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World J Clin Pediatr. Nov 8, 2013; 2(4): 54-64
Published online Nov 8, 2013. doi: 10.5409/wjcp.v2.i4.54
Imaging evaluation of hemoptysis in children
Divya Singh, Ashu Seith Bhalla, Prasad Thotton Veedu, Arundeep Arora
Divya Singh, Ashu Seith Bhalla, Prasad Thotton Veedu, Arundeep Arora, Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
Author contributions: Singh D, Arora A and Thotton Veedu P completed the initial literature survey; Singh D and Bhalla AS drafted the manuscript; all authors read and approved the final manuscript.
Correspondence to: Ashu Seith Bhalla, MD, MAMS, Additional Professor, Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. ashubhalla1@yahoo.com
Telephone: +91-11-26594925 Fax: +91-98-68398805
Received: May 28, 2013
Revised: September 4, 2013
Accepted: October 16, 2013
Published online: November 8, 2013
Processing time: 164 Days and 13.2 Hours
Abstract

Hemoptysis is an uncommon but distressing symptom in children. It poses a diagnostic challenge as it is difficult to elicit a clear history and perform thorough physical examination in a child. The cause of hemoptysis in children can vary with the child’s age. It can range from infection, milk protein allergy and congenital heart disease in early childhood, to vasculitis, bronchial tumor and bronchiectasis in older children. Acute lower respiratory tract infections are the most common cause of pediatric hemoptysis. The objective of imaging is to identify the source of bleeding, underlying primary cause, and serve as a roadmap for invasive procedures. Hemoptysis originates primarily from the bronchial arteries. The imaging modalities available for the diagnostic evaluation of hemoptysis include chest radiography, multi-detector computed tomography (MDCT), magnetic resonance imaging (MRI) and catheter angiography. Chest radiography is the initial screening tool. It can help in lateralizing the bleeding with high degree of accuracy and can detect several parenchymal and pleural abnormalities. However, it may be normal in up to 30% cases. MDCT is a rapid, non-invasive multiplanar imaging modality. It aids in evaluation of hemoptysis by depiction of underlying disease, assessment of consequences of hemorrhage and provides panoramic view of the thoracic vasculature. The various structures which need to be assessed carefully include the pulmonary parenchyma, tracheobronchial tree, pulmonary arteries, bronchial arteries and non-bronchial systemic arteries. Since the use of MDCT entails radiation exposure, optimal low dose protocols should be used so as to keep radiation dose as low as reasonably achievable. MRI and catheter angiography have limited application.

Keywords: Hemoptysis; Lower respiratory tract infection; Bronchiectasis; Cystic fibrosis; Foreign body

Core tip: Hemoptysis is a cause of immense concern to the child, the family and the pediatrician. Thorough history and physical examination is necessary to ascertain its presence, which is particularly challenging in the pediatric population. Imaging has an important role in identifying the source of bleeding and its underlying cause. Acute lower respiratory tract infections are the most common cause of pediatric hemoptysis. The imaging modalities include chest radiography, multi-detector computed tomography (MDCT), magnetic resonance imaging (MRI) and catheter angiography. MDCT is a rapid multiplanar imaging modality which should be used judiciously to keep radiation dose to a minimum. MRI and catheter angiography have selected application.