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Pediatric radiology
10, 2024;54 (11): 1769-1784.

Pediatric hemoptysis: diagnostic and interventional challenges.

Anisha Garg, Ashu Bhalla, Priyanka Naranje, Devasenathipathy Kandasamy
Author Information
  1. Anisha Garg: Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, 110029, New Delhi, India. ORCID
  2. Ashu Bhalla: Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, 110029, New Delhi, India. ashubhalla1@yahoo.com. ORCID
  3. Priyanka Naranje: Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, 110029, New Delhi, India. ORCID
  4. Devasenathipathy Kandasamy: Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, 110029, New Delhi, India. ORCID
PMID: 39128986 DOI: 10.1007/s00247-024-06002-7

Abstract

Hemoptysis in the pediatric population, while infrequent, poses significant challenges for both the family and healthcare practitioners. The severity of hemoptysis dictates management decisions. Most cases being mild and self-limiting are treated conservatively. However, "life-threatening hemoptysis" may occur, and is defined as any degree of blood loss that endangers the airway and is arbitrarily considered to be���>���8 ml/kg in 24 h in children. It requires prompt airway management and resuscitation followed by a tailored approach consisting of bronchoscopy, computed tomography (CT), interventional radiology, and/or surgery depending on the patient 's clinical status and cardiopulmonary comorbidities. Bronchial arteries are hypertrophied in myriad conditions and account for 90-95% cases of hemoptysis due to their systemic pressure levels; the rest being contributed by pulmonary artery pathologies. Despite similar pathogenic mechanisms, the etiologies of pediatric hemoptysis differ from those in adults, with acute lower respiratory tract infections being the predominant cause. Imaging plays a crucial role in identifying the source and cause of hemorrhage. Multidetector computed tomography (MDCT) has emerged as a prime modality in the diagnostic evaluation of hemoptysis and provides a roadmap for potential interventional procedures. This article discusses the etiopathogenesis of hemoptysis along with a brief mention of the diagnostic modalities. It provides a structured reporting format and uses it to illustrate the imaging features in hemoptysis, with emphasis on CT angiography. The key findings in the lung parenchyma, airways, bronchial and non-bronchial systemic collaterals, and pulmonary arteries are elaborated upon. It further addresses the nuances of interventional management, particularly emphasizing the applications of bronchial artery embolization and pulmonary artery embolization in the pediatric population. The article also underscores the potential complications and factors influencing recurrence rates.

Keywords

Bronchial artery Computed tomography angiography Hemoptysis Pediatric Pseudoaneurysm Pulmonary artery

