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Antoine Khalil - One of the best experts on this subject based on the ideXlab platform.
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Transcatheter embolotherapy of pulmonary artery aneurysms as emergency treatment of Hemoptysis in Behcet patients: experience of a referral center and a review of the literature
Internal and Emergency Medicine, 2018Co-Authors: Guillaume Voiriot, Antoine Parrot, Martine Antoine, Aude Gibelin, Samuel Haddad, Marie-france Carette, Muriel Fartoukh, Antoine KhalilAbstract:Hemoptysis is a life-threatening complication of Behcet’s disease that is likely related to pulmonary artery aneurysm (PAA). Vascular interventional radiology may offer effective emergency therapeutic option, but has not been thoroughly investigated in this setting. A case series of a French referral center for Hemoptysis combined with a literature review of case reports was conducted. Between 1995 and 2016, 12 patients were referred to our center for Hemoptysis revealing or complicating the course of Behcet’s disease. Pulmonary artery aneurysm (PAA) was the mechanism of Hemoptysis in ten patients, nine of whom were treated by a transcatheter embolotherapy. Combining an additional 8 case reports from the literature, 17 patients treated by transcatheter embolotherapy for PAA were analyzed. The duration of the course of Behcet’s disease was 22 months [IQR 3–45] at the time of PAA diagnosis. Transcatheter embolotherapy of PAA was successful for immediately controlling Hemoptysis in all patients, without major complication except for one. Hemoptysis recurred in seven patients (41%) within 5 months [IQR 1–12]. The use of coils for transcatheter embolotherapy was associated with Hemoptysis recurrence. A bronchosystemic hypervascularization related to the previously occluded PAA was the main mechanism of bleeding recurrence, leading to bronchosystemic artery embolization in four patients and surgery in two patients. Behcet’s disease-related Hemoptysis is mainly due to PAA. Transcatheter embolotherapy should be considered as the first-line emergency treatment for PAA-related Hemoptysis, in association with the immunosuppressive regimen. Hemoptysis may recur in half of the cases, involving preferentially a bronchosystemic arterial mechanism.
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impact of mdct angiography on the management of patients with Hemoptysis
American Journal of Roentgenology, 2010Co-Authors: Antoine Khalil, Antoine Parrot, Muriel Fartoukh, C Marsault, Bernard Bazelly, M F CaretteAbstract:OBJECTIVE. The aim of this study was to evaluate the ability of MDCT angiography to modify early results in patients undergoing endovascular embolization for Hemoptysis.MATERIALS AND METHODS. A comparative study was performed of two consecutive cohorts with 200 patients each who were treated by endovascular embolization for severe Hemoptysis; one cohort underwent MDCT angiography and the other did not, but patients underwent further exploration with global aortography. We compared the two groups for patients' age and sex and for the volume, cause, and mechanisms of Hemoptysis. Evaluation included the number of sessions needed to control the Hemoptysis, the primary failure of bronchial artery embolization, the recurrence of Hemoptysis, pulmonary artery vasoocclusion, urgent surgical resection, and death by massive Hemoptysis during hospitalization. Failure was defined as the absence of embolization during the first session. Recurrence was defined as rebleeding despite technically successful bronchial arter...
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severe Hemoptysis of pulmonary arterial origin signs and role of multidetector row ct angiography
Chest, 2008Co-Authors: Antoine Khalil, Antoine Parrot, Muriel Fartoukh, Cosmina Nedelcu, C Marsault, M F CaretteAbstract:Background Hemoptysis of pulmonary arterial origin is a diagnostic challenge in patients admitted to a respiratory ICU (RICU) for treatment of Hemoptysis. Its early accurate recognition and treatment reduce morbidity and prevent mortality. Multidetector row CT angiography (MDCTA) is an accurate method for imaging the systemic vascular network. Our aim was to assess the MDCTA signs and role in managing Hemoptysis of pulmonary arterial origin. Methods We performed a retrospective clinical and radiologic analysis of all consecutive patients who were referred for severe Hemoptysis to our RICU and were treated by endovascular means between January 2004 and December 2006. We reviewed all of those cases with Hemoptysis of pulmonary arterial origin. Results Of 272 patients who were referred for severe Hemoptysis to the RICU, 189 patients were treated by endovascular means. Thirteen patients (nine men, four women; mean age, 45 years) had Hemoptysis of pulmonary arterial origin. Signs of pulmonary arterial Hemoptysis seen on MDCTA were of the following three types: pseudoaneurysm (n = 5); aneurysm of the pulmonary artery (n = 3); or the presence of a pulmonary artery in the inner wall of a cavity (n = 5). Hypertrophy of the bronchial arteries seen on MDCTA associated with any of these signs predicted the necessity to treat both the bronchial and pulmonary arteries. Pulmonary artery vasoocclusion was performed as a first treatment in eight patients with such an association (n = 1) or without such an association (n = 7) along with bronchial artery embolization. The remaining five patients were treated with systemic artery embolization, followed by surgery (n = 1), pulmonary artery vasoocclusion (n = 3), and death from massive Hemoptysis (n = 1). Conclusions MDCTA performed prior to endovascular treatment allows the correct identification and early appropriate management of severe Hemoptysis of pulmonary arterial origin.
