Can CT Replace Bronchoscopy in the Detection of the Site and Cause of Bleeding in Patients with Large or Massive Hemoptysis?

Can CT Replace Bronchoscopy in the Detection of the Site and Cause of Bleeding in Patients with Large or Massive Hemoptysis?

Marie Pierre Revel¹, Laure S. Fournier¹, Anne Sophie Hennebicque¹, Charles Andre Cuenod¹, Guy Meyer², Philippe Reynaud² and Guy Frija¹

^¹ Department of Radiology, Georges Pompidou Hospital, 20 rue Leblanc, 75015 Paris, France.
^² Department of Pneumology, Georges Pompidou Hospital, 75015 Paris, France.

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Fig. 1A. —49-year-old woman with massive hemoptysis. Location of bleeding was shown on chest radiography, but cause was not identified on chest radiography. CT was not performed. Chest radiograph shows alveolar opacities in right upper lobe after recurrence of massive hemoptysis. Note associated anomalies in both lower lobes, probably inhaled blood, and note predominance of alveolar abnormalities in right upper lobe.

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Fig. 1B. —49-year-old woman with massive hemoptysis. Location of bleeding was shown on chest radiography, but cause was not identified on chest radiography. CT was not performed. Chest radiograph obtained at admission, a few hours before A, shows that alveolar consolidation visible in A is nonspecific and is being caused by rebleeding.

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Fig. 1C. —49-year-old woman with massive hemoptysis. Location of bleeding was shown on chest radiography, but cause was not identified on chest radiography. CT was not performed. Bronchial arteriogram shows dilated right bronchial artery and systemic hypervascularization in right upper lobe. Bronchiectasis was found at pathologic examination after surgical resection of right upper lobe, which was performed to avoid further life-threatening recurrence of hemoptysis.

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Fig. 2A. —85-year-old man with large hemoptysis. Chest CT scans show both site and cause of bleeding. This case shows that bronchiectasis inducing large bleeding may be discrete on CT and also that ground-glass opacities help localize bleeding in diseases with diffuse distribution. CT scan reveals discrete bronchiectasis (arrow) distally in right middle lobe.

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Fig. 2B. —85-year-old man with large hemoptysis. Chest CT scans show both site and cause of bleeding. This case shows that bronchiectasis inducing large bleeding may be discrete on CT and also that ground-glass opacities help localize bleeding in diseases with diffuse distribution. CT scan depicts associated focal ground-glass opacity anterior to major fissure. This finding localizes bleeding to right middle lobe.

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Fig. 3A. —54-year-old woman with large hemoptysis. Chest CT shows both site and cause of bleeding. Chest CT scan shows dense nodule in right upper lobe. This finding is consistent with posttuberculous calcified lesion.

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Fig. 3B. —54-year-old woman with large hemoptysis. Chest CT shows both site and cause of bleeding. High-resolution CT scan shows ground-glass opacities and reveals bleeding site is in right upper lobe.

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Fig. 3C. —54-year-old woman with large hemoptysis. Chest CT shows both site and cause of bleeding. Control CT scan obtained 1 month after A and B reveals that ground-glass opacities are no longer visible.

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Fig. 4. —50-year-old man with massive hemoptysis. Chest CT scan shows both site and cause of bleeding. Contrast-enhanced CT scan shows aortic false aneurysm, fistulized into left lower lobe bronchi. Lesion was seen on millimetric unenhanced images (not shown), and contrast-enhanced CT was subsequently performed.

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