1. Intern Journal reading
Multi–Detector Row CT of Hemoptysis

2. Hemoptysis Expectoration of blood from the respiratory tract
Massive: >100 to >600 mL over a 24-h period →not reliable
Potential risk:
Underlying tumor
Massive hemoptysis induced impaired gas exchange

3. Etiology
Source other than the lower respiratory tract   Upper airway (nasopharyngeal) bleeding  
Gastrointestinal bleeding
Tracheobronchial source  
Neoplasm (bronchogenic carcinoma, endobronchial metastatic tumor, Kaposi's sarcoma, bronchial carcinoid) 
Bronchitis (acute or chronic)  
Bronchiectasis
Broncholithiasis  
Airway trauma  
Foreign body 
Pulmonary parenchymal source  
Lung abscess 
Pneumonia  
Tuberculosis  
Mycetoma ("fungus ball")  
Goodpasture's syndrome  
Idiopathic pulmonary hemosiderosis  
Wegener's granulomatosis  
Lupus pneumonitis  
Lung contusion 
Primary vascular source  
Arteriovenous malformation  
Pulmonary embolism 
Elevated pulmonary venous pressure (esp. mitral stenosis) 
Pulmonary artery rupture secondary to balloon-tip pulmonary artery catheter manipulation
Miscellaneous/rare causes 
Pulmonary endometriosis  
Systemic coagulopathy or use of anticoagulants or thrombolytic agents

4. Lung arterial supply Pulmonary artery Bronchial artery
Non-bronchial artery
Bleeding from the artery itself
Fragile anastomosis from neovascularization→caused by increased bronchial artery, chronic inflammation…etc
Cryptogenic hemoptysis

6. Bronchoscopy Useful diagnostic tool Can help maintain airway
Can’t detect the underlying etiology
Difficult to examination with massive blood in airway
Would cause recurrent hemorrhage

7. Maximum Intensity Projection Technique
The connectivity algorithm starts with picking a surface value and seed point as input. The next subsequent step is to find out and mark out those points which lie on the surface of our interest. In the construction of surface step, this method only considers those marked points [8]. This 3D reconstruction technique includes the procedure shown in figure 5.

9. CT
Fast examination
Could detail the lung tissue and recognize the underlying problem
“Road map” for further intervention

10. Lung Parenchyma
presence of liquified material in segmental and lobar bronchi and hazy consolidation or ground-glass infiltrates in the lung parenchyma
Bronchiectasis
Lung carcinoma
acute and chronic lung infections (in particular, tuberculosis and aspergillosis)
cardiogenic pulmonary edema

12. Pulmonary arteries Acute thromboembolic disease
Vascular invasion with tumor or tuberculosis
Rasmussen aneurysm, sentinel bleeding
Pulmonary arteriovenous malformation
With feeding artery > 3mm

13. Bronchial arteries 95% bleeding origin
Abnormal dilatation in bronchial artery: >2mm
May bleeding from the thin wall anastomosis
Could only detect by contrast in airway lumen or angiography
Bronchial aneurysm
Orthotopic and anomalous origin

16. Bronchial arteries have ectopic origins outside the T5 through T6 range in 20% of cases

17. Non-Bronchial systemic artery
Abnormally dilated arteries that course into the lungs along trajectories
41%–88% of cases of massive hemoptysis
The CT evaluation of hemoptysis should always be extended, if possible, to include the supraaortic great vessels and the upper abdomen
Pseudosequestration

20. Bronchial-to-Systemic Artery Communications
inadvertent embolization of a major spinal artery, with resultant paraplegia.
Coronary-to-bronchial artery anastomoses
cyanotic congenital heart disease
chronic thromboembolic disease
vasculitides such as Takayasu arteritis,
“Pulmonary steal” syndrome

23. Cryptogenic hemoptysis
diagnosis of exclusion
prevalence of approximately 3%–42%
6% of such patients will present with unresectable lung carcinoma within the next 3 years
risk rises to 10% among patients who are over 40 years old

24. Conclusion
CT is a quick and noninvasive tool that is helpful in the diagnosis and management of hemoptysis, and its use should be considered in any patient who presents with this condition.

25. Thank you for the listening~
The End
Thank you for the listening~