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PubMed1997

Hemoptysis: etiology, evaluation, and outcome in a tertiary referral hospital.

OBJECTIVES: Hemoptysis, an important and alarming symptom, often indicates serious disease. This study was designed to assess the different causes of hemoptysis, the relative importance of the different diagnostic modalities employed, and the outcome in an Israeli population cohort. DESIGN: A retrospective analysis of 208 patients with hemoptysis at the Hadassah University Hospital, Jerusalem, Israel between January 1980 and August 1995. RESULTS: Bronchiectasis (20%), lung cancer (19%), bronchitis (18%), and pneumonia (16%) accounted for most causes of hemoptysis. In contrast to older studies, active tuberculosis was a rare finding (1.4%). Bronchiectasis and bleeding diathesis were major causes of moderate to severe hemoptysis while bronchitis and lung cancer were commonly associated with milder degrees of bleeding. CT scan was the most sensitive diagnostic test when employed alone, with a positive yield of 67%. However, it failed to locate at least three cases of lung cancer. When combining a CT study together with a bronchoscopy, the positive yield increased to 93%. The mortality rate for patients with mild to moderate hemoptysis was low (2.5% and 6%, respectively), while patients with massive hemoptysis had high mortality rates (38%). Patients with lung cancer or bleeding diathesis had higher mortality rates compared with the rest of the cohort. CONCLUSIONS: Hemoptysis is a common symptom with a good prognosis in most cases. However, patients exhibiting massive bleeding or those with lung malignancy and patients with bleeding diathesis had a poorer prognosis. Patients older than 50 years with a positive smoking history need an extensive evaluation and follow-up to exclude lung carcinoma. The combined use of bronchoscopy and chest CT has the best yield in evaluating hemoptysis.

Bronchiectasis↗
PubMed2002

Percutaneous embolotherapy for life-threatening hemoptysis.

STUDY OBJECTIVES: The management of life-threatening hemoptysis frequently poses a therapeutic dilemma because such patients are often poor surgical risks. Less often, patients refuse surgical intervention. The value of percutaneous embolotherapy, a useful alternative in these situations, was assessed. DESIGN, SETTING, PATIENTS, INTERVENTIONS: Sixteen consecutive patients who underwent percutaneous embolotherapy for life-threatening hemoptysis in a tertiary-care hospital were evaluated retrospectively. The bronchial arteries, as well as other intrathoracic arteries, were evaluated and selectively embolized if they were considered to supply the pathologic area from which the hemoptysis arose. RESULTS: The most common cause for hemoptysis was posttuberculous bronchiectasis (n = 12) with or without mycetomas. Ten patients required blood transfusions before embolotherapy. Pleural disease was noted on the chest radiograph in 13 patients and was generally associated with the presence of nonbronchial systemic collateral vessels. In three patients, arteries other than the bronchial arteries were the only source of hemoptysis. Percutaneous embolotherapy was successful in controlling the hemoptysis in all patients. The only complication documented was a transient paraparesis in one patient. Six patients did not return for follow-up. Of the remaining 10 patients, 3 patients had minor episodes of hemoptysis that were treated conservatively with success. One patient had significant recurrent hemoptysis that was managed with radiotherapy. One patient subsequently underwent a lobectomy. CONCLUSION: Percutaneous embolotherapy is a useful therapeutic modality in the management of life-threatening hemoptysis. The contribution of nonbronchial systemic collateral vessels, particularly where there is evidence of coexistent pleural disease, should always be suspected. In experienced hands, this is a safe and potentially life-saving procedure.

Adult↗
PubMed1997

Hemoptysis: a 10-year retrospective study.

