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Objective. To evaluate the safety and efficacy of interventional care in pediatric hemoptysis for anomalous bronchial arteries (BAs) and to identify the potential factors resulting in hemoptysis recurrence. Methods. 20 children complained of hemoptysis were diagnosed with anomalous BAs. All patients received transcatheter plug occlusion in Department of Cardiology, Children’s Hospital of Chongqing Medical University. The safety and efficacy were evaluated according to clinical symptoms and images monitoring of enrolled subjects grouped as recurrence group and nonrecurrence group. The potential factors causing hemoptysis recurrence were reviewed and summarized. Results. No deaths were recorded in a follow-up. Otherwise, hemoptysis recurrence was found in 8 subjects for 14 times, accounting for about 40%. Compared with nonrecurrence group, it indicated a statistical significance in hemoglobin levels (P=0.049), mycoplasma pneumonia particle assays (MP-PA) titers (P=0.030), and number of anomalous BAs (P=0.020). Meanwhile, 50% recurrent scenarios were associated with a respiratory infection by microbiological assessment before transcatheter plug occlusion. The repeat occlusion was applied for unclosed BAs leading to visual recurrent hemoptysis, the average interval time of which was 5.4 ± 3.6 mon. Conclusion. The data from this retrospective study have shown that transcatheter plug occlusion is a relatively safe procedure with a low mortality. The number of abnormal BAs has been identified as a highly significant predictor of recurrence, and the role of MP and other potential factors should be verified in a multicenter, larger sample size, and randomized controlled trial.

ObjectivesTo compare the average number of culprit arteries per patient, clinical success rate, and hemoptysis-free survival rate between hemoptysis patients with multidetector computed tomography (MDCT) angiography prior to bronchial artery embolization (BAE) and those without preprocedural MDCT angiographyMethodsThis retrospective study was approved by the institutional review board with waiver of patient informed consent. From September 2012 to March 2017, 157 consecutive hemoptysis patients had been undergoing BAE. Among them, 106 patients received preprocedural MDCT angiography (MDCT group), while 51 patients did not receive preprocedural MDCT angiography (control group). The average number of culprit arteries per patient, clinical success rate, and hemoptysis-free survival rate were compared between the two groups.ResultsThe average number of culprit ectopic bronchial arteries and that of non-bronchial systemic arteries originating from the subclavian and internal mammary arteries per patient in the MDCT group were both significantly higher than those in the control group (0.15 ± 0.51 vs 0.04 ± 0.20, p = 0.022, and 0.17 ± 0.56 vs 0.08 ± 0.39, p = 0.040, respectively). The clinical success rate of BAE with preprocedural MDCT angiography tended to be higher than that without MDCT angiography (97.2 vs 88.2%, p = 0.057). Importantly, patients in the MDCT group had a significantly higher hemoptysis-free early survival rate compared to those in the control group (96.1 vs 86.7%, p = 0.031).ConclusionsPreprocedural MDCT angiography helps detect culprit ectopic bronchial arteries and non-bronchial systemic arteries originating from subclavian and internal mammary arteries during BAE, and can improve the hemoptysis-free early survival rate, which could be recommended as a regular examination prior to BAE in patients with hemoptysis.Key Points• Preprocedural MDCT angiography helps detect culprit ectopic bronchial arteries and NBSAs originating from subclavian and internal mammary arteries during BAE.• Conducting MDCT angiography prior to BAE can improve hemoptysis-free early survival rate in hemoptysis patients.

Background Bronchial Dieulafoy disease (BDD) is a rare vascular anomaly that can cause severe hemoptysis, often complicating the management of patients with unexplained bleeding. Misdiagnosis and inappropriate procedures, such as blind bronchoscopic biopsies, can lead to catastrophic hemorrhage. This study is aimed to enhance clinicians’ understanding of BDD and to evaluate the effectiveness of interventional treatment strategies in preventing severe hemorrhage. Case presentation The patient, a male, 34 years old, was admitted to the hospital due to a 3-year history of intermittent hemoptysis, which had worsened over the past 12 days. Symptoms included intermittent hemoptysis accompanied by occasional chest tightness and shortness of breath but without nausea or vomiting. A contrast-enhanced chest CT scan conducted on May 13, 2020, consistent with Dieulafoy disease. The patient underwent right femoral artery puncture, bronchial artery angiography and malformed artery embolization. The procedure was completed successfully without complications. Postoperatively, the patient exhibited no further symptoms of hemoptysis. During the out-of-hospital follow-up, the patient experienced no recurrence of hemoptysis. Conclusion Although rare, BDD should be considered in cases of unexplained hemoptysis, especially to prevent severe bleeding during blind bronchoscopic biopsies. Interventional embolization of abnormal arteries offers a minimally invasive, safe, and effective treatment option, making it a key approach in managing this condition.