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cryptogenic Hemoptysis from a benign to a life threatening pathologic vascular condition
American Journal of Respiratory and Critical Care Medicine, 2007Co-Authors: Laurent Savale, Antoine Parrot, Charles Mayaud, Martine Antoine, Antoine Khalil, M F Carette, Jonathan Theodore, Muriel FartoukhAbstract:Rationale Data on Hemoptysis of unknown origin (i.e., "cryptogenic") are scarce and the outcome of patients affected is controversial. Objectives To describe the clinical spectrum and course of patients with cryptogenic Hemoptysis, as well as pathologic findings when surgery is performed. Methods A cohort of 81 patients referred for cryptogenic Hemoptysis after clinical evaluation, chest radiography, fiberoptic bronchoscopy, and computed tomographic scan to a respiratory intermediate care and intensive care unit, from December 1995 to August 2004, with a prospective follow-up by visit or telephone interview. Measurements and main results The 81 patients (69 males) had a mean cumulative volume of Hemoptysis averaging 190 ml on admission. First-line conservative measures and bronchial artery embolization controlled Hemoptysis in 73 patients (90%). Emergency surgery was performed in six patients (7%) because of failure of bronchial artery embolization, and secondary surgery was scheduled in a seventh patient. A total of 73 patients were followed for a mean of 47 (+/- 35) months. No lung cancer developed. Hemoptysis recurred in 10 patients (4 within the first year; 6 between 1 and 8 yr later), 2 of whom underwent surgery. A specific bronchial vascular involvement (Dieulafoy disease) was demonstrated in five of the nine patients who had undergone surgery, especially in those with high amounts of bleeding. Conclusions Cryptogenic Hemoptysis may be a life-threatening condition. Nonsurgical approaches provide immediate control of bleeding in most patients with cryptogenic Hemoptysis, with few recurrences in both short and long terms. Dieulafoy disease of the bronchus, unsuspected after routine imaging investigations, may be involved in a subset of patients yet to be determined.
Muriel Fartoukh - One of the best experts on this subject based on the ideXlab platform.
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Transcatheter embolotherapy of pulmonary artery aneurysms as emergency treatment of Hemoptysis in Behcet patients: experience of a referral center and a review of the literature
Internal and Emergency Medicine, 2018Co-Authors: Guillaume Voiriot, Antoine Parrot, Martine Antoine, Aude Gibelin, Samuel Haddad, Marie-france Carette, Muriel Fartoukh, Antoine KhalilAbstract:Hemoptysis is a life-threatening complication of Behcet’s disease that is likely related to pulmonary artery aneurysm (PAA). Vascular interventional radiology may offer effective emergency therapeutic option, but has not been thoroughly investigated in this setting. A case series of a French referral center for Hemoptysis combined with a literature review of case reports was conducted. Between 1995 and 2016, 12 patients were referred to our center for Hemoptysis revealing or complicating the course of Behcet’s disease. Pulmonary artery aneurysm (PAA) was the mechanism of Hemoptysis in ten patients, nine of whom were treated by a transcatheter embolotherapy. Combining an additional 8 case reports from the literature, 17 patients treated by transcatheter embolotherapy for PAA were analyzed. The duration of the course of Behcet’s disease was 22 months [IQR 3–45] at the time of PAA diagnosis. Transcatheter embolotherapy of PAA was successful for immediately controlling Hemoptysis in all patients, without major complication except for one. Hemoptysis recurred in seven patients (41%) within 5 months [IQR 1–12]. The use of coils for transcatheter embolotherapy was associated with Hemoptysis recurrence. A bronchosystemic hypervascularization related to the previously occluded PAA was the main mechanism of bleeding recurrence, leading to bronchosystemic artery embolization in four patients and surgery in two patients. Behcet’s disease-related Hemoptysis is mainly due to PAA. Transcatheter embolotherapy should be considered as the first-line emergency treatment for PAA-related Hemoptysis, in association with the immunosuppressive regimen. Hemoptysis may recur in half of the cases, involving preferentially a bronchosystemic arterial mechanism.
