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At least 217 records · Page 12Linked to original sources
PubMed1997

Detecting lung cancer as a cause of hemoptysis in patients with a normal chest radiograph: bronchoscopy vs CT.

OBJECTIVE: To determine whether fiberoptic bronchoscopy (FOB) or CT results in the lowest number of tests needed to diagnose (NTND) lung cancers in patients presenting with hemoptysis and a normal chest radiograph (CXR). DESIGN: Calculation of the NTND in a hypothetical cohort of patients presenting with hemoptysis and a normal CXR. INTERVENTIONS: In the primary analysis, either FOB or CT is performed to detect lung cancers. FOB is used to diagnose endobronchial abnormalities, and transthoracic needle aspirate is relied on to diagnose parenchymal findings. Patients then undergo serial follow-up CXRs. In a secondary analysis, sputum cytologic tests are performed prior to FOB and CT. Abnormal cytologic results require FOB. Unremarkable cytologic results allow a choice between FOB or CT. MEASUREMENTS: NTND and number of lung cancers detected during serial follow-up CXRs. RESULTS: Performing FOB results in a much lower NTND than CT with a similar number of lung cancers detected during serial follow-up with each approach. Reducing the false-positive rate for lung cancers of airway evaluations by CT reduces the NTND for the CT strategy. Performing both FOB and CT results in a large NTND. Adding sputum cytology as a guide for performing FOB substantially reduces the NTND for the FOB approach. CONCLUSION: A strategy relying on initial sputum cytologic testing as a screen for choosing either FOB as an immediate diagnostic step or serial follow-up CXR to detect lung cancer in patients presenting with hemoptysis and a normal CXR results in the lowest NTND with only a marginal reduction in the early detection of all cancers.

Bronchoscopy↗
PubMed2001

Video-assisted thoracoscopic surgery for catamenial hemoptysis.

Catamenial hemoptysis is a rare condition, and only 36 cases have been reported since the first published case. We describe a woman with catamenial hemoptysis recurring over 8 years. The lesion was diagnosed using chest CT scan during menses and was also visualized clearly via thoracoscopy. The patient was treated successfully with a partial resection of the lung using video-assisted thoracic surgery (VATS) and has been asymptomatic for 14 months since the operation. We suggest that VATS for catamenial hemoptysis is a more effective treatment than medical therapy.

Adult↗
PubMed2002

Bronchial artery embolization for the management of nonmassive hemoptysis in cystic fibrosis.

STUDY OBJECTIVES: Hemoptysis is a common complication in patients with cystic fibrosis (CF). Current approaches to patients with hemoptysis include conservative medical therapy, bronchial artery embolization (BAE), and surgery. We investigated the effectiveness of early BAE on the outcome in patients with minor bleeding. DESIGN, PATIENTS, AND INTERVENTIONS: We reviewed the clinical records from the Cystic Fibrosis Service for eight consecutive patients treated with medical therapy who had undergone early BAE and eight matched patients treated with conservative medical therapy alone. MEASUREMENTS: We assessed the mean number of bleeding episodes, pulmonary exacerbations, lung function (FEV(1)), Shwachman score, and Nottingham Health Profile (NHP) scores, the year before BAE and for the 3 ensuing years. RESULTS: During a 3-year follow-up, patients who underwent embolization had significantly fewer bleeding episodes (p < 0.001) and pulmonary exacerbations (p < 0.006). Lung function declined significantly in both groups (p < 0.001). The modified Shwachman score declined significantly during the follow-up only in patients who did not undergo embolization (p < 0.001). Patients treated by early embolization had significantly better NHP scores, indicating a better quality of life (p < 0.05). None of the patients who underwent BAE had adverse reactions. CONCLUSIONS: Early BAE in patients with CF who have nonmassive hemoptysis is an effective, safe therapeutic approach offering better long-term control of recurrent bleeding and quality of life than medical therapy alone.

Bronchial Arteries↗
PubMed1979

Hemoptysis in patients with septic pulmonary infarcts from tricuspid endocarditis.

