支气管扩张和慢性肺部感染伴咯血患者行初次支气管动脉栓塞术后非支气管系统性罪犯动脉的发生率。

Prevalence of non-bronchial systemic culprit arteries in patients with hemoptysis with bronchiectasis and chronic pulmonary infection who underwent de novo bronchial artery embolization.

机构信息

Hemoptysis and Pulmonary-Circulation Center, Eishinkai Kishiwada Rehabilitation Hospital, 2-8-10 Kamimatsu-cho, Kishiwada, City Osaka, 596-0827, Japan.

出版信息

Eur Radiol. 2023 Jun;33(6):4198-4204. doi: 10.1007/s00330-022-09310-4. Epub 2022 Dec 6.

DOI:10.1007/s00330-022-09310-4

PMID:36472693

Abstract

OBJECTIVES

To identify the prevalence of non-bronchial systemic culprit arteries and their relationship to bleeding lobes in patients with hemoptysis with bronchiectasis and chronic pulmonary infection who underwent de novo bronchial artery embolization (BAE).

METHODS

Data of 83 consecutive patients with bronchiectasis and chronic pulmonary infection (non-tuberculous mycobacteriosis, aspergillosis, and tuberculosis) who underwent de novo BAE between January 2019 and December 2020 were retrospectively reviewed. The prevalence of culprit arteries was investigated.

RESULTS

Fifty-five patients (66%) had 172 non-bronchial systemic culprit arteries. The bleeding lobes were the right upper, right middle, right lower, left upper, and left lower lobes in 14 (17%), 20 (24%), 7 (8%), 31 (37%), and 11 (13%) patients, respectively. The internal thoracic (49%; n = 41), intercostal (28%; n = 23), and inferior phrenic (28%; n = 23) arteries were the top three non-bronchial systemic culprit arteries, which were involved in all five types of bleeding lobes. The costocervical trunk and thoracoacromial and lateral thoracic arteries were predominant in patients with upper lobe bleeding. Ligament arteries were predominant in patients with left lower lobe bleeding.

CONCLUSIONS

These findings will better ensure the identification of non-bronchial systemic culprit arteries in patients with hemoptysis with bronchiectasis and chronic pulmonary infection. All systemic arteries, especially those which are adjacent to the lung lesions, should be evaluated carefully using MDCT; the internal thoracic, intercostal, and inferior phrenic arteries should be proactively assessed using angiography.

KEY POINTS

• Non-bronchial systemic culprit arteries were identified in 66% of patients with hemoptysis with bronchiectasis and chronic pulmonary infection who underwent de novo bronchial artery embolization. • The internal thoracic (49%), intercostal (28%), and inferior phrenic (28%) arteries were the top three arteries, which were involved in all five types of bleeding lobes. • The costocervical trunk and thoracoacromial and lateral thoracic arteries were prominent in patients with upper lobe bleeding, and the ligament artery was prominent in patients with left lower lobe bleeding.

摘要

目的

确定支气管扩张和慢性肺部感染伴咯血患者行初次支气管动脉栓塞术（BAE）时非支气管系统性罪魁祸首动脉的流行情况及其与出血肺叶的关系。

方法

回顾性分析 2019 年 1 月至 2020 年 12 月期间 83 例初次接受 BAE 的支气管扩张和慢性肺部感染（非结核分枝杆菌病、曲霉菌病和肺结核）患者的数据。研究了罪魁祸首动脉的流行情况。

结果

55 例（66%）患者有 172 条非支气管系统性罪魁祸首动脉。14 例（17%）、20 例（24%）、7 例（8%）、31 例（37%）和 11 例（13%）患者的出血肺叶分别为右上叶、右中叶、右下叶、左上叶和左下叶。胸内动脉（49%；n=41）、肋间动脉（28%；n=23）和膈下动脉（28%；n=23）是前三种非支气管系统性罪魁祸首动脉，涉及所有五种类型的出血肺叶。锁骨下干、肋颈干和胸肩峰动脉在肺上叶出血患者中更为常见。左肺下叶出血患者以韧带动脉为主。