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impact of mdct angiography on the management of patients with Hemoptysis
American Journal of Roentgenology, 2010Co-Authors: Antoine Khalil, Antoine Parrot, Muriel Fartoukh, C Marsault, Bernard Bazelly, M F CaretteAbstract:OBJECTIVE. The aim of this study was to evaluate the ability of MDCT angiography to modify early results in patients undergoing endovascular embolization for Hemoptysis.MATERIALS AND METHODS. A comparative study was performed of two consecutive cohorts with 200 patients each who were treated by endovascular embolization for severe Hemoptysis; one cohort underwent MDCT angiography and the other did not, but patients underwent further exploration with global aortography. We compared the two groups for patients' age and sex and for the volume, cause, and mechanisms of Hemoptysis. Evaluation included the number of sessions needed to control the Hemoptysis, the primary failure of bronchial artery embolization, the recurrence of Hemoptysis, pulmonary artery vasoocclusion, urgent surgical resection, and death by massive Hemoptysis during hospitalization. Failure was defined as the absence of embolization during the first session. Recurrence was defined as rebleeding despite technically successful bronchial arter...
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severe Hemoptysis of pulmonary arterial origin signs and role of multidetector row ct angiography
Chest, 2008Co-Authors: Antoine Khalil, Antoine Parrot, Muriel Fartoukh, Cosmina Nedelcu, C Marsault, M F CaretteAbstract:Background Hemoptysis of pulmonary arterial origin is a diagnostic challenge in patients admitted to a respiratory ICU (RICU) for treatment of Hemoptysis. Its early accurate recognition and treatment reduce morbidity and prevent mortality. Multidetector row CT angiography (MDCTA) is an accurate method for imaging the systemic vascular network. Our aim was to assess the MDCTA signs and role in managing Hemoptysis of pulmonary arterial origin. Methods We performed a retrospective clinical and radiologic analysis of all consecutive patients who were referred for severe Hemoptysis to our RICU and were treated by endovascular means between January 2004 and December 2006. We reviewed all of those cases with Hemoptysis of pulmonary arterial origin. Results Of 272 patients who were referred for severe Hemoptysis to the RICU, 189 patients were treated by endovascular means. Thirteen patients (nine men, four women; mean age, 45 years) had Hemoptysis of pulmonary arterial origin. Signs of pulmonary arterial Hemoptysis seen on MDCTA were of the following three types: pseudoaneurysm (n = 5); aneurysm of the pulmonary artery (n = 3); or the presence of a pulmonary artery in the inner wall of a cavity (n = 5). Hypertrophy of the bronchial arteries seen on MDCTA associated with any of these signs predicted the necessity to treat both the bronchial and pulmonary arteries. Pulmonary artery vasoocclusion was performed as a first treatment in eight patients with such an association (n = 1) or without such an association (n = 7) along with bronchial artery embolization. The remaining five patients were treated with systemic artery embolization, followed by surgery (n = 1), pulmonary artery vasoocclusion (n = 3), and death from massive Hemoptysis (n = 1). Conclusions MDCTA performed prior to endovascular treatment allows the correct identification and early appropriate management of severe Hemoptysis of pulmonary arterial origin.