BACKGROUND: Hemoptysis is uncommon in pediatric practice. We reviewed 10 years of experience with hemoptysis in a tertiary pediatric hospital to identify patient characteristics and predictors of mortality. METHODS: Patients were divided into four age groups (0 to 5, 6 to 10, 11 to 20, and >20 years). Hemoptysis was defined as mild (<150 mL/day), large (150 to 400 mL/day), or massive (>400 mL/day). Fever was defined as >/=38.5 degrees C. RESULTS: A total of 228 patients (115 males and 113 females) with 246 episodes of hemoptysis were identified and grouped according to primary diagnosis. There were 149 patients in the cystic fibrosis (CF) group, 37 in the congenital heart disease (CHD) group, and 42 in the Other group. Age was significantly higher in the CF group compared with the CHD and Other groups. Length of stay was significantly prolonged in the CF group compared with the Other group. The overall mortality was 13%. After initial analysis, mortality predictors were age, amount of hemoptysis, receipt of blood products, and fever. After stratification, we found: 1) in the >20-year age group, there was a difference in mortality when comparing CF patients with CHD patients; 2) for patients who received blood products, there were differences in mortality in patients with CF, CHD, and Other diagnoses; 3) for patients who received blood, there were differences in mortality only for the 0- to 5-year age group; and 4) the amount of hemoptysis was predictive for mortality only in CHD patients. CONCLUSIONS: Hemoptysis presented in young adult CF patients and in adolescent CHD patients. Young adult CF patients with hemoptysis had a higher risk of mortality compared with young adult CHD patients. The amount of hemoptysis predicted mortality only for CHD patients. Receiving blood products was predictive of mortality for all patients.

Adolescent↗
PubMed1978

Hemoptysis and pulmonary aspergilloma: operative versus nonoperative treatment.

The clinical experience with 42 patients with pulmonary aspergilloma evaluated at the Vanderbilt University Affliated Hospitals in a 22-year period was reviewed to determine the necessity and advisability of pulmonary resection. Twenty-nine patients (69%) had sustained one or more episodes of gross hemoptysis. Eleven of the 42 patients were treated operatively with lobectomy, wedge resection, or cavernostomy. Five of them had had hemoptysis preoperatively, but in only 1 patient was massive hemoptysis the primary indication for operation. The single death among these 11 patients occurred in the patient undergoing operation for control of massive hemoptysis. Nonoperative treatment was selected in 31 patients because of advanced chronic lung disease. Twenty-four of these 31 patients experienced 41 episodes of gross hemoptysis during observation periods up to 8 years (average, 32 months). Superimposed bacterial infection usually accompanied the episodes of hemoptysis, and medical therapy with bedrest, antibiotics, and postural drainage was successful in controlling the hemorrhage in 40 of the 41 episodes. One patient died from massive hemoptysis. On the basis of this experience, pulmonary resection for aspergilloma in patients with hemoptysis seems rarely indicated.

Adult↗
PubMedDate not supplied

[Have the causes of hemoptysis changed? An analysis of 213 patients undergoing fiber bronchoscopic exploration].

For decades the most frequent causes of hemoptysis have been bronchiectasis, tuberculosis and bronchogenic carcinoma. A recent study, however, has shown that the etiology has changed, as the incidence of hemoptysis due to tuberculosis or bronchiectasis has decreased while that due to bronchitis has increased. To determine the causes of hemoptysis in patients who underwent fiberoptic bronchoscopy (FB). We conducted a retrospective analysis of clinical profiles and radiologic and FB findings for 213 patients who came to our hospital with hemoptysis between 1990 and 1994. The site of bleeding was located by FB in 139 (64%) patients and a conclusive diagnosis of the cause of hemoptysis was achieved in 170 (78%) cases. The main causes were chronic bronchitis in 64 (29%) patients, neoplasia in 61 (28%) and bronchiectasis in 22 (10%). Tuberculosis was responsible for hemoptysis in only 7 patients (3%). The incidences of the various causes of hemoptysis requiring FB for diagnosis have changed substantially in recent years. Chronic bronchitis and neoplasia are now the most frequent causes. Tuberculosis has become less important. Bronchiectasis, on the other hand, continues to cause of a significant number of cases of hemoptysis in our area.

Adolescent↗
PubMed2003

Pulmonary resection for massive hemoptysis of benign etiology.

