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PubMed1989

The role of fiberoptic bronchoscopy in patients with hemoptysis and a normal chest roentgenogram.

We reviewed the charts of 478 patients who had fiberoptic bronchoscopy (FOB) performed for evaluating hemoptysis with a normal chest roentgenogram. FOB provided a definite diagnosis of endobronchial lesion in only 10 patients (2.1%): bronchogenic carcinoma in 2 patients, bronchial adenoma in 1 patient, tracheal cancer in 1 patient, foreign body in 3 patients and endobronchial tuberculosis in 3 patients. FOB neither visualized tumor mass nor localized the bleeding site in 300 (95.8%) of 313 patients with mild hemoptysis. However, the bleeding site could be localized by FOB in 56% of the patients (n = 165) if the bleeding amount exceeded 60 ml/day. In conclusion, in patients with hemoptysis and normal chest roentgenograms, routine FOB may not rule out airway malignancy. In contrast, it is a good diagnostic tool for localizing the bleeding site if patients present with moderate amount of hemoptysis.

Adolescent↗
PubMed1989

[Treatment of severe hemoptysis with terlipressin. Study of the efficacy and tolerance of this product].

Terlipressin (Glypressin) is a "pro-hormone"; after intravenous injection the glycyl radicals are slowly cleaved by enzymatic action, liberating vasopressin. We have assessed the efficacy of terlipressin in the treatment of severe hemoptysis. The study was performed on 20 patients: in 5 cases there was very copious hemoptysis and in 15 cases there was repeated hemoptysis of lesser volume. The cause was distributed as follows: 6 cases of neoplasms, 5 were sequelae of tuberculosis, bronchial dilatation 2 cases, pneumonia with abscess 2 cases, chronic airflow obstruction (COPD) 2 cases and 3 cases of silicosis. The treatment consisted of a slow intravenous injection of 2 mgm 4 times per day (9 patients), then in 11 patients an injection of 2 mgm at the time of acute episodes followed by 1 mgm every 6 hours. The patients received an average of between 15 and 20 mgm of the product for a treatment lasting over 5 days at the maximum. The results were as follows: total success 12 cases; partial success (a reduction to at least one-third of the initial hemoptysis): 5 cases; failure: 3 cases. The failures were linked in two cases to neoplastic disease and in one case there was an intolerance to the drug which did not allow the treatment to be pursued.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1986

Massive hemoptysis.

Hemoptysis is usually a symptom of cardiopulmonary disease and is generally not in itself associated with death. A blood loss into the tracheobronchial tree of 600 ml in 24 hours or at a rate that poses a threat to life is referred to as massive hemoptysis. Hypervascularity within the bronchial circulation, usually associated with diffuse inflammatory disease of the lung, is common in patients with massive hemoptysis. Management should be directed at maintenance of oxygenation and localization of the source of bleeding. Temporizing maneuvers such as iced saline lavage, intravenous administration of vasopressin, endobronchial tamponade and bronchial artery embolization will often stabilize the patient in preparation for definitive surgery. Such a sequential plan of management may result in a 50% reduction in the rate of death from massive hemoptysis, which is otherwise 50% to 100%.

Bronchoscopy↗
PubMed1984

Evaluation of hemoptysis in patients with a normal chest roentgenogram.

Hemoptysis is a common presenting complaint in patients with pulmonary disease. Although controversial, many clinicians suggest that all patients with hemoptysis should be evaluated with bronchoscopy to exclude the presence of a serious pathologic condition. We reviewed records for an 18-month period, during which 113 patients had hemoptysis as their principal complaint. In all, 26 of the 113 patients had normal chest roentgenograms. All underwent bronchoscopy as part of their evaluations. Results of bronchoscopy in these patients neither altered therapeutic decisions nor led to diagnoses of specific pathologic processes. We conclude that close observation of patients with normal chest roentgenograms who have hemoptysis may be an acceptable clinical approach.

Hemoptysis↗
PubMed1982

Exsanguinating hemoptysis.