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cryptogenic Hemoptysis from a benign to a life threatening pathologic vascular condition
American Journal of Respiratory and Critical Care Medicine, 2007Co-Authors: Laurent Savale, Antoine Parrot, Charles Mayaud, Martine Antoine, Antoine Khalil, M F Carette, Jonathan Theodore, Muriel FartoukhAbstract:Rationale Data on Hemoptysis of unknown origin (i.e., "cryptogenic") are scarce and the outcome of patients affected is controversial. Objectives To describe the clinical spectrum and course of patients with cryptogenic Hemoptysis, as well as pathologic findings when surgery is performed. Methods A cohort of 81 patients referred for cryptogenic Hemoptysis after clinical evaluation, chest radiography, fiberoptic bronchoscopy, and computed tomographic scan to a respiratory intermediate care and intensive care unit, from December 1995 to August 2004, with a prospective follow-up by visit or telephone interview. Measurements and main results The 81 patients (69 males) had a mean cumulative volume of Hemoptysis averaging 190 ml on admission. First-line conservative measures and bronchial artery embolization controlled Hemoptysis in 73 patients (90%). Emergency surgery was performed in six patients (7%) because of failure of bronchial artery embolization, and secondary surgery was scheduled in a seventh patient. A total of 73 patients were followed for a mean of 47 (+/- 35) months. No lung cancer developed. Hemoptysis recurred in 10 patients (4 within the first year; 6 between 1 and 8 yr later), 2 of whom underwent surgery. A specific bronchial vascular involvement (Dieulafoy disease) was demonstrated in five of the nine patients who had undergone surgery, especially in those with high amounts of bleeding. Conclusions Cryptogenic Hemoptysis may be a life-threatening condition. Nonsurgical approaches provide immediate control of bleeding in most patients with cryptogenic Hemoptysis, with few recurrences in both short and long terms. Dieulafoy disease of the bronchus, unsuspected after routine imaging investigations, may be involved in a subset of patients yet to be determined.
Antoine Parrot - One of the best experts on this subject based on the ideXlab platform.
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Transcatheter embolotherapy of pulmonary artery aneurysms as emergency treatment of Hemoptysis in Behcet patients: experience of a referral center and a review of the literature
Internal and Emergency Medicine, 2018Co-Authors: Guillaume Voiriot, Antoine Parrot, Martine Antoine, Aude Gibelin, Samuel Haddad, Marie-france Carette, Muriel Fartoukh, Antoine KhalilAbstract:Hemoptysis is a life-threatening complication of Behcet’s disease that is likely related to pulmonary artery aneurysm (PAA). Vascular interventional radiology may offer effective emergency therapeutic option, but has not been thoroughly investigated in this setting. A case series of a French referral center for Hemoptysis combined with a literature review of case reports was conducted. Between 1995 and 2016, 12 patients were referred to our center for Hemoptysis revealing or complicating the course of Behcet’s disease. Pulmonary artery aneurysm (PAA) was the mechanism of Hemoptysis in ten patients, nine of whom were treated by a transcatheter embolotherapy. Combining an additional 8 case reports from the literature, 17 patients treated by transcatheter embolotherapy for PAA were analyzed. The duration of the course of Behcet’s disease was 22 months [IQR 3–45] at the time of PAA diagnosis. Transcatheter embolotherapy of PAA was successful for immediately controlling Hemoptysis in all patients, without major complication except for one. Hemoptysis recurred in seven patients (41%) within 5 months [IQR 1–12]. The use of coils for transcatheter embolotherapy was associated with Hemoptysis recurrence. A bronchosystemic hypervascularization related to the previously occluded PAA was the main mechanism of bleeding recurrence, leading to bronchosystemic artery embolization in four patients and surgery in two patients. Behcet’s disease-related Hemoptysis is mainly due to PAA. Transcatheter embolotherapy should be considered as the first-line emergency treatment for PAA-related Hemoptysis, in association with the immunosuppressive regimen. Hemoptysis may recur in half of the cases, involving preferentially a bronchosystemic arterial mechanism.
