Yonsei Med J.  2006 Jun;47(3):377-383. 10.3349/ymj.2006.47.3.377.

The Effectiveness of Embolotherapy for Treatment of Hemoptysis in Patients with Varying Severity of Tuberculosis by Assessment of Chest Radiography

• Kwon W
• Kim YJ
• Lee YH
• Lee WY
• Kim MS

• KMID: 1715857
• DOI: http://doi.org/10.3349/ymj.2006.47.3.377

Abstract

The effectiveness of percutaneous embolotherapy in cases of hemoptysis due to pulmonary tuberculosis from increasing severity of lung parenchymal injury was compared. The pattern of pleural involvement, as seen on chest radiography and angiography, were comparatively analyzed in 230 patients who were available for follow-ups from March 1992 to December 2003. Chest radiography findings were classified into 4 types based on levels of complicated lesions and pleural involvement. Angiography findings were divided into 4 groups based on the level of blood supply to lesions. Early hemostasis with respect to radiographic group were as follows: Type I-92% (73/79), Type II-80% (52/65), Type III-70% (42/60), and Type IV-56% (52/92); there was an average success rate of 73% (219/296), and continued hemostasis was found in 80% of Type I patients (62/77), 77% of Type II patients (41/53), 62% of Type III patients (25/40), and 45% of Type IV patients (27/60), with an average long-term hemostatic rate of 67% (155/230). Increasing severity of pleural involvement and associated complications correlated with increasing development of systemic collateral arteries other than the bronchial artery. The severely increased circulation in systemic collateral arteries makes it difficult to predict good hemostatic results following embolization. Therefore, we recommend aggressive treatment, such as surgical intervention, after embolization in such instances.

Keyword

Lung; pulmonary tuberculosis; hemoptysis; angiography; embolization

MeSH Terms

Tuberculosis, Pulmonary/*complications/radiography
Treatment Outcome
Severity of Illness Index
Middle Aged
Male
Humans
Hemoptysis/*microbiology/radiography/*therapy
Follow-Up Studies
Female
*Embolization, Therapeutic
Angiography
Aged, 80 and over
Aged
Adult
Adolescent

Figure

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  Fig. 1 An angiogram shows pulmonary tuberculosis in the right upper lung field (Type I). Right intercostobronchial angiography shows hypervascularity from the bronchial artery (Grade I).

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  Fig. 2 Chest PA shows pulmonary tuberculosis with a cavitary lesion in the right lung (Type II).

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  Fig. 3 Destructive change, bronchiectasis, and extensive pleural invasion are seen on a chest PA (Type IV).

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  Fig. 4 (A) Hypervascularity and shunting are noted in an angiogram of the right intercostobronchial (Group II). (B) A Right subclavian angiogram shows numerous collateral branches and shunting from the subclavian artery (Group IV).

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  Fig. 5 (A) A Chest PA shows destructive lung parenchyma and pleural invasion in the left upper lung field (Type IV). (B) A left subclavian angiogram shows a hypertrophied internal mammary artery, shunting, and numerous collaterals with blushes from main trunk of the subclavian artery (Group IV). (C) The left internal mammary artery supplies a destructive lung parenchyma rather than the pleural lesion.

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