Three drug addicts with tricuspid valve endocarditis and pulmonary cavitation secondary to septic pulmonary infarcts developed massive hemoptysis. Two patients died of asphyxia and one survived. Both who died were improving clinically and had negative blood cultures when the fatal hemoptysis occurred. Therefore, however slight it may be, hemoptysis occurring in association with septic pulmonary infarcts associated with endocarditis may require prompt and aggressive measures.

Adult↗
PubMed1979

Palliation of massive hemoptysis from unresectable carcinoma of the lung.

Unresectable carcinoma of the lung has traditionally been recognized as a contraindication to surgery in massive hemoptysis. A 60-year-old man had massive hemoptysis. At surgery an unresectable neoplastic mass invading the mediastinum and great vessels was encountered. Subtotal resection was accomplished using a stapler (Autostapler). The margins of the bronchial and vascular staples were of necessity placed directly through the tumor. The patient had an uneventful recovery and has survived six months without further hemoptysis. This method is presented as an effective strategic retreat under circumstances not permitting definitive therapy.

Hemoptysis↗
PubMed1987

Computed chest tomography in the evaluation of hemoptysis. Impact on diagnosis and treatment.

The results of computed chest tomograms (CT) and chest roentgenograms (CR) were compared in 32 patients who presented with hemoptysis. The CT demonstrated roentgenographic abnormalities more often than CR (p less than 0.01), providing new diagnostic information in 15 patients (46.9 percent), and clarifying CR abnormalities in five (15.6 percent) others. In addition, CT correctly localized sources of bleeding in 23 (88.5 percent) of the 26 patients in whom a site was identified at bronchoscopy, while CR localization was correct in 17 (65.4 percent) (p less than 0.05). Despite this augmentation of roentgenographic yield, information derived from CT scans influenced the management of only six patients, did not obviate the need for bronchoscopy, and supplemented the combined diagnostic yield of CR and bronchoscopy in only two. Outcome was changed in one patient in whom CT had demonstrated an otherwise unrecognized malignant solitary pulmonary nodule. The chest roentgenogram and fiberoptic bronchoscopy provided all the information essential for diagnosis and therapeutic recommendations in 93.7 percent of these patients. Although the CT provided additional information in over one half of our patients, its overall impact on clinical management was small and does not support routine use of this imaging procedure in evaluation of hemoptysis. The possible role of chest CT in evaluating carefully selected patients with hemoptysis requires further study.

Bronchitis↗
PubMed1988

Severe hemoptysis associated with pulmonary aspergilloma. Percutaneous intracavitary treatment.

Surgical therapy for massive hemoptysis associated with pulmonary aspergilloma carries a high morbidity and mortality in patients with limited pulmonary reserve. Bronchial artery embolization has proven ineffective in treating and in preventing recurrent episodes of hemoptysis in this group of patients. Over a four-and-one-half year period, we have successfully treated six episodes of acute hemoptysis in four patients using a percutaneously placed catheter and intracavitary instillation of amphotericin B, N-acetylcysteine, and aminocaproic acid. Advantages of this method of treatment for patients with severely compromised pulmonary reserve include: (1) no further loss of lung function; (2) ease and rapidity of catheter insertion; (3) prompt response to treatment; (4) relatively short hospitalization; and (5) ability to repeat the procedure in the same or another cavity if necessary.

Acetylcysteine↗
PubMed1989

Bronchoscopy to evaluate hemoptysis in older men with nonsuspicious chest roentgenograms.

Six of 106 older men with hemoptysis and a nonsuspicious chest roentgenogram who underwent fiberoptic bronchoscopy were found to have cancer. Four of the five bronchogenic carcinomas appeared to be surgically resectable. Cancer patients were significantly older, had smoked within the last five years, and had a significantly higher frequency of central abnormalities on chest roentgenogram. Six additional bronchogenic carcinomas were diagnosed at follow-up. Two of these were probably present but not detected at the time of bronchoscopy. We conclude that (1) hemoptysis with a nonsuspicious chest roentgenogram carries an appreciable risk of cancer in older men with substantial smoking histories, (2) these cancers are often resectable, (3) a chest roentgenogram in which the central lung fields are obscured in any way should not be considered negative in patients with hemoptysis, and (4) a negative bronchoscopic examination does not exclude the possibility of cancer in these patients.

