Ectopic pituitary adenoma with an empty sella

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Bronchial artery embolization in hemoptysis: a systematic review

We systematically reviewed the role of bronchial artery embolization (BAE) in hemoptysis. Literature search was done for studies on BAE published between 1976 and 2016. Twenty-two studies published in English, with sample size of at least 50 patients, reporting indications, technique, efficacy, and follow-up were included in the final analysis. Common indications for BAE included tuberculosis (TB), post-tubercular sequelae, bronchiectasis, and aspergillomas. Most common embolizing agent used was polyvinyl alcohol (size, 300–600 μm) with increasing use of glue in recent years. Overall immediate clinical success rate of BAE, defined as complete cessation of hemoptysis, varied from 70%–99%. However, recurrence rate remains high, ranging from 10%–57%, due to incomplete initial embolization, recanalization of previously embolized arteries, and recruitment of new collaterals. Presence of nonbronchial systemic collaterals, bronchopulmonary shunting, aspergillomas, reactivation TB, and multidrug resistant TB were associated with significantly higher recurrence rates (P < 0.05). Rate of major complications remained negligible and stable over time with median incidence of 0.1% (0%–6.6%). Despite high hemoptysis recurrence rates, BAE continues to be the first-line, minimally invasive treatment of hemoptysis in emergency settings, surgically unfit patients, or in patients with diffuse or bilateral lung disease

Pulmonary lymphoma mimicking metastases: a case report

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Imaging findings as predictors of the site of bleeding in patients with hemoptysis: Comparison between split-bolus dual-energy CT angiography and digital subtraction angiography

PURPOSESystemic to pulmonary vasculature shunting (SPS) is an important finding to identify the probable site of bleeding, especially in multicentric parenchymal lung disease. The purpose of this study was to evaluate the value of imaging findings, which can locate SPS on dual-energy computed tomography angiography (DECTA), and correlate with digital subtraction angiography (DSA), which was considered as a gold standard.METHODSRetrospective analysis of 187 patients (148 males, 39 females, mean age: 43.7 ± 15.1 years) between October 2014 and November 2018 who underwent both DECTA and DSA. Computed tomography angiography was performed using dual-source (80 and 140kV), 2 × 128 slice equipment, using 50-80mL iodinated contrast (400mg iodine/mL). These patients were divided into shunting (group A) and non-shunting groups (group B), based on the presence or absence of signs of shunting on DECTA. Group A had 98 and group B had 89 patients. We analyzed the following imaging signs for identifying SPS: (1) non-tapering pulmonary artery sign, (2) clustering of vessels sign, and (3) significant differential attenuation sign (>25 HU difference in attenuation between segmental pulmonary arteries of shunting side and normal non-shunting side was considered significant). The correlation was done with DSA to identify the presence of SPS.RESULTSIn 187 patients, 281 lobes were evaluated to look for the signs of shunting from systemic artery to pulmonary vessels on DECTA. A total of 98 patients who showed signs of shunting on DECTA presented 135 lobes with parenchymal, with or without pleural, abnormalities. Of these, 84 patients had one or more aspergilloma in the lobe where shunting was seen. In one patient, a specific artery could not be cannulated due to a tortuous course; hence, all arteries which were seen on CTA causing shunting were also seen on DSA. Non-tapering pulmonary artery segmental branches were seen in 97 (99%) patients, clustering of systemic vessels was seen in 90 (91.8%) patients, and significant attenuation difference was seen in 74 (75.5%) patients. In the rest of the 89 patients, 146 lobes were assessed but no signs of shunting were seen on DECTA. Nine arteries in 8 patients showed shunting on DSA, while the rest did not show any shunting. Digital subtraction angiography correlation showed 96.4%, 100%, 100%, and 93.8% of sensitivity, specificity, positive predictive value, and negative predictive value, respectively, for DECTA in detecting SPS on a per artery basis.CONCLUSIONThe proposed signs on DECTA help in identifying the systemic vessels that cause shunting, and hence, the most likely bleeding site, which aids in planning the endovascular management by targeting specific arteries in case of multicentric disease. Being the gold standard, DSA is an ideal modality for detecting very small SPSs and in classifying the latter

Pulmonary Artery Narrowing: A Less Known Cause for Massive Hemoptysis

Chronic pulmonary artery narrowing may result from diverse causes; congenital as well as acquired. The relative hypoperfusion of the lung results in hypertrophy of multiple systemic arteries. Such patients can present with recurrent hemoptysis from hypertrophied systemic arteries, most commonly bronchial arteries. These patients remain undiagnosed for a long time because of the lack of awareness of this entity. We present three cases of chronic pulmonary artery narrowing presenting with massive hemoptysis

The ‘dark bronchus’ sign: HRCT diagnosis of Pneumocystis carinii pneumonia

We report the importance of the ‘dark bronchus’ sign in the diagnosis of uniform, diffuse ground glass opacification on high resolution computerized tomography (HRCT). This sign is useful to identify diffuse ground glass opacity on HRCT in cases of Pneumocystis carinii pneumonia who may present with a normal or equivocal chest radiograph in the early course of disease

The &#x2032;dark bronchus&#x2032; sign: HRCT diagnosis of <i> Pneumocystis carinii </i> pneumonia

We report the importance of the &#x2032;dark bronchus&#x2032; sign in the diagnosis of uniform, diffuse ground glass opacification on high resolution computerized tomography (HRCT). This sign is useful to identify diffuse ground glass opacity on HRCT in cases of <i> Pneumocystis carinii </i> pneumonia who may present with a normal or equivocal chest radiograph in the early course of disease