergency management of severe hemoptysis . Eur J Radiol 2013 ; 82 ( 11 ): e742 - 7 . doi: 10.1016/j.ejrad.2013.07.009 10.1016/j.ejrad.2013.07.009 . DOI: 10.1016/j.ejrad.2013.07.009 http://doi.org/10.1016/j.ejrad.2013.07.009

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