A 46-year-old man with Behcet's disease was admitted because of acute hemoptysis. Seven years earlier, the patient had been diagnosed with an aneurysm of the left lower lobe segmental pulmonary artery (Figure 1A) and had undergone transcatheter embolization with metallic coils for the aneurysm.

Risk of death in childhood asthma is associated with the overuse of short-acting ß-agonist drug therapy, poor drug compliance, reduced symptom perception with the onset of asthma exacerbations, past history of the need for intensive care unit care, and delayed or poor care coordination related to socioeconomic issues (1). Recently, prominent intrapulmonary bronchopulmonary anastomoses (IBAs) have been demonstrated in a variety of severe lung disorders in neonates, children, and adults that are characterized by disorders of compromised microvascular growth with hypoxemia, including alveolar capillary dysplasia, bronchopulmonary dysplasia, congenital diaphragmatic hernia, idiopathic pulmonary artery hypertension, and Down syndrome (6). The sudden opening of intrapulmonary vascular anastomotic pathways has been suggested as a cause of death in a subset of patients with sudden infant death syndrome (7). ß-Agonist drugs are critical for asthma management; however, at least some of the increase in asthma mortality has been linked to the overuse of these drugs, ß2-receptor dysfunction, and genetic polymorphisms (8, 9).

The purpose of this study was to determine non-invasively the frequency of ectopic bronchial arteries (BA) (i.e., bronchial arteries originating at a level of the descending aorta other than T5-T6 or from any aortic collateral vessel) on multidetector-row CT angiograms (CTA) obtained in patients with hemoptysis. Over a 5-year period (2000-2005), 251 consecutive patients with hemoptysis underwent multidetector-row CT angiography of the thorax. From this population, 37 patients were excluded because of a suboptimal CTA examination (n = 19), the presence of extensive mediastinal disease (n = 15) or severe chest deformation (n = 3) precluding any precise analysis of the bronchial arteries at CTA. Our final study group included 214 patients who underwent a thin-collimated CT angiogram (contrast agent: 300 to 350 mg/ml) on a 4- (n = 56), 16- (n = 119) and 64- (n = 39) detector-row scanner. The site of origin and distribution of bronchial arteries were analyzed on transverse CT scans, maximum intensity projections and volume-rendered images. The site of the ostium of a bronchial artery was coded as orthotopic when the artery originated from the descending aorta between the levels of the fifth and sixth thoracic vertebrae; all other bronchial arteries were considered ectopic. From the studied population, 137 (64%) patients had only orthotopic bronchial arteries, whereas 77 patients (36%) had at least one bronchial artery of ectopic origin. A total of 147 ectopic arteries were depicted, originating as common bronchial trunks (n = 23; 19%) or isolated right or left bronchial arteries (n = 101; 81%). The most frequent sites of origin of the 124 ostiums were the concavity of the aortic arch (92/124; 74%), the subclavian artery (13/124; 10.5%) and the descending aorta (10/124; 8.5%). The isolated ectopic bronchial arteries supplied the ipsilateral lung in all but three cases. Bronchial artery embolization was indicated in 26 patients. On the basis of CTA information, (1) bronchial embolization was attempted in 24 patients; it was technically successful in 21 patients (orthotopic BAs: 6 patients; orthotopic and ectopic BAs: 3 patients; ectopic BAs: 12 patients) and failed in 3 patients due to an instable catheterization of the ectopic BAs; the absence of additional bronchial arterial supply and no abnormalities of nonbronchial systemic arteries at CTA avoided additional arteriograms in these 3 patients; (2) owing to the iatrogenic risk of the embolization procedure of ectopic BAs, the surgical ligation of the abnormal vessels was the favored therapeutic option in 2 patients. This study enabled the depiction of ectopic bronchial arteries in 36% of the studied population, important anatomical information prior to therapeutic decision making.