Iyappan, Ponnuswamy (2010) Bleeding Vessels in Life Threatening Hemoptysis: Comparison of 64 Detector Row CT Angiography with Conventional Angiography Prior to Endovascular Management. Masters thesis, Madras Medical College, Chennai.
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Abstract
Hemoptysis Is Defined As Bleeding That Originates From The Lower Respiratory Tract. (1) In Developing Countries, The Majority Of Cases Are Due To Tuberculosis. (2) Massive Hemoptysis Is A Major Clinical And Surgical Problem With A Mortality Of 80%, Which Is Most Often Related To Asphyxiation. (3,4) Conservative Management Of Massive Hemoptysis Carries A Mortality Rate Of 50%–100% (5) And The Mortality Is Up To 35% Even In Patients Undergoing Operation. (6) Because Of Poor Pulmonary Reserve And Other Medical Comorbid Conditions, Most Patients With Massive Hemoptysis Are Not Ideal Surgical Candidates. ( 4,5) Therapeutic Bronchial Artery Embolization Is A Good Treatment Adjunct To Control Bronchial Bleeding And Reduces The Need For High-Risk Emergency Lung Resections. (7) It Has Become An Established Procedure In The Management Of Massive And Recurrent Hemoptysis; Its Use Was First Reported In 1973 By Remy Et Al. (8) It Is A Useful Therapy To Control Both Acute And Chronic Hemoptysis (9) And Is An Effective Method For Management Of Massive Hemoptysis In Developing Countries And Has A Low Complication Rate. (10,11) BAE May Help To Avoid Surgery In Patients Who Are Not Good Surgical Candidates. Should Hemoptysis Recur In These Patients, Repeat Embolization Can Be Performed Safely. (9) Surgery Remains The Procedure Of Choice In The Treatment Of Massive Hemoptysis Caused By Specific Conditions, Such As Hydatid Cyst, Thoracic Vascular Injury, Bronchial Adenoma, And Aspergilloma That Is Resistant To Other Therapies. (12) Even In Surgical Candidates, BAE Is Effective In Preparing The Patient For Elective Rather Than High-Risk Emergency Surgery. (7) Various Nonbronchial Systemic Arteries, As Well As Pulmonary Arteries, May Also Contribute To Hemoptysis, And Their Implication Is Dependent On The Underlying Pathologic Condition. (13-18) Nonbronchial Systemic Collateral Vessels Must Be Particularly Suspected When There Is Evidence Of Coexistent Pleural Disease. (11,19) Recognition And Occlusion Of Nonbronchial Systemic Collaterals Providing Blood To Hypervascular Pulmonary Lesions Is Essential For Successful Percutaneous Embolotherapy Of Hemoptysis. (2,17-20) Prior To Embolization, The Interventional Radiologist Needs To Be Aware Of The Side Of The Bronchial Artery Bleeding, And The Most Likely Source Of Bleeding Has To Be Identified To Determine Which Vessel(S) Is To Be Occluded. Since The Bronchial Circulation Is The Most Frequent Source Of Hemoptysis, Embolization Of Bronchial Arteries Is Usually The Favored Therapeutic Option To Stop The Bleeding. (11,21) Recent Important Technologic Advances In CT, Particularly The Development Of Multi– Detector Row CT, Have Introduced A Comprehensive, Noninvasive Method Of Evaluating The Entire Thorax, Allowing Detailed Assessment Of The Mediastinum And Lung Parenchyma. (11,21) Multi–Detector Row Helical CT Angiography Can Also Help In The Planning Of A Focused And Efficient Nonbronchial Systemic Artery Embolization. It Provides A Precise Road Map For The Interventional Radiologist In Performing An Endovascular Treatment For Hemoptysis. The Availability Of This Information Before The Patient Arrives In The Angiographic Suite Is Expected To Help Reduce The Examination Time By Facilitating Attempts At Direct Selective Catheterization Of The Arteries To Be Occluded. (21)
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Bleeding Vessels ; Life Threatening Hemoptysis ; Comparison ; 64 Detector Row CT Angiography ; Conventional Angiography Prior ; Endovascular Management. |
| Subjects: | MEDICAL > Radio Diagnosis |
| Depositing User: | Subramani R |
| Date Deposited: | 29 Jun 2017 11:58 |
| Last Modified: | 29 Jun 2017 11:58 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/652 |
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