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CT FINDINGS IMPLY THE BLEEDING SITE COMPARED WITH ANGIOGRAPHY IN TUBERCULOSIS PATIENTS WITH MASSIVE HEMOPTYSIS

Pusan National University Hospital, Internal Medicine, Pusan, South Korea

PURPOSE: Pulmonary Tuberculosis has been major cause of the massive hemoptysis in Korea. CT(Computed tomography) can provide useful informations about the cause of disease and the bleeding site as well. It allows more rapid and exact managements to know the bleeding site obviously from CT in emergent situation such as patients presented with massive hemoptysis. The aim of this study is to elucidate significant CT findings implying the bleeding site in pulmonary tuberculosis patients.

METHODS: From March 31, 2001 to June 30, 2004., 28 pulmonary tuberculosis patients of massive hemoptysis with chest CT of hemoptysis proctocol, bronchial angiography and embolization were reviewed retrospectively. To examine the CT findings implying the bleeding site, we determined bleeding lobe based on angiography and calculate the concordance rate of each CT findings. CT findings were classified to the air-meniscus sign, cavity, consolidation, fibrotic scar, bronchial dilatation, ground glass opacity. We analyzed the corresponding sites of CT and the angiographic findings of the foci lobe of bleeding. In other words, Numbers of lobes which each CT finding observed in bleeding lobe/numbers of lobes which each CT finding observed in whole lung of overall patients was calculated. The hemoptysis proctocol is composed of two part. One is high resolution CT with 1mm thickness, 7-10 mm interval from apex to diaphragm. The other is contrast enhanced spiral CT with 1.25-2.5mm thickness and injection speed of dye 2.5ml/sec.

RESULTS: The concordance rate of air-meniscus sign is 90.9%, cavity 84%, consolidation 83.3%, fibrotic scar 75.7%, bronchial dilatation 67.5%, ground glass opacity 40.6%.

CONCLUSION: Air-meniscus sign, cavity, consolidation of chest CT suggest the bleeding site strongly in pulmonary tuberculosis patient presented with massive hemoptysis.

CLINICAL IMPLICATIONS: Air meniscus sign, cavity and consolidation suggest bleeding site could allow more rapid, precise management of massive hemoptysis patients of pulmonary tuberculosis.

DISCLOSURE: Jin Hoon Cho, None.