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impact of mdct angiography on the management of patients with Hemoptysis
American Journal of Roentgenology, 2010Co-Authors: Antoine Khalil, Antoine Parrot, Muriel Fartoukh, C Marsault, Bernard Bazelly, M F CaretteAbstract:OBJECTIVE. The aim of this study was to evaluate the ability of MDCT angiography to modify early results in patients undergoing endovascular embolization for Hemoptysis.MATERIALS AND METHODS. A comparative study was performed of two consecutive cohorts with 200 patients each who were treated by endovascular embolization for severe Hemoptysis; one cohort underwent MDCT angiography and the other did not, but patients underwent further exploration with global aortography. We compared the two groups for patients' age and sex and for the volume, cause, and mechanisms of Hemoptysis. Evaluation included the number of sessions needed to control the Hemoptysis, the primary failure of bronchial artery embolization, the recurrence of Hemoptysis, pulmonary artery vasoocclusion, urgent surgical resection, and death by massive Hemoptysis during hospitalization. Failure was defined as the absence of embolization during the first session. Recurrence was defined as rebleeding despite technically successful bronchial arter...
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severe Hemoptysis of pulmonary arterial origin signs and role of multidetector row ct angiography
Chest, 2008Co-Authors: Antoine Khalil, Antoine Parrot, Muriel Fartoukh, Cosmina Nedelcu, C Marsault, M F CaretteAbstract:Background Hemoptysis of pulmonary arterial origin is a diagnostic challenge in patients admitted to a respiratory ICU (RICU) for treatment of Hemoptysis. Its early accurate recognition and treatment reduce morbidity and prevent mortality. Multidetector row CT angiography (MDCTA) is an accurate method for imaging the systemic vascular network. Our aim was to assess the MDCTA signs and role in managing Hemoptysis of pulmonary arterial origin. Methods We performed a retrospective clinical and radiologic analysis of all consecutive patients who were referred for severe Hemoptysis to our RICU and were treated by endovascular means between January 2004 and December 2006. We reviewed all of those cases with Hemoptysis of pulmonary arterial origin. Results Of 272 patients who were referred for severe Hemoptysis to the RICU, 189 patients were treated by endovascular means. Thirteen patients (nine men, four women; mean age, 45 years) had Hemoptysis of pulmonary arterial origin. Signs of pulmonary arterial Hemoptysis seen on MDCTA were of the following three types: pseudoaneurysm (n = 5); aneurysm of the pulmonary artery (n = 3); or the presence of a pulmonary artery in the inner wall of a cavity (n = 5). Hypertrophy of the bronchial arteries seen on MDCTA associated with any of these signs predicted the necessity to treat both the bronchial and pulmonary arteries. Pulmonary artery vasoocclusion was performed as a first treatment in eight patients with such an association (n = 1) or without such an association (n = 7) along with bronchial artery embolization. The remaining five patients were treated with systemic artery embolization, followed by surgery (n = 1), pulmonary artery vasoocclusion (n = 3), and death from massive Hemoptysis (n = 1). Conclusions MDCTA performed prior to endovascular treatment allows the correct identification and early appropriate management of severe Hemoptysis of pulmonary arterial origin.
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cryptogenic Hemoptysis from a benign to a life threatening pathologic vascular condition
American Journal of Respiratory and Critical Care Medicine, 2007Co-Authors: Laurent Savale, Antoine Parrot, Charles Mayaud, Martine Antoine, Antoine Khalil, M F Carette, Jonathan Theodore, Muriel FartoukhAbstract:Rationale Data on Hemoptysis of unknown origin (i.e., "cryptogenic") are scarce and the outcome of patients affected is controversial. Objectives To describe the clinical spectrum and course of patients with cryptogenic Hemoptysis, as well as pathologic findings when surgery is performed. Methods A cohort of 81 patients referred for cryptogenic Hemoptysis after clinical evaluation, chest radiography, fiberoptic bronchoscopy, and computed tomographic scan to a respiratory intermediate care and intensive care unit, from December 1995 to August 2004, with a prospective follow-up by visit or telephone interview. Measurements and main results The 81 patients (69 males) had a mean cumulative volume of Hemoptysis averaging 190 ml on admission. First-line conservative measures and bronchial artery embolization controlled Hemoptysis in 73 patients (90%). Emergency surgery was performed in six patients (7%) because of failure of bronchial artery embolization, and secondary surgery was scheduled in a seventh patient. A total of 73 patients were followed for a mean of 47 (+/- 35) months. No lung cancer developed. Hemoptysis recurred in 10 patients (4 within the first year; 6 between 1 and 8 yr later), 2 of whom underwent surgery. A specific bronchial vascular involvement (Dieulafoy disease) was demonstrated in five of the nine patients who had undergone surgery, especially in those with high amounts of bleeding. Conclusions Cryptogenic Hemoptysis may be a life-threatening condition. Nonsurgical approaches provide immediate control of bleeding in most patients with cryptogenic Hemoptysis, with few recurrences in both short and long terms. Dieulafoy disease of the bronchus, unsuspected after routine imaging investigations, may be involved in a subset of patients yet to be determined.