Massive hemoptysis (600 ml in 24 hours) results in a mortality of more than 50%. We have performed 74 pulmonary resections in patients with massive hemoptysis in the last 15 years, with a mortality of 13%. The mortality correlated with the rate and the amount of recorded blood loss before the operation. From this experience, we have identified a subgroup of patients with such massive hemoptysis that life was threatened by exsanguination. Twenty-four of our patients lost more than 1,000 ml of blood, at a rate of at least 150 ml an hour, before the pulmonary resection was performed. The bleeding site was always identified by bronchoscopy. All patients were treated by resection of the bleeding lung parenchyma. Several methods were used to avoid the patient's drowning in his own blood during the operation. In five patients, a double-lumen endotracheal tube was used: Two died of suffocation during the procedure and another died of respiratory and liver failure. In four patients, single-lung ventilation with an endotracheal tube in the left main bronchus was used: All four survived. In another 10 patients a bronchial blocker (No. 9 Fogarty balloon venous catheter) was used to stop bleeding. Two patients died of renal failure and gastrointestinal bleeding, respectively, but none had aspiration problems. In five additional patients, a regular endotracheal tube was used: One patient died of massive aspiration. Our experience indicates that bleeding from the left lung and right lower lobe should be controlled by intubation of the left bronchus. Patients with exsanguinating hemoptysis should be treated, when possible, by pulmonary resection. A survival rate of 75% was obtained in our patients.

Adolescent↗
PubMed1995

[A case of tuberculosis in which hemoptysis was caused by bleeding from intercostal arteries].

A 60-year-old man was referred to our hospital because of persistent hemoptysis. Chest roentgenogram and computed tomogram revealed that the right hemithorax was almost completely occupied by solid material with scattered calcifications. Mycobacteria were detected in the sputum culture. Administration of antituberculosis agents began after admission. Four months after admission, massive hemoptysis occurred. Topical treatment via fiberoptic bronchoscopy resulted in no improvement. Surgical resection of the right lung would probably have been difficult because of the almost complete collapse of the right lung and the extensive calcifications within the right hemithorax. Angiographic examination revealed extravasation of contrast medium from the right 7th, 8th, 9th, 10th, and 12th intercostal arteries. After transcatheter embolization of each of these intercostal arteries, hemoptysis stopped. It is unclear how bleeding from intercostal arteries caused massive hemoptysis, but the bleeding may have caused a right hemothorax that drained into an airway.

Embolization, Therapeutic↗
PubMed1995

[The use of fibrinogen-thrombin via endoscope in the treatment of massive hemoptysis].

We assessed the efficacy of fibrinogen-thrombin instillation through the fiberoptic bronchoscope to treat massive hemoptysis in patients to whom embolization of bronchial arteries was not available, was contraindicated or had failed. The fibrinogen-thrombin solution used was Tissucol, which in addition to 2% fibrinogen and 4 U/ml of thrombin, also contained factor XIII an aprotinin. The fibrinogen-thrombin solution was instilled with the aid of the Duplojec system and a 70 cm x 2 mm 4-way catheter. In 53 of the 628 fiberoptic bronchoscopies performed during the study, the indication was hemoptysis > or = 150 ml/12 h. Of these, bronchoscopic instillation of fibrinogen-thrombin was indicated in 5 cases because bronchial artery embolization was impossible. The point of bleeding was located by bronchoscopy in all cases and fibrinogen-thrombin instillation controlled hemoptysis immediately and throughout the follow-up period, which ranged 4 to 10 months. Morning expectoration of blood (< 10 ml) was observed in only 1 patient in the 3 days after treatment. The mean time taken for bronchoscopic exploration was 3 minutes (range, 2-7). In all cases fiberoptic bronchoscopy was performed without complications that might have required the procedure to be suspended. We conclude that the local use of fibrinogen-thrombin or fibrin glue instilled through the fiberoptic bronchoscope to the point of bleeding is a simple, fast and cheap way to control massive hemoptysis on a short and long-term basis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1997

[Massive hemoptysis in a patient with a tuberculous thoracic aneurysm].

