Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, 110029, New Delhi, India.
Pediatr Radiol. 2024 Oct;54(11):1769-1784. doi: 10.1007/s00247-024-06002-7. Epub 2024 Aug 12.
Hemoptysis in the pediatric population, while infrequent, poses significant challenges for both the family and healthcare practitioners. The severity of hemoptysis dictates management decisions. Most cases being mild and self-limiting are treated conservatively. However, "life-threatening hemoptysis" may occur, and is defined as any degree of blood loss that endangers the airway and is arbitrarily considered to be > 8 ml/kg in 24 h in children. It requires prompt airway management and resuscitation followed by a tailored approach consisting of bronchoscopy, computed tomography (CT), interventional radiology, and/or surgery depending on the patient 's clinical status and cardiopulmonary comorbidities. Bronchial arteries are hypertrophied in myriad conditions and account for 90-95% cases of hemoptysis due to their systemic pressure levels; the rest being contributed by pulmonary artery pathologies. Despite similar pathogenic mechanisms, the etiologies of pediatric hemoptysis differ from those in adults, with acute lower respiratory tract infections being the predominant cause. Imaging plays a crucial role in identifying the source and cause of hemorrhage. Multidetector computed tomography (MDCT) has emerged as a prime modality in the diagnostic evaluation of hemoptysis and provides a roadmap for potential interventional procedures. This article discusses the etiopathogenesis of hemoptysis along with a brief mention of the diagnostic modalities. It provides a structured reporting format and uses it to illustrate the imaging features in hemoptysis, with emphasis on CT angiography. The key findings in the lung parenchyma, airways, bronchial and non-bronchial systemic collaterals, and pulmonary arteries are elaborated upon. It further addresses the nuances of interventional management, particularly emphasizing the applications of bronchial artery embolization and pulmonary artery embolization in the pediatric population. The article also underscores the potential complications and factors influencing recurrence rates.
儿童咯血虽然不常见，但对家庭和医疗保健从业者都构成重大挑战。咯血的严重程度决定了管理决策。大多数病例为轻度且自限性，可采用保守治疗。然而，可能会出现“威胁生命的咯血”，其定义为任何程度的失血，危及气道，并被任意认为是儿童 24 小时内>8ml/kg。需要及时进行气道管理和复苏，然后根据患者的临床状况和心肺合并症，采用支气管镜检查、计算机断层扫描（CT）、介入放射学和/或手术等针对性方法。在许多情况下，支气管动脉会发生肥大，占咯血的 90-95%，这是由于其全身压力水平；其余则由肺动脉病变引起。尽管发病机制相似，但儿童咯血的病因与成人不同，急性下呼吸道感染是主要原因。影像学在确定出血源和原因方面发挥着关键作用。多层螺旋 CT（MDCT）已成为咯血诊断评估的主要方式，为潜在的介入治疗提供了路线图。本文讨论了咯血的病因和发病机制，并简要提及了诊断方式。它提供了一个结构化的报告格式，并使用它来说明咯血的影像学特征，重点是 CT 血管造影。详细阐述了肺实质、气道、支气管和非支气管系统性侧支循环以及肺动脉的主要发现。进一步探讨了介入治疗管理的细节，特别是强调了支气管动脉栓塞和肺动脉栓塞在儿科人群中的应用。文章还强调了潜在的并发症和影响复发率的因素。