Aged↗
PubMed1990

Hemoptysis: clinicians' perspectives.

Clinicians who were interested and considerably experienced in assessing patients with hemoptysis were surveyed during a computer-assisted interactive presentation at the 1988 ACCP Annual Scientific Assembly. The approach to ambulatory patients with minor bleeding was consistent with recently published guidelines: fiberoptic bronchoscopy has a central role, with a less apparent impact of other new technologies. Although specific diagnostic results were significantly more useful (p less than 0.01), even nonspecific bronchoscopy findings were though to have clinical value. External factors such as medicolegal concerns and obligations to provide service were acknowledged to influence selection of patients for bronchoscopy, and community-based clinicians cited such effects more often than academicians (p less than 0.02). Approaches to patients with massive hemoptysis reflected caution essential to acute management. Bronchoscopy was performed earlier (p less than 0.01) than in patients with minor bleeding, but opinions differed regarding instrument selection, the best method of airway support, and the roles of interventional angiography. This survey suggests that real-world settings are addressed incompletely by published experiences accumulated in tertiary centers. Clarification of optimum approaches to patients with hemoptysis requires further input from practicing clinicians.

Ambulatory Care↗
PubMed1990

Transcatheter bronchial artery embolization in the multimodality management of massive hemoptysis.

To illustrate the potential role of transcatheter bronchial artery embolization (TBAE) in the multimodality management of massive hemoptysis, we describe a case in which TBAE was successfully employed as the definitive therapy. In recent years, the technique of TBAE has joined the armamentarium of managing methods for massive hemoptysis. While massive hemoptysis has traditionally been defined in terms of the volume of blood produced within a period of time, with a rate of 600 ml in 24 hours the most commonly used definition, a more functional definition has been proposed: bleeding into the tracheobronchial tree at a rate that poses a threat to life. It is the life-threatening nature of this symptom that often results in the early involvement of thoracic surgeons in the care of these patients.

Bronchial Arteries↗
PubMed1991

Pathologic bronchial vasculature in a case of massive hemoptysis due to chronic bronchitis.

The cause of bleeding in a patient with recurrent massive hemoptysis was not apparent after bronchoscopy and gross examination of the lobectomy specimen. Histologic submission of all major bronchi uncovered dilated, tortuous bronchial arteries just below the bronchial mucosa with sites of both current and healing arterial rupture. This bronchial arterial abnormality is common to several chronic pulmonary diseases, but is rarely diagnosed as a cause of massive hemoptysis. Careful pathologic examination of major bronchi in the setting of hemoptysis of unknown causation is recommended.

Aged↗
PubMed1983

Bronchial artery occlusion for severe hemoptysis: use of isobutyl-2 cyanoacrylate.

Isobutyl-2 cyanoacrylate (IBC) was used to embolize the bronchial arteries of 14 patients with severe hemoptysis. The site of bleeding was supplied by a bronchial artery from the aorta in 11 cases and from a right bronchointercostal trunk in three. IBC was injected after previous reduction of the blood flow in the artery by embolization with particles of dura mater. In all cases, bleeding stopped immediately after occlusion and no spinal cord complications were observed. The results indicate that IBC may be a valuable occluding agent in severe hemoptysis, since it produced virtually permanent occlusion of both the distal and proximal parts of the artery. In 13 patients, bleeding did not recur throughout follow-up periods of 2-17 months. In one patient, it recurred 12 months after embolization but stopped after occlusion of another bronchial artery with IBC. It should be noted, however, that immediately after embolization, five patients experienced violent transient retrosternal burning, and one patient experienced dysphagia and fever for 2 days. Since mediastinal ischemia cannot always be avoided, this procedure must be reserved for cases of severe hemoptysis for which surgical treatment is contraindicated.

