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Diagnostic and Interventional Radiology... 2014Hemoptysis is the expectoration of blood that originates from the lower respiratory tract. It is usually a self-limiting event but in fewer than 5% of cases it may be... (Review)
Review
Hemoptysis is the expectoration of blood that originates from the lower respiratory tract. It is usually a self-limiting event but in fewer than 5% of cases it may be massive, representing a life-threatening condition that warrants urgent investigations and treatment. This article aims to provide a comprehensive literature review on hemoptysis, analyzing its causes and pathophysiologic mechanisms, and providing details about anatomy and imaging of systemic bronchial and nonbronchial arteries responsible for hemoptysis. Strengths and limits of chest radiography, bronchoscopy, multidetector computed tomography (MDCT), MDCT angiography and digital subtraction angiography to assess the cause and lead the treatment of hemoptysis were reported, with particular emphasis on MDCT angiography. Treatment options for recurrent or massive hemoptysis were summarized, highlighting the predominant role of bronchial artery embolization. Finally, a guide was proposed for managing massive and nonmassive hemoptysis, according to the most recent medical literature.
Topics: Angiography, Digital Subtraction; Bronchial Arteries; Embolization, Therapeutic; Hemoptysis; Humans; Multidetector Computed Tomography
PubMed: 24808437
DOI: 10.5152/dir.2014.13426 -
Japanese Journal of Clinical Oncology May 2021Previous reports on transarterial treatment for lung cancer were reviewed. The bronchial arterial infusion therapy has a long history since 1964. Better local control... (Review)
Review
Previous reports on transarterial treatment for lung cancer were reviewed. The bronchial arterial infusion therapy has a long history since 1964. Better local control with less doses of anti-neoplastic agents was warranted by trying transarterial administration to lung and mediastinal tumors. It is reported that both primary and metastatic tumors are fed by bronchial or other systemic arteries. The bronchial arterial embolization for hemoptysis has been introduced for clinical practice since 1973. Hemoptysis by not only benign but also malignant diseases has been well controlled by embolization. In recent decades, the technical elements for transarterial treatments have markedly improved. They make it possible to carry out precise procedures of selective catheter insertion to the tumor relating arteries. Current concepts of transarterial treatment, technical aspects and treatment outcomes are summarized. Tentative result from chemo-embolization for advanced lung cancer using recent catheter techniques was also described. It provides favorable local control and survival merits. It is considered that a population of lung cancer patients can benefit from transarterial management using small doses of anti-neoplastic agents, with less complications and less medical costs.
Topics: Bronchial Arteries; Catheterization, Peripheral; Disease Progression; Embolization, Therapeutic; Hemoptysis; Humans; Lung; Lung Neoplasms; Treatment Outcome
PubMed: 33855367
DOI: 10.1093/jjco/hyab050 -
Allergy Dec 2022Neutrophil granulocytes, or neutrophils, are the most abundant circulating leukocytes in humans and indispensable for antimicrobial immunity, as exemplified in patients... (Review)
Review
Neutrophil granulocytes, or neutrophils, are the most abundant circulating leukocytes in humans and indispensable for antimicrobial immunity, as exemplified in patients with inborn and acquired defects of neutrophils. Neutrophils were long regarded as the foot soldiers of the immune system, solely destined to execute a set of effector functions against invading pathogens before undergoing apoptosis, the latter of which was ascribed to their short life span. This simplistic understanding of neutrophils has now been revised on the basis of insights gained from the use of mouse models and single-cell high-throughput techniques, revealing tissue- and context-specific roles of neutrophils in guiding immune responses. These studies also demonstrated that neutrophil responses were controlled by sophisticated feedback mechanisms, including directed chemotaxis of neutrophils to tissue-draining lymph nodes resulting in modulation of antimicrobial immunity and inflammation. Moreover, findings in mice and humans showed that neutrophil responses adapted to different deterministic cytokine signals, which controlled their migration and effector function as well as, notably, their biologic clock by affecting the kinetics of their aging. These mechanistic insights have important implications for health and disease in humans, particularly, in allergic diseases, such as atopic dermatitis and allergic asthma bronchiale, as well as in autoinflammatory and autoimmune diseases. Hence, our improved understanding of neutrophils sheds light on novel therapeutic avenues, focusing on molecularly defined biologic agents.
