Olsen Kathryn M, Manouchehr-Pour Shawdi, Donnelly Edwin F, Henry Travis S, Berry Mark F, Boiselle Phillip M, Colletti Patrick M, Harrison Nicholas E, Kuzniewski Christopher T, Laroia Archana T, Maldonado Fabien, Pinchot Jason W, Raptis Constantine A, Shim Kyungran, Tong Betty C, Wu Carol C, Kanne Jeffrey P
Radiology Imaging Associates, Englewood, Colorado.
Research Author, Keck School of Medicine of USC, Los Angeles, California.
J Am Coll Radiol. 2020 May;17(5S):S148-S159. doi: 10.1016/j.jacr.2020.01.043.
Hemoptysis, the expectoration of blood, ranges in severity from nonmassive to massive. This publication reviews the literature on the imaging and treatment of hemoptysis. Based on the literature, the imaging recommendations for massive hemoptysis are both a chest radiograph and CT with contrast or CTA with contrast. Bronchial artery embolization is also recommended in the majority of cases. In nonmassive hemoptysis, both a chest radiograph and CT with contrast or CTA with contrast is recommended. Bronchial artery embolization is becoming more commonly utilized, typically in the setting of failed medical therapy. Recurrent hemoptysis, defined as hemoptysis that recurs following initially successful cessation of hemoptysis, is best reassessed with a chest radiograph and either CT with contrast or CTA with contrast. Bronchial artery embolization is increasingly becoming the treatment of choice in recurrent hemoptysis, with the exception of infectious causes such as in cystic fibrosis. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
咯血，即咳出的血液，严重程度从非大量到大量不等。本出版物回顾了关于咯血的影像学检查和治疗的文献。根据文献，大量咯血的影像学检查建议是胸部X光片和增强CT或CTA。在大多数情况下也推荐支气管动脉栓塞术。对于非大量咯血，建议进行胸部X光片和增强CT或CTA检查。支气管动脉栓塞术的应用越来越普遍，通常用于药物治疗失败的情况。复发性咯血定义为咯血在最初成功停止后再次出现，最好通过胸部X光片以及增强CT或CTA进行重新评估。除了如囊性纤维化等感染性病因外，支气管动脉栓塞术在复发性咯血中越来越成为首选治疗方法。美国放射学会适宜性标准是针对特定临床情况的循证指南，每年由多学科专家小组进行审查。指南的制定和修订包括对同行评审期刊上的当前医学文献进行广泛分析，并应用成熟的方法（兰德/加州大学洛杉矶分校适宜性方法以及推荐评估、制定和评价分级系统或GRADE）来评估特定临床场景下影像学检查和治疗程序的适宜性。在缺乏证据或证据不明确的情况下，专家意见可能会补充现有证据以推荐影像学检查或治疗方法。
