Hemoptysis on Tuberculosis Sequelae: From the Physiopathology to the Endovascular Treatment

Educational Poster Background: Pulmonary tuberculosis is still a deadly endemic infection in most developing countries. In 2015, the incidence of tuberculosis in Morocco was 89/100,000/year. Parenchymal sequelae are frequent presenting as cavitation, cicatricial fibrosis, and parenchymal destruction. Airways lesions often associated are paracicatricial bronchectiasis, tracheobronchial stenosis, and broncholithiasis. Hemoptysis is systemic in these cases and due to bronchial artery hypervascularization. Since described in 1974, bronchial artery embolization (BAE) in controlling bleeding has improved in terms of technique and efficacy. It is indicated generally in mild to massive, life-threatening hemoptysis. Embolization's aim is to devascularize the hypervascular territory or at least decrease the hyperemia. The principal vascular occlusion's agents used nowadays are microparticles. Others additional agents are coils for proximal occlusion and liquids agents that require specific training. Hemoptysis on tuberculosis sequelae is due to systemic hypervascularization and bronchopulmonary shunt. Angio-computed tomograpy with acquisition at an aortic phase allows the detection of the hemorrhage site by searching for “ground glass” zones, and the visualization of bronchopulmonary sequelae. Arguments sustaining the hemoptysis's systemic origin are the dilatation of the bronchial artery, visualization of an early enhancement of pulmonary artery which is a sign of the bronchopulmonary shunt. Selective embolization of the systemic arteries bronchial or collateral such as intercostal, internal mammary artery, and diaphragmatic artery is indicated in case of life-threatening bleeding. Nowadays, the agents of choice are particles. Their size should be above 325 μm so that they do not cross bronchopulmonary anastomoses. The immediate clinical efficacy varies between 70% and 99% with a great percentage of recurrence between 12% and 57%. Despite high recurrence rates, BAE is still the first-line, minimally invasive treatment of hemoptysis in emergency and within surgically unfit patients. Complications are rare (1%). The most severe are spinal ischemia and pulmonary embolism.

Publication History

Article published online:
26 April 2021