Adult↗
PubMed1984

Massive hemoptysis of pulmonary arterial origin: diagnosis and treatment.

Among 189 patients treated for massive or repeated hemoptysis by transcatheter techniques between 1973 and 1983, a prospective study was attempted between 1979 and 1983 (72 patients) to search for bleeding of pulmonary arterial origin. Among these 72 patients, six were treated by surgical (one) or angiographic (five) occlusion of segmental pulmonary arteries. Pulmonary erosive pseudoaneurysms were seen in five cases (one with intracavitary aspergilloma, two with cavitary tuberculosis, and two with pyogenic abscesses). Among these six cases, one patient died from massive hemoptysis, one from unknown causes, and four are still alive. They are compared with five other patients who died from massive hemoptysis among 117 patients treated only by embolization of their systemic arteries between 1973 and 1979 (one with cavitary tuberculosis, two with intracavitary aspergillomas, one with an abscess of the lung, and one with a necrotic hilar cancer). A pulmonary arterial source of bleeding should be considered in addition to systemic arterial sources in the setting of destructive lung disease.

Aged↗
PubMed2001

Utility of fiberoptic bronchoscopy before bronchial artery embolization for massive hemoptysis.

OBJECTIVE: We wanted to investigate the utility of performing fiberoptic bronchoscopy before bronchial artery embolization in patients with massive hemoptysis. MATERIALS AND METHODS: We retrospectively reviewed the cases of all patients with hemoptysis who had presented at either of two local hospitals, one county hospital and one community hospital, between 1988 and 2000 and who had undergone fiberoptic bronchoscopy before bronchial arteriography. All data were abstracted using a standardized coding form, and radiographs were independently reviewed by two of the authors. RESULTS: Twenty-nine patients meeting the inclusion criteria were identified; one patient was excluded because of missing radiographs. The remaining 28 patients consisted of 19 men and nine women, with an average age of 54.6 years (age range, 16-91 years). The clinically determined diagnoses of their symptoms were tuberculous bronchiectasis (n = 14; 50.0%); bronchogenic carcinoma (n = 4; 14.3%); active tuberculosis (n = 2; 7.1%); nontuberculous bronchiectasis (n = 2; 7.1%); active coccidioidomycosis, pancreaticobronchial fistula, arteriovenous malformation, and tetralogy of fallot (n =1 each; 3.6% each); and unknown cause (n = 2; 7.1%). The bleeding site determined through bronchoscopy was consistent with that determined through radiographs in 23 patients (82.1%); all had either unilateral disease (n = 15), bilateral disease with unilateral cavities (n = 5), or a preponderance of disease on one side (n = 3). Bronchoscopy was an essential tool in determining the bleeding site in only three patients (10.7%), all of whom had bronchiectasis without localizing features visible on chest radiographs. In the remaining two patients (7.1%), bronchoscopic findings were indeterminate, but radiographs were helpful. CONCLUSION: Fiberoptic bronchoscopy before bronchial artery embolization is unnecessary in patients with hemoptysis of known causation if the site of bleeding can be determined from radiographs and no bronchoscopic airways management is needed.

Adolescent↗
PubMed2002

Can CT replace bronchoscopy in the detection of the site and cause of bleeding in patients with large or massive hemoptysis?

OBJECTIVE: We assessed the capacity of chest radiography and CT to determine the cause and site of bleeding in patients with either large or massive hemoptysis compared with bronchoscopy. MATERIALS AND METHODS: We reviewed the chest radiographs, CT scans, and bronchoscopic findings in 80 patients with either large or massive hemoptysis who were admitted to our intensive care unit between January 1995 and June 1999. RESULTS: Findings on chest radiography were normal in only 13% of patients, of whom 70% had bronchiectasis. The chest radiographs revealed the site of bleeding in 46% of the patients and the cause in 35%, most of whom had tuberculosis or tumors. CT was more efficient than bronchoscopy for identifying the cause of bleeding (77% vs 8%, respectively; p < 0.001), whereas the two methods were comparable for identifying the site of bleeding (70% vs 73%, respectively; p = not significant). CONCLUSION: These data suggest that CT could replace bronchoscopy as the first-line procedure for screening patients with large and those with massive hemoptysis. However, these results must be confirmed in a prospective multicenter study.

