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Cryptogenic haemoptysis in smokers: angiography and results of embolisation in 35 patients

Depts of ¹ Thoracic Imaging (EA 2694), ⁴ Pulmonology, and, ⁵ Pulmonary Function, Hospital Calmette, University Centre of Lille, Depts of ³ Pathology, and, ⁶ Medical Statistics (EA 2694), University Center of Lille, Lille Cedex, France. ² Dept of Radiology Paediatric Hospital "Bambino Gesù", Rome, Italy.

CORRESPONDENCE: M. Remy-Jardin, Dept of Thoracic Imaging, Hospital Calmette, Boulevard Jules Leclercq, 59037 Lille Cedex, France. E-mail: mremy-jardin{at}chru-lille.fr

Keywords: Bronchial arteries, chronic obstructive pulmonary disease, smoker's lung

Received: February 4, 2009
Accepted March 16, 2009

The aim of the present study was to describe angiographic findings and embolisation results in smokers with haemoptysis.

We retrospectively reviewed the clinical data and angiographic findings from 35 patients with smoking-related bronchopulmonary disease and no associated comorbidity, who were referred for embolisation for mild (n = 6), moderate (n = 14) and severe (n = 15) haemoptysis. Spirometric classification subdivided our population into: 16 patients with chronic bronchitis but no airflow limitation; and 19 patients with chronic obstructive pulmonary disease (COPD) (stage I: n = 12; stage II: n = 5; stage III: n = 2).

Bronchoscopy depicted focal submucosal vascular abnormalities in three patients and only endobronchial inflammation in 32 (91%) patients. Bronchial artery angiography revealed moderate (n = 18) or severe (n = 10) hypervascularisation in 28 (80%) patients, and normal vascularisation in seven (20%). No statistically significant difference was observed between the angiographic findings and the severity of COPD, tobacco consumption or the amount of bleeding. Cessation of bleeding was obtained by embolisation in 29 out of the 34 technically successful procedures (85%), requiring surgery in three out of five patients with recurrence. Follow-up (mean duration 7 yrs) demonstrated no recurrence of bleeding in 32 (94%) out of 34 patients and excluded late endobronchial malignancy.

Smokers with various stages of COPD severity may suffer from haemoptysis that is efficiently treatable by endovascular treatment.