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Life-threatening Hemoptysis in adults with community-acquired pneumonia due to Panton-Valentine leukocidin-secreting Staphylococcus aureus.
Intensive care medicine, 2003Co-Authors: Véronique Boussaud, Jerome Etienne, Antoine Parrot, Charles Mayaud, Marie Wislez, Martine Antoine, Clément Picard, Françoise Delisle, Jacques CadranelAbstract:Three new consecutive cases of life-threatening Hemoptysis in adults with community-acquired pneumonia due to Panton-Valentine leukocidin-secreting Staphylococcus aureus are presented, focusing on the particular clinical presentation of this new entity. Between December 1999 and March 2001, three adults aged from 23 to 67 years were admitted to our respiratory intensive care unit for massive Hemoptysis and septic shock associated with community-acquired Staphylococcus aureus pneumonia. Isolates were sent to the Centre National de Reference des Toxemies Staphylococciques in Lyon, France, where they were found to secrete Panton-Valentive leukocidin. The clinical course was similar in the three patients, with massive Hemoptysis and septic shock necessitating mechanical ventilation. Two patients died rapidly; necropsy showed pulmonary vascular necrosis in one of them. The third patient recovered after appropriate antibiotic therapy. Leukocidin/neutrophil interactions in the pulmonary vasculature may cause severe Hemoptysis in patients with community-acquired Staphylococcus aureus pneumonia secreting Panton-Valentine leukocidin. Adult patients with massive Hemoptysis and suspected community-acquired pneumonia should receive antibiotic regimens covering Staphylococcus aureus.
M F Carette - One of the best experts on this subject based on the ideXlab platform.
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impact of mdct angiography on the management of patients with Hemoptysis
American Journal of Roentgenology, 2010Co-Authors: Antoine Khalil, Antoine Parrot, Muriel Fartoukh, C Marsault, Bernard Bazelly, M F CaretteAbstract:OBJECTIVE. The aim of this study was to evaluate the ability of MDCT angiography to modify early results in patients undergoing endovascular embolization for Hemoptysis.MATERIALS AND METHODS. A comparative study was performed of two consecutive cohorts with 200 patients each who were treated by endovascular embolization for severe Hemoptysis; one cohort underwent MDCT angiography and the other did not, but patients underwent further exploration with global aortography. We compared the two groups for patients' age and sex and for the volume, cause, and mechanisms of Hemoptysis. Evaluation included the number of sessions needed to control the Hemoptysis, the primary failure of bronchial artery embolization, the recurrence of Hemoptysis, pulmonary artery vasoocclusion, urgent surgical resection, and death by massive Hemoptysis during hospitalization. Failure was defined as the absence of embolization during the first session. Recurrence was defined as rebleeding despite technically successful bronchial arter...
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severe Hemoptysis of pulmonary arterial origin signs and role of multidetector row ct angiography
Chest, 2008Co-Authors: Antoine Khalil, Antoine Parrot, Muriel Fartoukh, Cosmina Nedelcu, C Marsault, M F CaretteAbstract:Background Hemoptysis of pulmonary arterial origin is a diagnostic challenge in patients admitted to a respiratory ICU (RICU) for treatment of Hemoptysis. Its early accurate recognition and treatment reduce morbidity and prevent mortality. Multidetector row CT angiography (MDCTA) is an accurate method for imaging the systemic vascular network. Our aim was to assess the MDCTA signs and role in managing Hemoptysis of pulmonary arterial origin. Methods We performed a retrospective clinical and radiologic analysis of all consecutive patients who were referred for severe Hemoptysis to our RICU and were treated by endovascular means between January 2004 and December 2006. We reviewed all of those cases with Hemoptysis of pulmonary arterial origin. Results Of 272 patients who were referred for severe Hemoptysis to the RICU, 189 patients were treated by endovascular means. Thirteen patients (nine men, four women; mean age, 45 years) had Hemoptysis of pulmonary arterial origin. Signs of pulmonary arterial Hemoptysis seen on MDCTA were of the following three types: pseudoaneurysm (n = 5); aneurysm of the pulmonary artery (n = 3); or the presence of a pulmonary artery in the inner wall of a cavity (n = 5). Hypertrophy of the bronchial arteries seen on MDCTA associated with any of these signs predicted the necessity to treat both the bronchial and pulmonary arteries. Pulmonary artery vasoocclusion was performed as a first treatment in eight patients with such an association (n = 1) or without such an association (n = 7) along with bronchial artery embolization. The remaining five patients were treated with systemic artery embolization, followed by surgery (n = 1), pulmonary artery vasoocclusion (n = 3), and death from massive Hemoptysis (n = 1). Conclusions MDCTA performed prior to endovascular treatment allows the correct identification and early appropriate management of severe Hemoptysis of pulmonary arterial origin.
