Management of haemoptysis (2025)

Description

Authors: M.Tsitskari and J. Vos

Reviewers: V. Bérczi, D. Filippiadis, S. Hopf-Jensen, R. Iezzi, R. Loffroy, C. Nice, B. Peynircioglu, S. Protto and P. Rao

This course corresponds to chapters 2.1.9 Core procedures in interventional radiology and 2.2.1.1.8 Visceral arterial disease in the European Curriculum and Syllabus for Interventional Radiology.

Abstract

Haemoptysis is defined as the expectoration of blood from the lower airways. Although minor amounts of blood are coughed up in the vast majority of cases, massive amounts indicate a potentially life-threatening condition. It is almost always associated with chronic pulmonary disease and normally originates from the bronchial arteries. In cases requiring treatment, a computed tomographic angiography () should be made if feasible, which will aid in treatment planning. The bronchial artery embolization (BAE) procedure is normally performed from a groin approach, using a 4 or 5 Fr sheath. Engaging the BA should be done with a 4 Fr catheter. If possible, a microcatheter should be placed in the BA in order to reduce the chance of spilling embolic material. If the right intercosto-bronchial trunk is treated, the microcatheter should be advanced well beyond the hairpin turn to avoid ischaemia of the thoracic wall in the territory of the first three intercostal arteries. Embolization should always be done with particulate embolic material. Before embolization material is inserted, a careful scrutiny of the angiograms for any sign of collateral filling into non-target organs should be performed. Specifically, any filling of the anterior spinal artery should be noted, as inadvertent embolization of this vessel may lead to spinal cord ischaemia and paraplegia. Cessation of flow in all BA’s to the culprit region signifies technical success. Repeat embolization may be necessary, especially if the underlying disease progresses; this carries a greater risk of complications, especially non-target embolization.

Learning objectives

After finishing this course, the participant should be familiar with:

• Main causes of haemoptysis
• Anatomy of the bronchial arteries
• Preprocedural work up of patients suffering from haemoptysis
• Indications and contraindications of bronchial artery embolization (BAE)
• Basic techniques and pitfalls of BAE
• Potential complications of BAE

Further information

This course covers a basic level of IR knowledge and is designed for trainees, students or young consultants aiming to acquire essential knowledge or prepare for the EBIR exam. Thereby, it is tailored to the European Curriculum and Syllabus for Interventional Radiology and corresponds to chapters 2.1.9 Core procedures in interventional radiology and 2.2.1.1.8 Visceral arterial disease.

The format of the course is interactive and easy to use, including texts, graphics, videos and a quiz to support your learning. The course duration is around two hours and is accredited by the European Accreditation Council for Continuing Medical Education (EACCME) to award 1 European CME credit (ECMEC). Please note that this course will be taken offline on October 15, 2030.

The acquired CME Certificate will be available in the myCIRSE area under CIRSE Academy.

The enrolment period of this course is linked to the validity of the All-Access Pass.

Release date: October 2025