Impact of multidetector CT-angiography on the emergency management of severe hemoptysis.
BACKGROUND
Multidetector CT-angiography (MDCTA) is commonly used in patients with severe haemoptysis requiring admission to intensive care unit. However, the impact of MDCTA on the management of severe haemoptysis in emergency setting is poorly evaluated.


METHODS
We prospectively compared data provided by clinical bedside evaluation (clinical examination, chest-X-ray and fiberoptic bronchoscopy) to MDCTA data in terms of lateralization, location of the bleeding site, etiology as well as impact on the treatment choice.


RESULTS
Over a 13-month period, 87 patients (men n=58, median age=61 years, median haemoptysis expectorated volume=180 mL) were included. Etiology was mainly (67%) bronchiectasis, tuberculosis sequelae and tumor. MDCTA and clinical bedside evaluation were equally effective in determining lateralization (87.4% and 93.1%, respectively, p=0.23) and location (85% and 82.7%, respectively, p=0.82) of the bleeding site. MDCTA was significantly more accurate than the clinical bedside strategy in determining the haemoptysis cause (86% and 70%, respectively, p=0.007). Moreover, MDCTA suggested the involvement of systemic arteries as bleeding mechanism in 92% of cases, leading to the modification of the treatment initially considered after bedside evaluation in 21.8% of patients.


CONCLUSIONS
MDCTA provides useful information for the management of patients with severe haemoptysis, especially in the treatment choice. Thus, in the absence of emergency fiberoptic bronchoscopy (FOB) requirement for airways management, MDCTA should be the first-line procedure performed in emergency clinical setting.
Service de Pneumologie et Réanimation, Hôpital Tenon, HUEP, APHP, 4 rue de la Chine, 75020 Paris, France.
Ludivine
L
Chalumeau-Lemoine
Antoine
A
Khalil
Hélène
H
Prigent
Marie-France
MF
Carette
Muriel
M
Fartoukh
Antoine
A
Parrot
D000368:Aged; D000792:Angiography / Q000706:statistics & numerical data*; D003422:Critical Care / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D005602:France / Q000453:epidemiology; D006469:Hemoptysis / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000706:statistics & numerical data*; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity
Bronchial artery embolization; Fibroptic bronchoscopy; Hemoptysis; Intensive care unit; Multidetector CT-angiography