Published online before print February 11, 2003, 10.1148/radiol.2271020324
(Radiology 2003;227:232.)
A more recent version of this article appeared on April 1, 2003
Massive Hemoptysis: Prediction of Nonbronchial Systemic Arterial Supply with Chest CT1
Woong Yoon, MD,
Yun Hyeon Kim, MD,
Jae Kyu Kim, MD,
Young Cheol Kim, MD,
Jin Gyoon Park, MD and
Heoung Keun Kang, MD
1 From the Departments of Diagnostic Radiology (W.Y., Y.H.K., J.K.K., J.G.P., H.K.K.) and Internal Medicine (Y.C.K.), Chonnam National University Medical School, Chonnam National University Hospital, 8 Hak-1-dong, Dong-gu, Gwangju 501-757, South Korea. From the 2001 RSNA scientific assembly. Received March 21, 2002; revision requested June 6; revision received July 8; accepted August 8. Address correspondence to W.Y. (e-mail: radyoon@cnuh.com).
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Figure 1a. True-positive CT findings in a 70-year-old man with chronic tuberculosis who presented with massive hemoptysis. (a) Transverse contrast-enhanced CT scan demonstrates multifocal pleural thickening (thick arrows) adjacent to parenchymal consolidations and enhancing vessels (large arrowheads) within the hypertrophied extrapleural fat layer. The image was interpreted as showing evidence of the presence of the posterior group of nonbronchial systemic arterial supplies. Note the tortuous bronchial artery (thin arrows) and collateral vessels (small arrowheads) in the mediastinum. (b) Corresponding anteroposterior selective intercostal angiogram shows tortuous enlargement of the artery (long arrows) that supplies the hypervascular parenchymal lesion (short arrows) and a shunt into the pulmonary artery (arrowheads).
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Figure 1b. True-positive CT findings in a 70-year-old man with chronic tuberculosis who presented with massive hemoptysis. (a) Transverse contrast-enhanced CT scan demonstrates multifocal pleural thickening (thick arrows) adjacent to parenchymal consolidations and enhancing vessels (large arrowheads) within the hypertrophied extrapleural fat layer. The image was interpreted as showing evidence of the presence of the posterior group of nonbronchial systemic arterial supplies. Note the tortuous bronchial artery (thin arrows) and collateral vessels (small arrowheads) in the mediastinum. (b) Corresponding anteroposterior selective intercostal angiogram shows tortuous enlargement of the artery (long arrows) that supplies the hypervascular parenchymal lesion (short arrows) and a shunt into the pulmonary artery (arrowheads).
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Figure 2a. True-positive CT findings in a 41-year-old woman with chronic tuberculosis who presented with massive hemoptysis. (a) Transverse contrast-enhanced CT scan demonstrates apical pleural thickening (arrows) and enhancing vessels (arrowheads) within the hypertrophied extrapleural fat layer. The scan was interpreted as showing evidence of the presence of the superolateral group of nonbronchial systemic arterial supplies. (b) Corresponding anteroposterior selective left subclavian angiogram shows enlargement of the superior (short arrow) and lateral (long arrow) thoracic arteries that supply the hypervascular lesion in the left upper lung zone and a shunt into the pulmonary artery (arrowheads).
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Figure 2b. True-positive CT findings in a 41-year-old woman with chronic tuberculosis who presented with massive hemoptysis. (a) Transverse contrast-enhanced CT scan demonstrates apical pleural thickening (arrows) and enhancing vessels (arrowheads) within the hypertrophied extrapleural fat layer. The scan was interpreted as showing evidence of the presence of the superolateral group of nonbronchial systemic arterial supplies. (b) Corresponding anteroposterior selective left subclavian angiogram shows enlargement of the superior (short arrow) and lateral (long arrow) thoracic arteries that supply the hypervascular lesion in the left upper lung zone and a shunt into the pulmonary artery (arrowheads).
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Figure 3a. False-positive CT findings in a 65-year-old man with chronic tuberculosis who presented with massive hemoptysis. (a) Transverse contrast-enhanced CT scan demonstrates diffuse pleural thickening (arrows) and tortuous vascular structures (arrowheads) within the extrapleural fat layer. The image was interpreted as showing evidence of the presence of an intercostal arterial supply. (b) Corresponding anteroposterior selective intercostal angiogram shows mild tortuosity of the intercostal artery (arrows) with no parenchymal staining or shunt.
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Figure 3b. False-positive CT findings in a 65-year-old man with chronic tuberculosis who presented with massive hemoptysis. (a) Transverse contrast-enhanced CT scan demonstrates diffuse pleural thickening (arrows) and tortuous vascular structures (arrowheads) within the extrapleural fat layer. The image was interpreted as showing evidence of the presence of an intercostal arterial supply. (b) Corresponding anteroposterior selective intercostal angiogram shows mild tortuosity of the intercostal artery (arrows) with no parenchymal staining or shunt.
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Figure 4a. False-negative CT finding in a 61-year-old man with acute pneumonia who presented with massive hemoptysis. (a) Transverse contrast-enhanced CT scan demonstrates parenchymal consolidation with associated pleural effusion in the right posterior lung zone. Pleural thickening, hypertrophy of extrapleural fat, and enhancing vascular structures are not depicted. These findings would be considered suspicious for the presence of a nonbronchial systemic arterial supply. Right internal mammary artery is not enlarged, and there is no anterior pleural thickening at CT (not shown). (b) Corresponding anteroposterior selective right subclavian angiogram shows enlargement of the internal mammary artery that supplies the hypervascular area (arrows) and a shunt into the pulmonary artery (arrowheads).
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Figure 4b. False-negative CT finding in a 61-year-old man with acute pneumonia who presented with massive hemoptysis. (a) Transverse contrast-enhanced CT scan demonstrates parenchymal consolidation with associated pleural effusion in the right posterior lung zone. Pleural thickening, hypertrophy of extrapleural fat, and enhancing vascular structures are not depicted. These findings would be considered suspicious for the presence of a nonbronchial systemic arterial supply. Right internal mammary artery is not enlarged, and there is no anterior pleural thickening at CT (not shown). (b) Corresponding anteroposterior selective right subclavian angiogram shows enlargement of the internal mammary artery that supplies the hypervascular area (arrows) and a shunt into the pulmonary artery (arrowheads).
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Copyright © 2003 by the Radiological Society of North America.
