Haemoptysis and bronchial artery embolization in children

doi:10.1016/j.prrv.2007.12.003

Paediatric Respiratory Reviews

Volume 9, Issue 2, June 2008, Pages 95-104

https://doi.org/10.1016/j.prrv.2007.12.003 Get rights and content

Summary

Haemoptysis varies in significance from trivial to fatal. The most common causes in children are tuberculosis, fungal infections and bronchiectasis of any cause. In populations of European origin, cystic fibrosis is the most common predisposing factor. Chronic or life-threatening haemoptysis requires further investigation. Various forms of treatment are possible, and management is optimized when a multidisciplinary team is available.

Bronchial artery embolization (BAE) is effective in controlling haemoptysis in most cases, although recurrent bleeding is not uncommon. BAE is often technically challenging, however, and requires angiographic skills that are not always available in children's hospitals. Although the procedure is usually regarded as relatively safe, complications are not uncommon and may be severe or even fatal.

Section snippets

Bronchial artery embolization

The usual indication for BAE in children is an immediate threat to life when other treatments have failed.⁵ Various authors have proposed thresholds for intervention based on the volume of expectorated blood. Sweezey et al.⁵ performed BAE in young people with CF who expectorated >300 ml/d for >2 d or >100 ml/d for >6 d.⁵ Barben et al. also used 100 ml as a threshold for for BAE in acute haemoptysis.⁶ The main problems with this strategy are that haemoptysis is difficult to measure accurately and

Conclusion

Haemoptysis, an uncommon symptom in childhood, may be due to several causes. Life-threatening haemoptysis may be difficult to treat. Although the complications of BAE may be severe (and are possibly under-reported), this technique is effective in the control of haemoptysis.

References (47)

P.A. Flume et al.
Massive hemoptysis in cystic fibrosis
Chest
(2005)
V. Vidal et al.
Bronchial artery embolization in adults with cystic fibrosis: impact on the clinical course and survival
J Vasc Interv Radiol
(2006)
N.B. Sweezey et al.
Bronchial artery embolization for severe hemoptysis in cystic fibrosis
Chest
(1990)
M. Antonelli et al.
Bronchial artery embolization for the management of nonmassive hemoptysis in cystic fibrosis
Chest
(2002)
K.L. Swanson et al.
Bronchial artery embolization: experience with 54 patients
Chest
(2002)
M.G. Cowling et al.
A potential pitfall in bronchial artery embolization
Clin Radiol
(1995)
M.L. Furnari et al.
Bronchial to subclavian shunt in a CF patient. A potential pitfall for embolization
J Cyst Fibros
(2003)
J.U. Barben et al.
Major haemoptysis in children with cystic fibrosis: a 20-year retrospective study
J Cyst Fibros
(2003)
K.N. Vinaya et al.
Reassessing bronchial artery embolotherapy with newer spherical embolic materials
J Vasc Interv Radiol
(2004)
D.J. Colson et al.
Management of pediatric hemoptysis: review and a case of isolated unilateral pulmonary artery agenesis
Int J Pediatr Otorhinolaryngol
(2005)

S.A. Chapman et al.

Unilateral diaphragmatic paralysis following bronchial artery embolization for hemoptysis

Chest

(2000)

P. Girard et al.

Left main-stem bronchial stenosis complicating bronchial artery embolization

Chest

(1990)

S.F. Liu et al.

Transient cortical blindness: a complication of bronchial artery embolization

Respir Med

(1998)

K.S. Wong et al.

Major hemoptysis in adolescents

Ind J Pediatr

(2005)

J.A. Coss-Bu et al.

Hemoptysis: a 10-year retrospective study

Pediatrics

(1997)

J. Barben et al.

Bronchial artery embolization for hemoptysis in young patients with cystic fibrosis

Radiology

(2002)

T.J. Marshall et al.

Vascular intervention in the thorax: bronchial artery embolization for haemoptysis

Eur Radiol

(1997)

P.S. Batra et al.

Etiology and management of pediatric hemoptysis

Arch Otolaryngol Head Neck Surg

(2001)

D.V. Schidlow et al.

Cystic Fibrosis Foundation consensus conference report on pulmonary complications of cystic fibrosis

Pediatr Pulmonol

(1993)

E.I. Hsiao et al.

Utility of fiberoptic bronchoscopy before bronchial artery embolization for massive hemoptysis

AJR Am J Roentgenol

(2001)

G.M. Brinson et al.

Bronchial artery embolization for the treatment of hemoptysis in patients with cystic fibrosis

Am J Respir Care Med

(1998)

Y.J. Jeong et al.

