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Utility of Fiberoptic Bronchoscopy Before Bronchial Artery Embolization for Massive Hemoptysis

Eric I. Hsiao1, Carl M. Kirsch2, Frank T. Kagawa2, John H. Wehner2, William A. Jensen2 and Richard B. Baxter3

1 Division of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, 300 Pasteur Dr., Stanford, CA 94305.
2 Division of Respiratory and Critical Care Medicine, Santa Clara Valley Medical Center, 751 S. Bascom Ave., San Jose, CA 95128, and Stanford University School of Medicine, Stanford, CA 94305.
3 Department of Radiology, Alta Bates Hospital, Ashby Campus, 2450 Ashby Ave., Berkeley, CA 94705, and Stanford University School of Medicine. Stanford, CA 94305.



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  		Fig. 1. —Bar graph shows comparison between radiographic studies (chest radiographs or CT scans or both) and bronchoscopic findings for determination of bleeding site during initial episode of hemoptysis.

 


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  		Fig. 2. —57-year-old woman with massive hemoptysis from tuberculous bronchiectasis. Chest radiograph shows unilateral disease.

 


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  		Fig. 3. —25-year-old man with massive hemoptysis from tuberculous bronchiectasis. Chest radiograph shows bilateral disease with multiple cavitary lesions in right lung (arrows).

 


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  		Fig. 4. —59-year-old man with massive hemoptysis from tuberculous bronchiectasis. Chest radiograph shows bilateral disease with preponderance of abnormality on right side.

 


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  		Fig. 5A. —21-year-old man with arteriovenous malformation who required chest CT scan to localize source of hemoptysis. Chest radiograph shows no abnormality.

 


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  		Fig. 5B. —21-year-old man with arteriovenous malformation who required chest CT scan to localize source of hemoptysis. Chest CT scan reveals infiltrate in posterior segment of right lower lobe not seen in A.

 


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  		Fig. 6A. —Vascular abnormalities seen on bronchial arteriograms of patients with hemoptysis (all images were obtained before embolization). 21-year-old man with tuberculous bronchiectasis. Descending thoracic aortogram shows bronchial artery (arrowhead) to pulmonary artery (arrow) shunting.

 


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  		Fig. 6B. —Vascular abnormalities seen on bronchial arteriograms of patients with hemoptysis (all images were obtained before embolization). Same patient as in A. Selective right bronchial arteriogram showing bronchial artery hypertrophy and neovascularity.

 


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  		Fig. 6C. —Vascular abnormalities seen on bronchial arteriograms of patients with hemoptysis (all images were obtained before embolization). 25-year-old man with tuberculous bronchiectasis. Selective arteriogram shows a common bronchial artery trunk giving rise to a hypertrophied right (arrowhead) and a normal left bronchial artery (arrow).

 


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  		Fig. 7. —Suggested algorithm for evaluation and management of massive hemoptysis in patients who are poor surgical candidates.

 

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