Guillaume Carteaux1,2, Damien Contou3, Guillaume Voiriot4,5, Antoine Khalil6,7,8, Marie-France Carette5,9, Martine Antoine9,10, Antoine Parrot5, Muriel Fartoukh4,5,9. 1. Assistance Publique-Hôpitaux de Paris, Groupe Henri Mondor-Albert Chenevier, Service de Réanimation Médicale, CHU Henri Mondor, 94010, Paris, Créteil, France. guillaume.carteaux@aphp.fr. 2. Faculté de Médecine de Créteil, Groupe de recherche clinique CARMAS, Université Paris Est Créteil, 94010, Paris, Créteil, France. guillaume.carteaux@aphp.fr. 3. Service de reanimation polyvalente, Centre Hospitalier d'Argenteuil, 69 rue du Lieutenant-colonel Prud'hon, 95107, Paris, Argenteuil, France. 4. Faculté de Médecine de Créteil, Groupe de recherche clinique CARMAS, Université Paris Est Créteil, 94010, Paris, Créteil, France. 5. Assistance Publique-Hôpitaux de Paris, Unité de Réanimation médico-chirurgicale, Groupe hospitalier des Hôpitaux Universitaires de l'Est Parisien, Hôpital Tenon, 4 rue de la Chine, 75970, Paris, Cedex 20, France. 6. Assistance Publique-Hôpitaux de Paris, Service d'Imagerie Médicale, Groupe Hospitalier des Hôpitaux Universitaires de l'Est Parisien, Hôpital Tenon, 75970, Paris, France. 7. Assistance Publique-Hôpitaux de Paris, Service d'Imagerie Médicale, Hôpital Bichat-Claude-Bernard, 46, rue Henri Huchard, 75018, Paris, France. 8. Université Paris 07, 75205, Paris, Cedex 13, France. 9. Sorbonne Universités, UPMC Université Paris 06, Paris, France. 10. Assistance Publique-Hôpitaux de Paris, Service d'anatomopathologie, Groupe Hospitalier des Hôpitaux Universitaires de l'Est Parisien, Hôpital Tenon, 75970, Paris, France.
Abstract
PURPOSE: Severe hemoptysis (SH) associated with non-tuberculosis bacterial lower respiratory tract infection (LRTI) is poorly described, and the efficacy of the usual decision-making process is unknown. This study aimed at describing the clinical, radiological patterns, mechanism, and microbiological spectrum of SH related to bacterial LRTI, and assessing whether the severity of hemoptysis and the results of usual therapeutic strategy are influenced by the presence of parenchymal necrosis. METHODS: A single-center analysis of patients with SH related to bacterial LRTI from a prospective registry of consecutive patients with SH admitted to the intensive care unit of a tertiary referral center between November 1996 and May 2013. RESULTS: Of 1504 patients with SH during the study period, 65 (4.3%) had SH related to bacterial LRTI, including non-necrotizing infections (n = 31), necrotizing pneumonia (n = 23), pulmonary abscess (n = 10), and excavated nodule (n = 1). The presence of parenchymal necrosis (n = 34, 52%) was associated with a more abundant bleeding (volume: 200 ml [70-300] vs. 80 ml [30-170]; p = 0.01) and a more frequent need for endovascular procedure (26/34; 76% vs. 9/31; 29%; p < 0.001). Additionally, in case of parenchymal necrosis, the pulmonary artery vasculature was involved in 16 patients (47%), and the failure rate of endovascular treatment was up to 25% despite multiple procedures. CONCLUSIONS: Bacterial LRTI is a rare cause of SH. The presence of parenchymal necrosis is more likely associated with bleeding severity, pulmonary vasculature involvement, and endovascular treatment failure.
PURPOSE: Severe hemoptysis (SH) associated with non-tuberculosis bacterial lower respiratory tract infection (LRTI) is poorly described, and the efficacy of the usual decision-making process is unknown. This study aimed at describing the clinical, radiological patterns, mechanism, and microbiological spectrum of SH related to bacterial LRTI, and assessing whether the severity of hemoptysis and the results of usual therapeutic strategy are influenced by the presence of parenchymal necrosis. METHODS: A single-center analysis of patients with SH related to bacterial LRTI from a prospective registry of consecutive patients with SH admitted to the intensive care unit of a tertiary referral center between November 1996 and May 2013. RESULTS: Of 1504 patients with SH during the study period, 65 (4.3%) had SH related to bacterial LRTI, including non-necrotizing infections (n = 31), necrotizing pneumonia (n = 23), pulmonary abscess (n = 10), and excavated nodule (n = 1). The presence of parenchymal necrosis (n = 34, 52%) was associated with a more abundant bleeding (volume: 200 ml [70-300] vs. 80 ml [30-170]; p = 0.01) and a more frequent need for endovascular procedure (26/34; 76% vs. 9/31; 29%; p < 0.001). Additionally, in case of parenchymal necrosis, the pulmonary artery vasculature was involved in 16 patients (47%), and the failure rate of endovascular treatment was up to 25% despite multiple procedures. CONCLUSIONS: Bacterial LRTI is a rare cause of SH. The presence of parenchymal necrosis is more likely associated with bleeding severity, pulmonary vasculature involvement, and endovascular treatment failure.
Authors: Antoine Khalil; Muriel Fartoukh; Marc Tassart; Antoine Parrot; Claude Marsault; Marie-France Carette Journal: AJR Am J Roentgenol Date: 2007-02 Impact factor: 3.959