Association between CT findings of pulmonary tuberculosis lesions and offending vessels of hemoptysis：an analysis based on CT angiography

Abstract:

Objective：To investigate the association between chest computed tomography（CT） findings of pulmonary tuberculosis lesions and the source of offending vessels of hemoptysis in patients with pulmonary tuberculosis and hemoptysis，and to improve the ability of chest computed tomography angiography（CTA） in search for offending vessels of hemoptysis. Methods：A retrospective analysis was performed for the clinical data，digital subtraction angiography（DSA） findings，and CTA findings of 64 patients with pulmonary tuber－culosis and hemoptysis who were treated from June 2013 to October 2018，with focuses on the CT findings of pulmonary tuberculosis lesions，the involvement of the adjacent pleura，and the association of pulmonary and pleural lesions with the source of offending ves－sels of hemoptysis. The association between chest CT findings of pulmonary tuberculosis lesions and offending vessels for hemoptysis was analyzed. Results：With reference to the offending vessels of hemoptysis identified by DSA，all 64 patients had pathologically di－lated bronchial arteries（BA） on CTA，among whom 41 also had involvement of the branches of non-bronchial systemic artery（NBSA） in hemoptysis. The most common NBSA involved was the intercostal artery found in 37 patients（40.2%），followed by the subclavian artery found in 22 patients（23.9%）. Of all 64 patients，17（26.6%） had proliferation of pulmonary lesions，15（23.4%） had exudation of pulmonary lesions，and 32（50%） had fibrosis of pulmonary lesions；26（40.6%） had no or mild pleural thickening，and 38（59.4%） had marked pleural thickening；25 （39.1%） had no or mild adhesion between lesions and the pleura，and 39（60.9%） had severe adhesion. The numbers of patients with pathological NBSA in each group were 6（35.3%），6（40.0%），29 （90.6%）；4（15.4%），37（97.4%），2（8.0%），and 39（100%），respectively，and there was a significant difference between groups（P<0.01）. The extent of lesions and the presence or absence of bronchiectasis in lesions were not significantly associated with the offending vessels of hemoptysis. Conclusion：In patients with pulmonary tuberculosis，chest CT findings of pulmonary tuberculosis lesions are closely associated with the source of offending vessels of hemoptysis. For patients with marked fibrosis of pulmonary lesions，marked thickening of the adjacent pleura，and severe adhesion between lesions and the pleura，CTA should be performed to evaluate BA，and it is also necessary to determine whether NBSAs are responsible for hemoptysis.