الفهرس 
Introduction and Aim of the workOnly 14 pages are availabe for public view
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Abstract
Hemoptysis may be a life-threatening condition with a propensity to recur if definitive therapy is not instituted. Massive hemoptysis (defined as _ loss of 200 mL blood per 24 h) .
In 90% of cases, the source of massive hemoptysis is the bronchial circulation. Massive hemoptysis may result from various causes. Pulmonary tuberculosis, including post tuberculous bronchiectasis, is the most common underlying cause of massive hemoptysis. Bronchogenic carcinoma and chronic inflammatory lung diseases due to bronchiectasis, cystic fibrosis, or aspergillosis .
Other causes include lung abscess, pneumonia, chronic bronchitis, pulmonary artery aneurysm (Rasmussen aneurysm), congenital cardiac or pulmonary vascular anomalies, aortobronchial fistula, ruptured aortic aneurysm, and ruptured bronchial artery aneurysm.
Diagnostic studies for massive hemoptysis include radiography, bronchoscopy, and computed tomography (CT) of the chest. Bronchoscopy and chest radiography have been considered the primary methods for the diagnosis and localization of hemoptysis. Many researchers currently suggest that CT should be performed prior to bronchoscopy in all cases of massive hemoptysis.
There are three lines of treatment of hemoptysis as conservative treatment ,surgical treatment and bronchial artery embolization. Bronchial artery embolization (BAE) is a safe and effective nonsurgical treatment for patients with massive hemoptysis.
Bronchial artery anatomy varies greatly. In the majority of patients, the bronchial arteries arise directly from the aorta or from the intercostal arteries. However, bronchial arteries have also been described to arise from the subclavian, brachiocephalic, internal mammary, phrenic, and coronary arteries.
Knowledge of the bronchial artery anatomy, together with an understanding of the pathophysiologic features of massive hemoptysis, are essential for planning and performing BAE in affected patients. In addition, interventional radiologists should be familiar with the techniques, results, and possible complications of BAE and with the characteristics of the various embolic agents used in the procedure.
Complications from embolotherapy in patients with hemoptysis are uncommon but have been described. These include spinal cord syndromes, bronchial stenosis, bronchoesophageal fistula, infarction of a bronchus, mediastinal hematoma after subintimal aortic dissection,recurrent bleeding and transient cortical blindness.
The recent use of microcatheters for superselective arterial embolization of target vessels is a promising method for minimizing complications in the future.
Massive hemoptysis constitutes a significant and often life-threatening respiratory emergency. CT is useful in diagnosing the disease that causes massive hemoptysis, localizing the bleeding site, and selecting vessels to be embolized .
Bronchial artery embolization is a safe and effective nonsurgical treatment for patients with massive hemoptysis. Knowledge of bronchial artery anatomy, together with an understanding of the pathophysiologic features of massive hemoptysis, are essential for performing BAE.
Most complications related to the procedure are minor. We believe the use of microcatheters for superselective catheterization and embolization may minimize serious complications related to spinal cord injury. With appropriate technique it is a safe and well-tolerated procedure with a better outcome than medical, surgical, or bronchoscopic techniques alone.