References

  1. Shera TA, Bhalla AS, Naranje P et al (2022) Role of computed tomography angiography in the evaluation of haemoptysis in children: decoding the abnormal vessels. Indian J Med Res 155:356���363 [PMID: 36124510]
  2. Roebuck DJ, Barnacle AM (2008) Haemoptysis and bronchial artery embolization in children. Pediatr Respir Rev 9:95���104 [DOI: 10.1016/j.prrv.2007.12.003]
  3. Larici AR, Franchi P, Occhipinti M et al (2014) Diagnosis and management of hemoptysis. Diagn Interv Radiol 20:299���309 [PMID: 24808437]
  4. Casta��er E, Gallardo X, Rimola J et al (2006) Congenital and acquired pulmonary artery anomalies in the adult: radiologic overview. Radiographics 26:349���371 [PMID: 16549603]
  5. Deffebach ME, Charan NB, Lakshminarayan S, Butler J (1987) The bronchial circulation: small, but a vital attribute of the lung. Am Rev Respir Dis 135:463���481 [PMID: 3544986]
  6. Gupta A, Sands M, Chauhan NR (2018) Massive hemoptysis in pulmonary infections: bronchial artery embolization. J Thorac Dis 10:S3458���S3464 [PMID: 30505533]
  7. Miyano Y, Kanzaki M, Onuki T (2017) Bronchial artery embolization: first-line option for managing massive hemoptysis. Asian Cardiovasc Thorac Ann 25:618���622 [PMID: 29073778]
  8. Almeida J, Leal C, Figueiredo L (2020) Evaluation of the bronchial arteries: normal findings, hypertrophy and embolization in patients with hemoptysis. Insights Imaging 11:1���5 [DOI: 10.1186/s13244-020-00877-4]
  9. Walker CM, Rosado-de-Christenson M, Mart��nez-Ji S et al (2015) Bronchial Arteries: anatomy, function, hypertrophy, and anomalies. Radiographics 35:32���49 [PMID: 25590386]
  10. Osiro S, Wear C, Hudson R et al (2012) A friend to the airways: a review of the emerging clinical importance of the bronchial arterial circulation. Surg Radiol Anat 34:791���798 [PMID: 22552583]
  11. Bannister M (2016) Pediatric haemoptysis and the otorhinolaryngologist: systematic review. Int J Pediatr Otorhinolaryngol 92:99���102 [PMID: 28012543]
  12. Turcios NL, Vega M (1987) The child with hemoptysis. Hosp Pract 22:214���218 [DOI: 10.1080/21548331.1987.11703343]
  13. Batra PS, Holinger LD (2001) Etiology and management of pediatric hemoptysis. Arch Otolaryngol-Head Neck Surg 127:377���382 [PMID: 11296044]
  14. Tom LW, Weisman RA, Handler SD (1980) Hemoptysis in children Ann Otol 89:419���424
  15. Singh D, Bhalla AS, Veedu PT, Arora A (2013) Imaging evaluation of hemoptysis in children. World J Clin Pediatr 2:54���64 [PMID: 25254175]
  16. Sim J, Kim H, Lee H et al (2009) Etiology of hemoptysis in children: a single institutional series of 40 cases. Allergy Asthma Immunol Res 1:41���44 [PMID: 20224669]
  17. Ittrich H, Bockhorn M, Klose H, Simon M (2017) The diagnosis and treatment of hemoptysis. Dtsch Arztebl Int 114:371���381 [PMID: 28625277]
  18. Olsen KM, Shwadi MP, Donnelly EF et al (2020) American College of Radiology ACR appropriateness criteria�� hemoptysis. J Am Coll Radiol 17:S148���S159 [PMID: 32370959]
  19. Khalil A, Fedida B, Parrot A et al (2015) Severe hemoptysis: from diagnosis to embolization. Diagn Interv Imaging 96:775���788 [PMID: 26141487]
  20. McGuinness G, Beacher JR, Harkin TJ et al (1994) Hemoptysis: prospective high-resolution CT/bronchoscopic correlation. Chest 105:1155���1162 [PMID: 8162743]
  21. Vohra S, Chowdhury V (2017) Multi-detector CT in evaluation of hemoptysis. Curr Radiol Rep 5:1���11 [DOI: 10.1007/s40134-017-0208-x]
  22. Kettenbach J, Ittrich H, Gaubert JY et al (2022) CIRSE standards of practice on bronchial artery embolisation. Cardiovasc Intervent Radiol 45:721���732 [PMID: 35396612]
  23. Wielp��tz MO, Puderbach M, Kopp-Schneider A et al (2014) Magnetic resonance imaging detects changes in structure and perfusion, and response to therapy in early cystic fibrosis lung disease. Am J Respir Crit Care Med 189:956���965 [PMID: 24564281]
  24. Fain S, Schiebler ML, McCormack DG, Parraga D (2010) Imaging of lung function using hyperpolarized helium-3 magnetic resonance imaging: review of current and emerging translational methods and applications. J Magn Reson 32:1398���1408