A 91-year-old man with a history of pulmonary tuberculosis 20 years earlier came to our hospital because of hemoptysis in May 1993. A chest X-ray film showed infiltrative shadows in the left first arch of the cardiac silhouette, and sputum cultures were positive for Mycobacterium tuberculosis. Despite treatment with antituberculosis drugs, chest X-ray films revealed gradual progression, and he had occasional hemoptysis. He was admitted because of massive hemoptysis in December 1993 and a computed tomogram of the chest revealed an aneurysm of the descending aorta. Sudden and massive hemoptysis occurred in January 1994. At autopsy, the wall of the aneurysm and the surrounding tissue were found to have histological changes characteristic of tuberculosis. Tuberculous thoracic aneurysms are quite rare, but may develop in patients with tuberculosis in other areas.

Aged↗
PubMed1996

Fatal Hemoptysis during Coronary Thrombolysis.

Cerebral hemorrhage is the most dreaded complication of coronary thrombolysis. Significant bleeding has also been described from catheter-entry sites, the retroperitoneum, and the gastrointestinal and genitourinary tracts. However, hemoptysis induced by thrombolysis has rarely been described in the literature. We present a 66-year-old male who received front-loaded tissue plasminogen activator (tPA) for acute transmural anterior wall myocardial infarction and developed massive hemoptysis from preexisting cavitary lung disease. The patient died within 5 hours. We believe this is the first case report of fatal hemoptysis induced by coronary thrombolysis. A history of cavitary lung disease may be a risk factor for life-threatening hemoptysis in patients receiving thrombolytic therapy.

Journal Article↗
PubMed1996

Treatment of recurrent hemoptysis in a child with cystic fibrosis by repeated bronchial artery embolizations and long-term tranexamic acid.

The course of a 12-year-old girl with cystic fibrosis (CF) and with recurrent hemoptysis since age 8 years is described. Conservative measures failed to control her bleeding. Hemoptysis was only partially controlled by repeated bronchial arterial embolizations. However, the addition of tranexamic acid (TXA) resulted in complete cessation of bleeding. Attempts to withdraw TXA therapy resulted in recurrence of hemoptysis; this patient has, therefore, been continuously maintained on this therapy for the past 4 years. No side effects of long-term TXA treatment have been noted.

Antifibrinolytic Agents↗
PubMed1980

Hemoptysis, recurrent cerebrovascular accident, and emergency mitral valve replacement.

Hemoptysis in mitral stenosis may occur frequently, but massive pulmonary hemorrhage is uncommon. We describe a patient with mitral stenosis who had severe hemoptysis and required anticoagulation for recurrent embolic cerebrovascular accidents. The patient underwent successful mitral valve replacement with a Hancock bioprosthesis. There was no evidence of pulmonary bleeding following operation. This case illustrated that mitral valve operation may be performed in acutely ill patients for the relief of hemoptysis.

Adult↗
PubMed2002

Laryngeal hirudiniasis: an unusual cause of airway obstruction and hemoptysis.

Cases of childhood hemoptysis are rare and usually result from foreign body aspiration or congenital heart or lung diseases. However, human hirudiniasis due to the leech still exists, and could involve the upper airways after drinking infested water from quiet streams and pools. We report the case of a 6-year-old child who presented suffocating at the emergency room after having been misdiagnosed and treated for asthma over a 1-month period. His mother reported he had had recurrent hemoptysis, as well. The child inadvertently drank leech-infested water in a rural area of northern Syria. Surgical removal of the leech resulted in prompt resolution of the symptoms. Although laryngeal hirudiniasis is rare in the developed world, it remains a possible cause of childhood airway obstruction, hemoptysis, and anemia which needs to be considered in patients with a suggestive history.

Airway Obstruction↗
PubMed2002

Cor triatriatum: a cause of hemoptysis.

Hemoptysis can be caused by either pulmonary or extrapulmonary causes. Congenital heart disease should be considered as a possible cause in patients who have no obvious evidence of pulmonary disease. We report on an 8-year-old girl who presented with recurrent hemoptysis without other cardiopulmonary signs, except for mild tachypnea and a prominent pulmonic component of the second heart sound, suggesting pulmonary hypertension. A chest X-ray revealed pulmonary venous congestion without other parenchymal disease. An echocardiogram revealed classical cor triatriatum, with a 6-mm orifice in the anomalous septum. Cardiac evaluation should be considered in patients with hemoptysis unexplained by pulmonary causes, even in the absence of overt cardiac symptoms.