Adult↗
PubMed2005

Peripheral pulmonary artery pseudoaneurysms and massive hemoptysis.

OBJECTIVE: The aim of this study was to determine the incidence and etiology of pulmonary artery pseudoaneurysms in patients undergoing bronchial angiography for massive hemoptysis and to assess patient outcome after the embolization of these pseudoaneurysms. CONCLUSION: Peripheral pulmonary artery pseudoaneurysms occur in up to 11% of patients undergoing bronchial angiography for hemoptysis. These are often most easily appreciated on bronchial and/or nonbronchial systemic arterial angiograms because of complete reversal of flow in pulmonary artery branches in the diseased lung. Embolization of bronchial and nonbronchial systemic arteries alone may not be sufficient therapy to control hemoptysis, and occlusion of the pseudoaneurysm itself via a pulmonary artery approach is recommended.

Adolescent↗
PubMed2000

[Right tracheal bronchus with anomalous ramification of the bronchial artery disclosed during an episode of hemoptysis].

A 63-year-old woman was referred to our hospital on June 18th, 1998 during an episode of hemoptysis that had lasted for 6 days. She had no hemorrhagic diathesis and no history of pulmonary disease. Chest X-ray films disclosed a ground-glass opacity in the right upper lung field. Bronchoscopic examination revealed bleeding from an anomalous ectopic orifice on the right lateral trachea, about 1 cm above the carina. Chest computed tomographic examinations by conventional and spiral methods readily disclosed an ectopic bronchus. Bronchial arteriography showed that the tracheal bronchus was fed by a branched vessel of the thyrocervical artery arising from the brachiocephalic artery. Atypical mycobacterium was detected in bronchoalveolar lavage fluid from the ectopic bronchus. A shunt had formed with the pulmonary artery and peripheral parts of the bronchial artery that fed the tracheal bronchus. It was speculated that the hemoptysis in this case might be due to the combined phenomena of infection and abnormal vessel formation in the tracheal bronchus. In our patient, the system of blood supply to the tracheal bronchus may have been a manifestation of atavism because it closely resembled the circulatory structure of the tracheal bronchi normally observed in sheep and giraffes. The tracheal bronchus should be taken into consideration as a potential cause of hemoptysis, inflammatory changes, and atelectasis during intubation.

Bronchi↗
PubMed2000

[Usefulness of carcinoembryonic antigen and other markers in patients with hemoptysis].

OBJECTIVE: We have examined the carcinoembryonic antigen (CEA) and other tumor markers (immunoglobulins, CA 19.9, LDH, alpha-fetoprotein and alpha-1-antitrypsin) with the purpose of recognize their utility in patients with hemoptysis and patients older than 45 years with a positive smoking history and hemoptysis. METHODS: We measured, analyzed and compared these markers in 336 patients with a known etiology of hemoptysis divided in group I (malignant etiology) with 101 cases (30.1%) and II (nonmalignant) with 235 cases (69.9%) (p < 0.001). RESULTS AND CONCLUSIONS: The values of CEA, LDH and CA 19.9 were increased in group I, without differences when we compared immunoglobulins (G, A and M), alpha-fetoprotein and alpha-1-antitrypsin in both groups. CEA and LDH were increased significantly according to the disease extent in nonsmall cell lung carcinoma. Smokers had an increased CEA only in group II. Plasma values of CEA higher than 5 ng/mL meant that the likelihood of bronchial carcinoma was high. Our markers proved to be more specific and with a high positive or negative predictive values than sensitives. These results would suggest that they are not of great help for early diagnosis of lung cancer, however an increase of CEA, LDH and CA 19.9 plasma concentrations could suggest with high probability a bronchial carcinoma, improving their diagnostic sensibility when we used them in combination.

Aged↗