Topics: Humans; Mice; Animals; Neutrophils; Autoimmunity; Autoimmune Diseases; Hypersensitivity; Inflammation; Anti-Infective Agents
PubMed: 36067034
DOI: 10.1111/all.15505 -
International Journal of Molecular... Jun 2019Bronchial asthma is a chronic disease characterized by reversible airway obstruction, mucus production, and bronchial hyperresponsiveness (BHR). Although Th2... (Review)
Review
Bronchial asthma is a chronic disease characterized by reversible airway obstruction, mucus production, and bronchial hyperresponsiveness (BHR). Although Th2 cell-mediated eosinophilic inflammation is an important disease mechanism in the majority of patients with bronchial asthma, recent studies suggest the possible development of Th2-independent airway inflammation and BHR. These non-Th2 endotype patients seem to consist of multiple subgroups, and often do not respond to inhaled corticosteroids. Therefore, to understand the pathogenesis of asthma, it is important to characterize these non-Th2 subgroups. Recently, we demonstrated that Th9 cells induce eosinophil infiltration and eosinophil-independent BHR, and Th9 cells-mediated BHR may be resistant to glucocorticoid. In this review, we summarize the contribution of several T cell subsets in the development of bronchial asthma and introduce our recent study demonstrating Th9 cell-mediated and eosinophil-independent BHR.
Topics: Animals; Asthma; Bronchial Hyperreactivity; Eosinophils; Humans; T-Lymphocyte Subsets; Th1 Cells; Th17 Cells; Th2 Cells
PubMed: 31216735
DOI: 10.3390/ijms20122980 -
British Medical Journal Mar 1980
Topics: Adult; Bronchial Neoplasms; Bronchoscopy; Hemoptysis; Humans; Lung Neoplasms
PubMed: 7370639
DOI: No ID Found -
Radiologic management of haemoptysis: diagnostic and interventional bronchial arterial embolisation.RoFo : Fortschritte Auf Dem Gebiete Der... Apr 2015Hemoptysis can be a life-threatening pulmonary emergency with high mortality, is symptomatic of an underlying severe pulmonary disease and requires immediate diagnosis... (Review)
Review
UNLABELLED
Hemoptysis can be a life-threatening pulmonary emergency with high mortality, is symptomatic of an underlying severe pulmonary disease and requires immediate diagnosis and treatment. Diagnostically, bronchoscopy, conventional chest x-ray and contrast-enhanced multislice computed tomography (MSCT) with CT angiography (CTA) provide information regarding the underlying pulmonary disease, bleeding site, the vascular anatomy of the bronchial arteries (BA) and extrabronchial branches, as well a basis for planning of endovascular intervention. Therapeutically, bronchial artery embolization (BAE) is a safe and effective technique in the hands of an experienced interventionist with profound knowledge of the BA anatomy and possible pitfalls as well as experience with first-line therapy of recurrent and massive hemoptysis or as an intervention prior to elective surgery. Recurrent episodes of hemoptysis are not uncommon and require a prompt repeat BAE after exclusion of extrabronchial systemic and pulmonary artery bleeding sources. This review article should give an overview of the history, anatomical and pathophysiological basics and the clinical context of hemoptysis and diagnosis, as well as a survey of management, treatment and results of BAE.
KEY POINTS
Hemoptyses are life threatening and require urgent diagnostic and therapy. Chest x-ray, bronchoscopy, and contrast-enhanced MSCT with CTA should be carried out before therapeutic bronchial artery embolization (BAE). BAE for the treatment of massive and recurrent hemoptysis is safe and effective. False embolization in spinal branches of BA are the most serious complication of a BAE. Repeatedly BAE refractory cases should undergo elective surgery.
