CTA localises the bleeding side and lobe, maps enlarged bronchial and non-bronchial systemic arteries, and names the cause (bronchiectasis, TB, aspergilloma, cancer) — the map that makes embolisation quicker and safer.
Orient first
- Massive haemoptysis comes from the bronchial circulation in about 90%.
- Bronchial arteries over 2 mm and non-bronchial systemic collaterals (intercostal, internal mammary, phrenic) are embolisation targets.
- The anterior spinal artery can arise from an intercostobronchial trunk — spinal ischaemia is the feared complication.
Acquire the study
- CT angiography of the chest with the arterial phase timed to the descending aorta; MIP and 3D reformats.
The manoeuvre
- Lung window: ground glass and consolidation from aspirated blood — side and lobe.
- Cause: bronchiectasis, cavity, aspergilloma, tumour.
- Bronchial artery origins from the aorta and their calibre in mm on MIP; non-bronchial systemic arteries.
- Pulmonary artery pseudoaneurysm (Rasmussen) in a cavity.
What confirms it
- Hypertrophied bronchial or systemic arteries supplying the abnormal lung on the bleeding side.
What licenses you to exclude it
- Normal-calibre bronchial arteries without a lung cause make a bronchial source less likely; look at the pulmonary arteries.
The classic misread
- Missing non-bronchial systemic collaterals and recurrence after embolisation.
- Embolising a trunk that gives the anterior spinal artery.