Prediction of recurrent hemoptysis with MDCT angiography

J Comput Assist Tomogr

(2006)

M. Remy-Jardin et al.

Bronchial and nonbronchial systemic arteries at multi-detector row CT angiography: comparison with conventional angiography

Radiology

(2004)

Cited by (26)

Bronchial Artery Embolization in Pediatric Pulmonary Hemorrhage: A Single-Center Experience
2020, Journal of Vascular and Interventional Radiology
Citation Excerpt :
Selective angiography of supraaortic vessels was performed with the use of a Vertebral catheter. The following angiographic findings were targeted for embolization (21): enlarged or tortuous vessels, parenchymal hypervascularity, bronchial-to-pulmonary shunting, and bronchial artery aneurysms. Superselection of the abnormal arteries was performed by using a coaxial microcatheter with a 2.2–2.5-F catheter (Cook, Bloomington, Indiana).
To explore the safety and effectiveness of bronchial artery (BA) embolization (BAE) in children with pulmonary hemorrhage.
Between February 2016 and February 2019, 41 patients (median age, 4 y; interquartile range, 2.3-8 y; median weight, 17.6 kg; interquartile range, 12.3–23.6 kg) underwent BAE. The indication of BAE included massive hemoptysis in 10 patients (24.4%), recurrent hemoptysis in 18 patients (43.9%), and refractory anemia in 13 patients (31.7%). The main etiology of pulmonary hemorrhage included pulmonary hemosiderosis (58.5%), congenital heart disease (17.1%), and infection (14.6%). A retrospective review was conducted of clinical outcomes of BAE.
There were 44 embolization sessions, with a total of 137 embolized vessels. Pulmonary hemorrhage was caused by BAs in 30 cases, nonbronchial systemic arteries plus BAs in 10, and nonbronchial systemic arteries in 1. Embolic particles were used in 30 cases (24 polyvinyl alcohol [PVA] and 6 microsphere), coils in 9 cases, and particles plus coils in 5 cases (4 PVA and 1 microsphere). Technical success (ability to embolize abnormal vessel) was achieved in 97.6% of patients (40 of 41), and clinical success (complete or partial resolution of hemoptysis within 30 days of embolization) was achieved in 90.2% (37 of 41). There was 1 procedure-related complication (2.4%) of cerebral infarction and 1 death from multiple-organ dysfunction (2.4%). Bleeding-free survival rates at 6, 12, 24, and 36 months were 92.5%, 83.9%, 83.9%, and 70.8%, respectively.
BAE is a safe and effective procedure in children with pulmonary hemorrhage.
Bronchial Artery Embolization for the Treatment of Acute Hemoptysis
2017, Techniques in Vascular and Interventional Radiology
Citation Excerpt :
CTA also allows for identification of variant bronchial artery anatomy, aiding the subsequent endovascular intervention. If CTA is not available and the procedure is performed under general anesthesia, some advocate bronchoscopy immediately prior to the BAE to localize bleeding.2 There are no absolute contraindications to BAE for the treatment of massive hemoptysis.
Massive hemoptysis is a life-threatening condition often defined as coughing up 300-600 mL of blood in 24 hours in an adult, or >8 mL/kg in 24 hours in a child. Although the definition is controversial, one should view massive hemoptysis as any volume of expectorated blood that can cause respiratory failure. This is because mortality in the setting of hemoptysis is usually associated with asphyxiation, rather than exsanguination. Massive hemoptysis accounts for only about 5% of cases of hemoptysis, but when treated conservatively, has a reported mortality rate between 50% and 85%. Etiologies vary widely based on demographics. In children, infectious causes predominate in developing countries, and cystic fibrosis predominates among children of European descent. In adults, malignancy, bronchiectasis, and chronic infection are the most common causes. Treatment begins with resuscitation and airway protection, followed by minimally invasive bronchoscopic and endovascular techniques. Surgical interventions are considered last line therapy due to mortality rates of 37%-43% in the setting of massive hemoptysis. Bronchial artery embolization is now considered the treatment of choice for massive hemoptysis.
Vascular pediatric interventional radiology
2012, Canadian Association of Radiologists Journal
Citation Excerpt :
Minor hemoptysis is almost always treated conservatively. Massive hemoptysis, defined as >8 mL/kg or 200-300 mL every 24 hours, requires more aggressive management [33–35]. Bronchial artery embolization (BAE) should be considered if bleeding continues despite bronchoscopic treatment.
Interventional radiology procedures are increasingly in demand in both the adult and pediatric populations. Pediatric procedures mirror many of the adult procedures but with increased complexity due to many considerations, notably patient size. This article reviews the various vascular pediatric interventional procedures. The aim is to provide a greater exposure to the possible treatment options for pediatric patients and to facilitate understanding of the success and complications rates related to various interventions.
La demande de procédures de radiologie d'intervention ne cesse de croître chez les patients adultes et pédiatriques. Les actes pédiatriques sont analogues à ceux pratiqués chez les adultes, mais ils présentent une complexité accrue en raison de facteurs liés à la taille du patient. L'article passe en revue les diverses procédures en radiopédiatrie vasculaire. Il vise à mieux faire connaître les choix de traitement possibles des patients pédiatriques et à faciliter l'interprétation des taux de réussite et de complications liés à l'imagerie après plusieurs interventions.
Hemoptysis - etiology, evaluation and treatment in a university hospital
2011, Revista Portuguesa de Pneumologia
Avaliar doentes admitidos por hemoptises quanto à etiologia, meios diagnósticos, tratamento e evolução.
Realizou-se um estudo retrospectivo dos doentes admitidos no Hospital de São João, por hemoptises, entre 01 de Janeiro de 2004 e 31 de Dezembro de 2008.
Foram estudados 237 doentes, com idade média de 57.9 anos. Nos doentes com idade inferior a 18 anos, os diagnósticos mais frequentes foram Bronquiectasias e Cardiopatia congénita. Nos adultos, as Sequelas de Tuberculose Pulmonar e as Bronquiectasias foram os diagnósticos predominantes (22.2% e 15.8%, respectivamente), seguidos pela neoplasia pulmonar. A infecção foi responsável pelas perdas hemáticas em 51 doentes, essencialmente Tuberculose Pulmonar, Pneumonia e Traqueobronquite. A etiologia ficou por esclarecer em 6.3%.
Todos os doentes realizaram radiografia de tórax. A TAC foi realizada em 81.4% dos doentes e a Broncofibroscopia em 52.7%, esta última localizando a fonte da hemorragia em 38.4% e estabelecendo diagnóstico definitivo em 17.6%.
Na maioria dos casos (90.7%), a hemorragia foi controlada com tratamento médico. Ao longo destes 5 anos, 11.8% dos doentes foram submetidos a embolização arterial, sendo a prevenção de recidiva o principal motivo da sua realização.
Foram registados 14 óbitos (5,9%), sendo identificados, como factores de mau prognóstico, a instabilidade hemodinâmica e a etiologia neoplásica.
As hemoptises continuam a ser um sintoma frequente, sendo actualmente as sequelas associadas a infecções crónicas e as neoplasias as principais etiologias. Neste estudo, os factores de pior prognóstico foram a instabilidade hemodinâmica e a etiologia neoplásica.
Evaluate patients admitted for hemoptysis, its etiology, use of diagnostic tests, treatment and outcome.
A retrospective analysis was done, checking clinical files of patients admitted for hemoptysis, between 1^st January 2004 and 31^st December 2008.
Two hundred and thirty seven patients were included in this study, with a mean age of 57.9 years. In patients under 18 years, the most frequent diagnoses were Bronchiectasis and Congenital Cardiopathy. In adults, Pulmonary Tuberculosis Sequelae and Bronchiectasis were the dominant diagnoses (22.2% and 15.8%, respectively), followed by Lung Cancer. Active infection was responsible for bleeding in 51 patients, especially Pulmonary Tuberculosis, Pneumonia and Tracheobronchitis. The etiology of hemoptysis was not established in 6.3%.
All patients performed chest X-Ray. Chest CT was performed in 81.4% of patients and Fiberoptic bronchoscopy in 52.7%, the latter locating the source of bleeding in 38.4% and establishing a final diagnosis in 17.6%.
In most patients, effective control of bleeding was achieved by medical treatment (90.7%).
During these 5 years, arterial embolization was performed in 11.8% of patients. The main reason for embolization was recurrence prevention.
There were 14 deaths (5.9%), being identified as poor prognostic factors, hemodynamic instability and malignancy.
Hemoptysis is still a frequent symptom, being chronic infection sequelae and lung cancer their main causes. In this study, factors associated with a worse prognosis were hemodynamic instability and malignancy.
Radiological Imaging in Chest Diseases: Moving Away from Conventional Modes
2023, Indian Journal of Pediatrics
Pediatric bronchial Dieulafoy's disease with bronchial artery embolization: two case reports
2023, Translational Pediatrics

