Fig 1.
Study diagram for patient inclusion.
Table 1.
Results of univariate analysis to determine influencing factors for severity of hemoptysis.
Fig 2.
59-year-old male patient with hepatocellular carcinoma, representative case of clinically significant hemoptysis due to penetrating injury of peripheral pulmonary artery and cutting injury of bronchial structure after firing of biopsy gun.
A. Pre-procedural CT image shows a 10mm-sized subpleural nodule in the left lower lobe which was suspected of lung metastasis from hepatocellular carcinoma. Small peripheral pulmonary vessel (white arrowhead) is located just behind the nodule. B. Intra-procedural transverse and sagittal CT images before biopsy show that the introducer needle penetrates the nodule. The vessel abuts the tip of introducer needle (white arrowheads) but does not lie along the expected track of biopsy gun. After pulling out the needle 1cm backwards, biopsy was performed once. After the firing, hemoptysis began abruptly. C., D. Transverse enhanced CT images 20 minutes after the onset of hemoptysis confirm an extravasation of contrast media from the peripheral small pulmonary artery. The extravasated contrast media filled the left main bronchus (white arrows). The patient was managed conservatively. Hemoptysis persists for 2.5 hours and then spontaneously decreased. E. The histopathologic examination of biopsy specimen show bronchial epithelium (white arrows) but not pulmonary vessel 1mm or larger.
Fig 3.
52-year-old female patients without specific medical history, representative case of clinically significant hemoptysis due to penetrating injury of pulmonary artery and bronchiole after firing of biopsy gun.
A. Pre-procedural CT image shows a 32mm-sized sub solid mass in the left lower lobe with open bronchus sign (white arrow) which was suspected of primary lung cancer. B. Intra-procedural transverse and sagittal CT images before biopsy show that the introducer needle tip located within the mass. The bronchiole (white arrowhead) located just behind the introducer needle tip along the expected needle path of biopsy gun in transverse and sagittal CT images. The vessel (white arrow) which was seen in the medial margin of the mass lie along the expected track of biopsy gun in sagittal CT images. Biopsy was performed once and after the firing, hemoptysis began abruptly. C., D. Transverse enhanced CT image 20 minutes after the onset of hemoptysis shows the parenchymal hemorrhage along the introducer track. There was no evidence of extravasated contrast media around the mass. The patient was managed conservatively. E. The histopathologic examination of biopsy specimen shows pulmonary vessel larger than 1mm (white arrows) and small piece of bronchial epithelium. The pathologic diagnosis was consistent with primary lung adenocarcinoma.
Fig 4.
70-year-old female patients with history of pulmonary tuberculosis and cervical cancer, representative case of clinically significant hemoptysis due to penetrating injury of pulmonary artery after the firing of biopsy gun.
A. Pre-procedural CT image shows a 22mm-sized spiculated nodule right lower lobe with air-bronchogram sign which was suspected of primary lung cancer. Small peripheral pulmonary vessel (white arrowhead) is located posterolateral margin of the mass. B. Intra-procedural transverse and sagittal CT images before biopsy show that the introducer needle tip located within the mass. The vessel (white arrowhead) located just behind the introducer needle tip along the expected needle path of biopsy gun. Biopsy was performed once and after the firing, hemoptysis began abruptly. C. Post-procedural transverse CT image with right decubitus position shows the parenchymal hemorrhage around the vessel (white arrow) expected to be damaged. D. The histopathologic examination of biopsy specimen show pulmonary vessel larger than 2mm (white arrows) but no bronchial structure was seen.
Table 2.
Results of multivariate analysis to determine influencing factors for severity of hemoptysis.