  25. Alexopoulou E, Prountzos S, Raissaki M et al (2024) Imaging of acute complications of community-acquired pneumonia in the pediatric population���from chest radiography to MRI. Children 11:122 [PMID: 38255434]
  26. Adams LC, Jayapal P, Ramasamy SK et al (2023) Ferumoxytol-enhanced MRI in children and young adults: state of the art. AJR Am J Roentgenol 220:590���603 [PMID: 36197052]
  27. Gr��fe D, Prenzel F, Hirsch FW (2023) Chest magnetic resonance imaging in cystic fibrosis: technique and clinical benefits. Pediatr Radiol 53:640���648 [PMID: 36372855]
  28. Singhal R, Santhosh Babu KB, Naranje P et al (2023) Society of Chest Imaging and Interventions consensus guidelines for the interventional radiology management of hemoptysis. Indian J Radiol Imaging 33:361���372 [PMID: 37362365]
  29. Meena P, Bhalla AS, Goyal A et al (2022) Imaging findings as predictors of the site of bleeding in patients with hemoptysis: comparison between split-bolus dual-energy CT angiography and digital subtraction angiography. Diagn Interv Radiol 28:344���351 [PMID: 35731711]
  30. Park MS (2013) Diffuse alveolar hemorrhage Tuberc Respir Dis 74:151���162 [DOI: 10.4046/trd.2013.74.4.151]
  31. Marquis KM, Raptis CA, Rajput MZ et al (2021) CT for evaluation of hemoptysis. Radiographics 41:742���761 [PMID: 33939537]
  32. Sundarakumar DK, Bhalla AS, Sharma R et al (2011) Multidetector CT evaluation of central airways stenoses: comparison of virtual bronchoscopy, minimal-intensity projection, and multiplanar reformatted images. Indian J Radiol Imaging 21:191���194 [PMID: 22013293]
  33. Milliron B, Henry TS, Veeraraghavan S, Little BP (2015) Bronchiectasis: mechanisms and imaging clues of associated common and uncommon diseases. Radiographics 35:1011���1030 [PMID: 26024063]
  34. Marshall TJ, Jackson JE (1997) Vascular intervention in the thorax: bronchial artery embolization for haemoptysis. Eur Radiol 7:1221���1227 [PMID: 9377505]
  35. Cauldwell EW, Siekert RG (1948) The bronchial arteries: an anatomic study of 150 human cadavers. Surg Gynecol Obstet 86:395���412 [PMID: 18905113]
  36. Kabilan K, Gulati M, Banday IA et al (2022) Myriad faces of active tuberculosis: intrapulmonary bronchial artery pseudoaneurysm. Vasc Endovascular Surg 56:212���215 [PMID: 34663143]
  37. Lee YJ, Park SS, Kim SY et al (2010) A case of systemic polyarteritis nodosa involving bronchial artery. Sarcoidosis Vasc Diffuse Lung Dis 27:164���168 [PMID: 21319600]
  38. Alex A, Ayyappan A, Valakkada J et al (2022) Major aortopulmonary collateral arteries. Radiol Cardiothorac Imaging 4:e210157 [PMID: 35782757]
  39. Shin S, Shin TB, Choi H, Cho JS (2010) Peripheral pulmonary arterial pseudoaneurysms: therapeutic implications of endovascular treatment and angiographic classifications. Radiol 256:656���664 [DOI: 10.1148/radiol.10091416]
  40. Kaufman CS, McDonald J, Balch H, Whitehead K (2022) Pulmonary arteriovenous malformations: what the interventional radiologist should know. Semin Intervent Radiol 39:261���270 [PMID: 36062221]
  41. Marra P, Di Fazio B, Dulcetta L et al (2022) Embolization in pediatric patients: a comprehensive review of indications, procedures, and clinical outcomes. J Clin Med 11:6626 [PMID: 36431102]
  42. Panda A, Bhalla AS, Goyal A (2017) Bronchial artery embolization in hemoptysis: a systematic review. Diagn Interv Radiol 23:307���317 [PMID: 28703105]
  43. Heran MK, Marshalleck F, Temple M et al (2010) Joint quality improvement guidelines for pediatric arterial access and arteriography: from the Societies of Interventional Radiology and Pediatric Radiology. Pediatr Radiol 40:237���250 [PMID: 20058129]
  44. Guillaume B, Vendrell A, Stefanovic X et al (2017) Acquired pulmonary artery pseudoaneurysms: a pictorial review. Br J Radiol 90:20160783 [PMID: 28337922]

MeSH Term

Humans
Hemoptysis
Child
Bronchoscopy
Radiography, Interventional
Journal Article Review

Word Cloud

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