The Role of Preprocedural Computed Tomography Angiography in Enhancing Arterial Embolisation for Life-Threatening Haemoptysis: A Case Series

Haemoptysis arises from diverse respiratory diseases and may involve a broad spectrum of thoracic vessels. Arterial embolisation (AE) is an effective, repeatable, minimally invasive treatment option for life-threatening haemoptysis. This case series included 10 patients (mean age 34 years; six males; five with cystic fibrosis) who underwent 17 AE procedures for life-threatening haemoptysis between January 2018 and September 2025. The study assessed the role of wide-field computed tomography angiography (CTA), extending from the thoracic inlet to L2, in preprocedural planning, bleeding localisation and detection of systemic collaterals. CTA accurately predicted the culprit region in 16 out of 17 procedures. Non-bronchial systemic arteries were identified in 6 out of 10 patients, consistent with previous reports. CTA showed strong concordance with angiography and enabled the detection of uncommon collaterals, including subclavian and phrenic branches. Recurrence of hemoptysis occurred in one patient during follow-up; however, three patients were lost to follow-up. Wide-field CTA enhances the identification of systemic feeders and supports procedural planning, potentially reducing recurrence associated with missed culprit vessels. AE remains a valuable option for haemoptysis control in cystic fibrosis, with outcomes further improved following initiation of CFTR modulators. The small sample size and incomplete follow-up limit generalisability, but findings highlight the importance of CTA in guiding AE and improving clinical outcomes.