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cryptogenic Hemoptysis from a benign to a life threatening pathologic vascular condition
American Journal of Respiratory and Critical Care Medicine, 2007Co-Authors: Laurent Savale, Antoine Parrot, Charles Mayaud, Martine Antoine, Antoine Khalil, M F Carette, Jonathan Theodore, Muriel FartoukhAbstract:Rationale Data on Hemoptysis of unknown origin (i.e., "cryptogenic") are scarce and the outcome of patients affected is controversial. Objectives To describe the clinical spectrum and course of patients with cryptogenic Hemoptysis, as well as pathologic findings when surgery is performed. Methods A cohort of 81 patients referred for cryptogenic Hemoptysis after clinical evaluation, chest radiography, fiberoptic bronchoscopy, and computed tomographic scan to a respiratory intermediate care and intensive care unit, from December 1995 to August 2004, with a prospective follow-up by visit or telephone interview. Measurements and main results The 81 patients (69 males) had a mean cumulative volume of Hemoptysis averaging 190 ml on admission. First-line conservative measures and bronchial artery embolization controlled Hemoptysis in 73 patients (90%). Emergency surgery was performed in six patients (7%) because of failure of bronchial artery embolization, and secondary surgery was scheduled in a seventh patient. A total of 73 patients were followed for a mean of 47 (+/- 35) months. No lung cancer developed. Hemoptysis recurred in 10 patients (4 within the first year; 6 between 1 and 8 yr later), 2 of whom underwent surgery. A specific bronchial vascular involvement (Dieulafoy disease) was demonstrated in five of the nine patients who had undergone surgery, especially in those with high amounts of bleeding. Conclusions Cryptogenic Hemoptysis may be a life-threatening condition. Nonsurgical approaches provide immediate control of bleeding in most patients with cryptogenic Hemoptysis, with few recurrences in both short and long terms. Dieulafoy disease of the bronchus, unsuspected after routine imaging investigations, may be involved in a subset of patients yet to be determined.
Herve Dutau - One of the best experts on this subject based on the ideXlab platform.
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massive Hemoptysis an update on the role of bronchoscopy in diagnosis and management
Respiration, 2010Co-Authors: Lama Sakr, Herve DutauAbstract:Hemoptysis is frequently encountered in clinical practice, and may be the presenting symptom of a number of diseases. Although massive Hemoptysis accounts for only 5-15% of episodes, it should always be considered as a life-threatening condition that warrants effective assessment and management. In this article, we review the literature with regard to the definition, etiology, epidemiology, pathophysiology, diagnosis and treatment of massive Hemoptysis, with special emphasis on the role of bronchoscopy as a diagnostic and therapeutic tool. We briefly present the circumstances under which the use of rigid bronchoscopy should be preferred for controlling massive bleeding. Moreover, we address the crucial importance of multidisciplinary collaboration by illustrating the roles of endovascular therapy and surgery in the optimal management of massive Hemoptysis.
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massive Hemoptysis an update on the role of bronchoscopy in diagnosis and management
Respiration, 2010Co-Authors: Lama Sakr, Herve DutauAbstract:Hemoptysis is frequently encountered in clinical practice, and may be the presenting symptom of a number of diseases. Although massive Hemoptysis accounts for only 5–15% of episodes, it should always