• Takahiro Ando, Masahiro Kawashima, Kimihiko Masuda, Keita Takeda, Kenichi Okuda, Junko Suzuki, Nobuharu Ohshima, Hirotoshi Matsui, Atsuhisa Tamura, Hideaki Nagai, Shinobu Akagawa, and Ken Ohta.
• Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan. Electronic address: takaando@me.com.
• Chest. 2017 Nov 1; 152 (5): 1008-1014.

BackgroundHemoptysis can cause a life-threatening condition and often needs to be treated urgently. Nearly 20% of hemoptysis cases are diagnosed as cryptogenic after clinical investigation. The purpose of this study was to clarify the clinical and angiographic characteristics of cryptogenic hemoptysis.MethodsWe retrospectively reviewed medical records of 35 patients admitted to our hospital with cryptogenic hemoptysis from October 2010 to September 2014.ResultsIn the 35 cases, bronchial artery embolization was successfully performed in 33 patients (94.3%), whereas bronchoscopic hemostatic therapy was added in one patient (2.8%), and embolization was not performed in one patient (2.8%) because the bronchial artery was too narrow. In the successful embolization group, the non-rebleeding rate was 97.0% for 20 months. The angiographic findings revealed that the diameter of the bronchial arteries was < 2 mm in 13 patients, 2 to 3 mm in 17 patients, and > 3 mm in five patients. Hypervascularization was detected in 29 patients (82.9%) and small bronchial aneurysms in eight patients (22.9%). The amount of hemoptysis was slight (< 50 mL/d) in 12, mild (50-100 mL/d) in 11, moderate (100-200 mL/d) in eight, and massive (> 200 mL/d) in four patients. No obvious relationship was found between the diameter of bronchial arteries and the amount of hemoptysis.ConclusionsBAE was highly effective for the management of cryptogenic hemoptysis. Most cases of cryptogenic hemoptysis have angiographic abnormalities, including small or microaneurysms, which were suspected as the cause in some cases.Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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