Dechao Wang, Lei Zhang, Fengqin Liu, Jijun Li, Jie Chen
A total of 81 bronchial arteries were embolized, with a technical success rate of 100%, and no major procedure-related complications occurred. Bleeding severity was significantly associated with etiology (χ² = 8.986, p = 0.029), total BA number (χ² = 9.287, p = 0.001), and maximum BA diameter (χ² = 6.222, p = 0.005). Patients with idiopathic pulmonary hemosiderosis were more likely to present with severe or life-threatening bleeding, whereas non-idiopathic pulmonary hemosiderosis patients predominantly exhibited mild to moderate hemoptysis. BA number increased progressively with bleeding severity, and larger BA diameters were observed in patients with life-threatening hemorrhage. Digital subtraction angiography in idiopathic pulmonary hemosiderosis demonstrated diffuse parenchymal contrast extravasation and disorganized distal vascular proliferation. During follow-up, recurrent hemoptysis occurred in only one patient with idiopathic pulmonary hemosiderosis.
INTRODUCTION: Bronchial artery embolization (BAE) is an established first-line treatment for life-threatening hemoptysis in adults; however, evidence regarding its safety and efficacy in pediatric patients remains limited, particularly in children with idiopathic pulmonary hemosiderosis-associated pulmonary hemorrhage.
METHODS: This retrospective study evaluated the clinical efficacy, angiographic characteristics, and mid-term outcomes of bronchial artery (BA) computed tomography angiography-guided superselective BAE in 33 pediatric patients with hemoptysis or pulmonary hemorrhage treated between January 2018 and September 2025. All patients underwent preprocedural BA computed tomography angiography followed by digital subtraction angiography-guided embolization. Clinical characteristics, BA features, bleeding severity, procedural outcomes, and follow-up data were analyzed.
RESULTS: A total of 81 bronchial arteries were embolized, with a technical success rate of 100%, and no major procedure-related complications occurred. Bleeding severity was significantly associated with etiology (χ² = 8.986, p = 0.029), total BA number (χ² = 9.287, p = 0.001), and maximum BA diameter (χ² = 6.222, p = 0.005). Patients with idiopathic pulmonary hemosiderosis were more likely to present with severe or life-threatening bleeding, whereas non-idiopathic pulmonary hemosiderosis patients predominantly exhibited mild to moderate hemoptysis. BA number increased progressively with bleeding severity, and larger BA diameters were observed in patients with life-threatening hemorrhage. Digital subtraction angiography in idiopathic pulmonary hemosiderosis demonstrated diffuse parenchymal contrast extravasation and disorganized distal vascular proliferation. During follow-up, recurrent hemoptysis occurred in only one patient with idiopathic pulmonary hemosiderosis.
DISCUSSION: These findings suggest that BA computed tomography angiography-guided superselective BAE is a feasible and potentially beneficial minimally invasive treatment for pediatric hemoptysis and pulmonary hemorrhage and may be particularly valuable in children with idiopathic pulmonary hemosiderosis-associated life-threatening pulmonary hemorrhage.