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Mini-Symposium: Imaging And Interventional RadiologyHaemoptysis and bronchial artery embolization in children

Summary

Section snippets

Bronchial artery embolization

Conclusion

Chest

J Vasc Interv Radiol

Chest

Chest

Chest

Clin Radiol

J Cyst Fibros

J Cyst Fibros

J Vasc Interv Radiol

Int J Pediatr Otorhinolaryngol

Chest

Chest

Respir Med

Major hemoptysis in adolescents

Ind J Pediatr

Hemoptysis: a 10-year retrospective study

Pediatrics

Bronchial artery embolization for hemoptysis in young patients with cystic fibrosis

Radiology

Vascular intervention in the thorax: bronchial artery embolization for haemoptysis

Eur Radiol

Etiology and management of pediatric hemoptysis

Arch Otolaryngol Head Neck Surg

Cystic Fibrosis Foundation consensus conference report on pulmonary complications of cystic fibrosis

Pediatr Pulmonol

Utility of fiberoptic bronchoscopy before bronchial artery embolization for massive hemoptysis

AJR Am J Roentgenol

Bronchial artery embolization for the treatment of hemoptysis in patients with cystic fibrosis

Am J Respir Care Med

Prediction of recurrent hemoptysis with MDCT angiography

J Comput Assist Tomogr

Bronchial and nonbronchial systemic arteries at multi-detector row CT angiography: comparison with conventional angiography

Radiology

Mini-Symposium: Imaging And Interventional Radiology
Haemoptysis and bronchial artery embolization in children