Topics: Angiography; Bronchial Arteries; Cooperative Behavior; Diagnosis, Differential; Embolization, Therapeutic; Emergencies; Hemoptysis; Humans; Image Enhancement; Interdisciplinary Communication; Multidetector Computed Tomography; Recurrence; Tomography, X-Ray Computed
PubMed: 25372159
DOI: 10.1055/s-0034-1385457 -
Current Opinion in Allergy and Clinical... Apr 2022To communicate recent insights about the natural history of childhood asthma, with a focus on prediction of persistence and remission of childhood asthma, up to early... (Review)
Review
PURPOSE OF REVIEW
To communicate recent insights about the natural history of childhood asthma, with a focus on prediction of persistence and remission of childhood asthma, up to early adulthood.
RECENT FINDINGS
Lung function around the age of 8-9 years is the strongest predictor: obstructive lung function predicts asthma persistence up to early adulthood, whereas normal lung function predicts remission. The ability to predict asthma remission improves when lung function is combined with blood eosinophil levels and degree of bronchial hyperresponsiveness. Interventions, such as inhaled corticosteroids and immunotherapy do not appear to alter the course of asthma. Epigenetic studies have revealed potential novel biomarkers of asthma remission, such as micro-RNA patterns in blood. Specifically, lower serum levels of mi-R221-5p, which is associated with lower IL-6 release and eosinophilic inflammation, predict remission. Higher levels of blood DNA-methylation of a CpG site in Peroxisomal Biogenesis Factor 11 Beta were associated with asthma remission.
SUMMARY
Lung function, allergic comorbidity and polysensitization in childhood predict the course of asthma. Recent epigenetic studies have provided a better understanding of underlying pathological processes in asthma remission, which may be used to improve prediction or develop novel treatments aimed at altering the course of asthma.
Topics: Adult; Asthma; Biomarkers; Bronchial Hyperreactivity; Child; Eosinophils; Humans; Hypersensitivity
PubMed: 35197433
DOI: 10.1097/ACI.0000000000000810 -
BMC Pulmonary Medicine Nov 2022Massive hemoptysis is a rare but potentially life-threatening condition of patients with cystic fibrosis (CF) and advanced pulmonary disease. Hypertrophied bronchial...
BACKGROUND
Massive hemoptysis is a rare but potentially life-threatening condition of patients with cystic fibrosis (CF) and advanced pulmonary disease. Hypertrophied bronchial arteries are understood to cause massive hemoptysis when rupturing. Risk factors to predict massive hemoptysis are scarce and bronchial artery diameters are not part of any scoring system in follow-up of patients with CF. Aim of this study was to correlate bronchial artery diameter with massive hemoptysis in CF.
METHODS
Bronchial artery and non-bronchial systemic artery diameters were measured in contrast enhanced computed tomography (CT) scans in patients with massive hemoptysis and compared to patients with end-stage CF and no history of hemoptysis. Demographic and clinical data and side of bronchial artery/non-bronchial systemic artery hypertrophy and coil embolization were documented.
RESULTS
In this retrospective multicenter study 33 patients with massive hemoptysis were included for bronchial artery/non-bronchial systemic artery diameter measurements, (13 female, 20 male, median age 30 years (18-55)). Bronchial artery diameters were significantly larger in the case group than in the control group with median 4 mm (2.2-8.2 mm), and median 3 mm (1-7 mm), respectively (p = 0.002). Sensitivity of bronchial arteries ≥ 3.5 mm to be associated with hemoptysis was 0.76 and specificity 0.71 with ROC creating an area under the curve of 0.719. If non-bronchial systemic arteries were present, they were considered culprit and embolized in 92% of cases.