Child↗
PubMed2004

Severe hemoptysis from dilated systemic aberrant arteries supplying normal lung segments.

Hemoptysis is an uncommon presentation in children. It can be caused by several systemic and pulmonary disorders. Bleeding from an anomalous arterial supply to normal lung segments with no underlying pulmonary or cardiovascular disorders was widely reported in adults but is extremely rare in the pediatric age group. Here we describe 4 previously normal children and one girl with chronic lung disease, secondary to bronchopumonary dysplasia, with acute and significant hemoptysis of variable severity. Extensive clinical and laboratory investigations did not identify any reasonable causes for their symptoms. Cardiac catheterization showed dilated anomalous systemic arteries that supplied a pulmonary arteriovenous malformation in one case and normal basal lung segments in the other 4 cases. Embolization of the anomalous arterial collaterals led to occlusion of these arteries and the cessation of further hemoptysis.

Adolescent↗
PubMedDate not supplied

Bronchial artery embolization for hemoptysis: immediate and long-term results.

The purpose of this study was to evaluate the immediate and long-term results in 63 patients who underwent transarterial embolization for control of hemoptysis. Overall immediate success rate was 86.1%. At long-term follow-up 50% of patients showed complete remission, 22% partial remission, and 28% recurrent hemoptysis. Hemoptysis remained controlled for a mean of 22 months and a median of 14 months. The long-term results among four disease groups differed substantially. Patients with bronchiectasis showed the best results, followed by those with idiopathic disease and with inflammation; patients with neoplasm showed the worst results.

Adult↗
PubMed2003

Massive hemoptysis due to Rasmussen aneurysm: detection with helicoidal CT angiography and successful steel coil embolization.

OBJECTIVE: To present the successful management of two cases of massive hemoptysis related to pulmonary aneurysms in patients with active tuberculosis. DESIGN AND SETTING: Retrospective study in the respiratory intensive care unit (ICU) of a university hospital. PATIENTS: Between July 1996 and January 2002, 46 cases of hemoptysis related to active tuberculosis needed ICU admission. In two cases, pulmonary aneurysm was the source of bleeding. RESULTS: Diagnosis was suspected on enhanced CT scan and confirmed by pulmonary angiograms. Transcatheter occlusion of pulmonary arterial circulation was successful. Both patients were alive at 1-year follow-up. CONCLUSIONS: Massive hemoptysis occurring in patients with active tuberculosis could arise from pulmonary aneurysms. In such cases, bronchial artery embolization is ineffective. Before referring those patients for emergency surgery, an alternative strategy using angiographic study and transcatheter occlusion of pulmonary arterial circulation might be of interest.

Adult↗
PubMedDate not supplied

Bronchial artery embolization for life-threatening hemoptysis using tris-acryl microspheres: short-term result.

A prospective study of 70 patients with life-threatening hemoptysis who had bronchial and systemic artery embolization with tris-acryl linked microspheres was performed over 15 months. The procedure was technically successful in 90% of patients and at 24 hr after the procedure (87%). Recurrent hemoptysis occurred in 13% of patients within the first week. Chest pain was experienced following embolization in 7% of patients. The mortality was 10% due to the inclusion of patients with pulmonary metastases. Bronchial artery embolization using microspheres is an effective and well-tolerated treatment for patients with life-threatening hemoptysis who are not surgical candidates.

Acrylic Resins↗
PubMedDate not supplied

Pulmonary angiography and embolization for severe hemoptysis due to cavitary pulmonary tuberculosis.

PURPOSE: To identify the role of pulmonary angiography in the diagnosis and treatment of severe hemoptysis due to cavitary pulmonary tuberculosis. METHODS: Selective pulmonary angiography was performed on eight patients with severe hemoptysis uncontrolled by previous bronchial and systemic arterial embolization. RESULTS: Three (38%) patients had Rasmussen aneurysms, which were successfully embolized with steel coils. Five patients demonstrated pulmonary arterial hypoperfusion in the diseased lung. CONCLUSIONS: We recommend pulmonary angiography in cavitary tuberculous patients with severe hemoptysis who do not respond to systemic arterial embolization. Rasmussen aneurysms are effectively treated by steel coil occlusion.

Adult↗