The characteristics of upper lobe-origin hemoptysis: analysis based on 31 patients.

BACKGROUND

Hemoptysis is associated with a variety of respiratory system diseases. Bronchial artery embolization (BAE) is effective for this condition, and preoperative computed tomography angiography (CTA) is helpful for the implementation of BAE. Some non-life-threatening cases have intermittent and recurrent episodes after conservative treatment, and no obvious abnormalities were found during tests and examinations, and they were defined as upper lobe-origin hemoptysis (ULOH), with concerns of embolism. This study aimed to describe the clinical characteristics of a distinct subtype of hemoptysis patients, termed ULOH, as well as the efficacy and outcomes of these patients after BAE.

METHODS

From April 2019 to March 2024, a total of 31 consecutive ULOH patients who suffered varying episodes of relapse after conservative treatment and then received BAE were included. After the procedure, each case ​underwent respiratory rehabilitation, followed by dual-energy computed tomography (DECT)​to quantitatively assess pulmonary function. Patients' demographics, clinical characteristics, imaging findings, details of BAE, and outcomes were reviewed and summarized.

RESULTS

The median age was 49.0 years old. Twenty-eight patients (90.3%) were male, and 22 (71.0%) cases were heavy smokers. CTA indicated that hemorrhage of alveoli was confined to the upper lobes, and the diameter of all bronchial arteries was no more than 2.0 mm. During bronchial artery angiography, each case showed symmetrical characteristic of systemic-pulmonary shunt (SPS) at bilateral apexes. One month after embolization, chest computed tomography (CT) scan demonstrated complete resolution of the lesion. All patients received 6 months of respiratory rehabilitation after procedures, and the followed integrated analysis of DECT showed structure and function were normal. During a median follow-up period of 24 months, no patient experienced hemoptysis recurrence.

CONCLUSIONS

Patients with ULOH presented as normal diameter of bronchial arteries and symmetrical characteristic of SPS at bilateral apexes during angiography. After BAE procedure, these patients could harvest complete recovery in both structure and function.