CONCLUSION
Bronchial arteries ≥ 3.5 mm and presence of hypertrophied non-bronchial systemic arteries correlate with massive hemoptysis in patients with CF and might serve as risk predictor for massive hemoptysis. Therefore, in patients with advanced CF we propose CT scans to be carried out as CT angiography to search for bronchial arteries ≥ 3.5 mm and for hypertrophied non-bronchial systemic arteries as possible risk factors for massive hemoptysis.
Topics: Humans; Male; Female; Adult; Bronchial Arteries; Cystic Fibrosis; Embolization, Therapeutic; Hemoptysis; Angiography
PubMed: 36397043
DOI: 10.1186/s12890-022-02233-2 -
BMJ Case Reports Mar 2012Teflon-coated pledgeted sutures can be used to reinforce the bronchial anastomosis site following a pulmonary resection in order to prevent bronchopleural fistula...
Teflon-coated pledgeted sutures can be used to reinforce the bronchial anastomosis site following a pulmonary resection in order to prevent bronchopleural fistula formation. The authors describe the case of a 42-year-old woman with recurrent haemoptysis secondary to the erosion of a pledgeted suture through the distal trachea. The pledgeted suture was used to reinforce a defect in the wall of the distal trachea after a right upper lobectomy for stage 2a squamous cell carcinoma. Surgically, a completion pneumonectomy with carinal reconstruction was thought necessary to treat the haemoptysis. Given her age and potential surgical morbidities, the decision was made to perform serial bronchoscopies with careful pruning and eventual removal of the pledget by using the cryoprobe and a flexible scissors. This resulted in the eventual removal of the suture. Follow-up bronchoscopy 4 weeks postremoval demonstrated no residual defect on the airway wall.
Topics: Adult; Bronchoscopy; Carcinoma, Squamous Cell; Female; Hemoptysis; Humans; Lung Neoplasms; Pneumonectomy; Polytetrafluoroethylene; Sutures
PubMed: 22605709
DOI: 10.1136/bcr.12.2011.5279 -
Respiratory Research Aug 2021To evaluate the safety, efficacy, and long-term outcome of bronchial artery embolization (BAE) in the treatment of non-massive hemoptysis and the prognostic factors...
PURPOSE
To evaluate the safety, efficacy, and long-term outcome of bronchial artery embolization (BAE) in the treatment of non-massive hemoptysis and the prognostic factors associated with recurrent bleeding.
MATERIALS AND METHODS
From March 2005 to September 2014, BAE was performed in 233 patients with non-massive hemoptysis. All patients had a history of persistent or recurrent hemoptysis despite conservative medical treatment. We assessed the technical and clinical success, recurrence, prognostic factors related to recurrent bleeding, recurrence-free survival rate, additional treatment, and major complications in all the patients.
RESULTS
Technical success was achieved in 224 patients (96.1%), and clinical success was obtained in 219 (94.0%) of the 233 patients. In addition, 64 patients (27.5%) presented hemoptysis recurrence with median time of 197 days after embolization. Tuberculosis sequelae and presence of aberrant bronchial artery or non-bronchial systemic collaterals were significantly related to recurrent bleeding (p < 0.05). The use of Histoacryl-based embolic materials significantly reduced the recurrent bleeding rate (p < 0.05). Patient who had a tuberculosis sequelae showed a significantly lower recurrence-free survival rate (p = 0.013). Presence of aberrant bronchial artery or non-bronchial systemic collaterals showed a statistically significant correlation with recurrence-free survival rate (p = 0.021). No patients had major complications during follow-up.
CONCLUSIONS
BAE is a safe and effective treatment to manage non-massive hemoptysis. The procedure may offer a better long-term control of recurrent hemoptysis and quality of life than conservative therapy alone.
Topics: Adult; Aged; Bronchial Arteries; Catheterization; Cohort Studies; Embolization, Therapeutic; Feasibility Studies; Female; Follow-Up Studies; Gelatin Sponge, Absorbable; Hemoptysis; Humans; Male; Middle Aged; Retrospective Studies; Treatment Outcome
PubMed: 34362373
DOI: 10.1186/s12931-021-01820-x