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Hemoptysis in Patients with Nontuberculous Mycobacterial Lung Disease
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A1982 - Hemoptysis in Patients with Nontuberculous Mycobacterial Lung Disease
Author Block: S. Lee1, Y. Ryu1, J. Lee1, J. Change1, M. Kim2, S. Choi2, S. Shim2; 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, college of Medicine, Ewha Womans University, Seoul, Korea, Republic of, 2Department of Radiology, college of Medicine, Ewha Womans University, Seoul, Korea, Republic of.
Introduction Pulmonary infections due to nontuberculous mycobacteria (NTM) are increasing worldwide. However, there are few data focused on hemoptysis in patients with NTM lung disease. The aim of this study was to evaluate the prognosis and intervention therapy of hemoptysis in patients with NTM lung disease. Methods Following a retrospective review between 2006 and 2016, 183 patients with NTM lung disease were enrolled based on the diagnostic criteria published by the American Thoracic Society/Infectious Disease Society of America. Of total 183 patients, Mycobacterium intracellulare (N=64, 35%) was major cause of NTM infection, followed by M. avium (N=59, 32.2%), M. abscessus complex (N=40, 21.9%). Results Seventy eight of 183(42.6%) were developed hemoptysis, and 33 of 78 (42.3%) had hemoptysis requiring bronchial artery embolization (BAE). No significant difference was found with respect to male sex (44.8% vs. 34.6%, P = 0.167), duration of follow up (48.26±36.1 vs. 49.2±37.9 month, P = 0.864), radiographic manifestations (cavitary vs. nodular bronchiectatic, P = 0.339), distribution over 3 lobe in chest CT (35.6% vs. 25.6%, P = 0.196), past history of tuberculosis (31.4% vs. 39.7%, P = 0.274), antiplatelet therapy (10.5% vs. 12.8% P = 0.646) and species of NTM (P = 0.181) between patients with hemoptysis group and those without hemoptysis group. However, the hemoptysis group tended to be of younger age compared with those without hemoptysis group. (65.7±12.8 vs. 59.7±11.8, P = 0.002). Comparison between the hemoptysis group with medical therapy and those requiring intervention therapy with BAE, there were no difference of dermographic findings, radiographic manifestations or extents. There were no procedure-related complications or mortality and no hemoptysis related mortality. During follow-up period of 43 months (IQR 17-82.5months), recurrent hemoptysis requiring repeated BAE occurred in 8 patients (24.2%) with a median of 2 repeated BAE procedures (range, 2-8). Median time interval between the first and second BAE was 10 months (IQR 7.5-53.5months) and 4 of 8 patients underwent repeated BAE within 12 months. Conclusion NTM patients commonly experienced hemoptysis and needed BAE. Bronchial artery embolization is safe and minimally invasive technique that can be performed repeatedly for treatment of hemoptysis in patients with NTM lung disease.
Author Block: S. Lee1, Y. Ryu1, J. Lee1, J. Change1, M. Kim2, S. Choi2, S. Shim2; 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, college of Medicine, Ewha Womans University, Seoul, Korea, Republic of, 2Department of Radiology, college of Medicine, Ewha Womans University, Seoul, Korea, Republic of.
Introduction Pulmonary infections due to nontuberculous mycobacteria (NTM) are increasing worldwide. However, there are few data focused on hemoptysis in patients with NTM lung disease. The aim of this study was to evaluate the prognosis and intervention therapy of hemoptysis in patients with NTM lung disease. Methods Following a retrospective review between 2006 and 2016, 183 patients with NTM lung disease were enrolled based on the diagnostic criteria published by the American Thoracic Society/Infectious Disease Society of America. Of total 183 patients, Mycobacterium intracellulare (N=64, 35%) was major cause of NTM infection, followed by M. avium (N=59, 32.2%), M. abscessus complex (N=40, 21.9%). Results Seventy eight of 183(42.6%) were developed hemoptysis, and 33 of 78 (42.3%) had hemoptysis requiring bronchial artery embolization (BAE). No significant difference was found with respect to male sex (44.8% vs. 34.6%, P = 0.167), duration of follow up (48.26±36.1 vs. 49.2±37.9 month, P = 0.864), radiographic manifestations (cavitary vs. nodular bronchiectatic, P = 0.339), distribution over 3 lobe in chest CT (35.6% vs. 25.6%, P = 0.196), past history of tuberculosis (31.4% vs. 39.7%, P = 0.274), antiplatelet therapy (10.5% vs. 12.8% P = 0.646) and species of NTM (P = 0.181) between patients with hemoptysis group and those without hemoptysis group. However, the hemoptysis group tended to be of younger age compared with those without hemoptysis group. (65.7±12.8 vs. 59.7±11.8, P = 0.002). Comparison between the hemoptysis group with medical therapy and those requiring intervention therapy with BAE, there were no difference of dermographic findings, radiographic manifestations or extents. There were no procedure-related complications or mortality and no hemoptysis related mortality. During follow-up period of 43 months (IQR 17-82.5months), recurrent hemoptysis requiring repeated BAE occurred in 8 patients (24.2%) with a median of 2 repeated BAE procedures (range, 2-8). Median time interval between the first and second BAE was 10 months (IQR 7.5-53.5months) and 4 of 8 patients underwent repeated BAE within 12 months. Conclusion NTM patients commonly experienced hemoptysis and needed BAE. Bronchial artery embolization is safe and minimally invasive technique that can be performed repeatedly for treatment of hemoptysis in patients with NTM lung disease.
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