OBJECTIVE: To assess the outcome of pulmonary resection in the management of massive hemoptysis caused by benign lung diseases. METHODS: A longitudinal cohort study of 53 consecutive patients who presented with hemoptysis and were treated with either emergency (group 1) or elective (group 2) pulmonary resection from January 1995 to December 1999. RESULTS: Fifty-three patients were studied, 27 in group 1 and 26 in group 2. The mean age of the patients was 47.2 years (range, 29-70 years). Urgent examination with a combination of rigid and flexible fiberoptic bronchoscope localized the bleeding site in 45 patients (85%). Age>50 years, hypertension, hemoglobin on admission<10 g/dl, cause of hemoptysis, and a prior attack of hemoptysis were the predictors for the need of emergency surgery. The overall hospital mortality rate was 4% (2/53). Postoperative complications occurred in 13 patients (25%). Complications were more common in patients who received blood transfusion than non-transfused patients (9/23 and 4/30, respectively; P=0.03). Patients with tuberculosis as the cause of massive hemoptysis had more complications 5/8 in comparison to all other patients (P=0.02). The mean follow-up was 4.5 years (range, 3-6 years) for all patients who survived. Hemoptysis recurred in four patients (8%) and all from group 1 (P=0.02). CONCLUSIONS: Immediate pulmonary resection for massive hemoptysis is effective in case of life-threatening bleeding that is not controlled by conservative measures. Elderly patients with a prior history of hemoptysis and/or hypertension and bleeding due to a fungus ball, necrotizing pneumonia, tuberculosis or lung abscess should be considered for early operation in an attempt to reduce morbidity and mortality.

Adult↗
PubMedDate not supplied

Prediction of recurrent hemoptysis with MDCT angiography.

OBJECTIVE: To identify the computed tomography (CT) findings to predict recurrent bleeding in patients with massive hemoptysis. METHODS: Fifty-eight patients with massive hemoptysis underwent both CT and conventional bronchial angiography for bronchial artery embolization. Retrospective analysis was done to analyze the statistical differences in the initial CT findings between the nonrecurrent and recurrent hemoptysis groups using the Mann-Whitney U test and the chi or Fisher exact test. Stepwise logistic regression analysis was used to find predictive variables for the recurrence of hemoptysis. RESULTS: After embolization, recurrence of hemoptysis was observed in 15 of 58 patients (26%). The diameter of bronchial (P = 0.001) and nonbronchial systemic arteries (P < 0.05), total number of dilated bronchial and nonbronchial systemic arteries (P = 0.001), pleural thickening (P = 0.01), extrapleural fat thickening (P = 0.004), and enhancing vascular structures within the extrapleural fat layer (P = 0.04) were significantly different in the nonrecurrent and recurrent hemoptysis groups. Stepwise logistic regression analysis showed that the total number of dilated bronchial and nonbronchial systemic arteries (odds ratio, 3.540; 95% confidence interval: 1.175, 10.662; P = 0.025) was a significant CT variable associated with the recurrence of hemoptysis. CONCLUSIONS: CT bronchial angiography may help in the prediction of recurrent bleeding in patients with massive hemoptysis.

Adult↗
PubMedDate not supplied

Bronchial and nonbronchial systemic artery embolization for life-threatening hemoptysis: a comprehensive review.

Massive hemoptysis is one of the most dreaded of all respiratory emergencies and can have a variety of underlying causes. In 90% of cases, the source of massive hemoptysis is the bronchial circulation. Diagnostic studies for massive hemoptysis include radiography, bronchoscopy, and computed tomography (CT) of the chest. Bronchoscopy and chest radiography have been considered the primary methods for the diagnosis and localization of hemoptysis. Many researchers currently suggest that CT should be performed prior to bronchoscopy in all cases of massive hemoptysis. Bronchial artery embolization (BAE) is a safe and effective nonsurgical treatment for patients with massive hemoptysis. However, nonbronchial systemic arteries can be a significant source of massive hemoptysis and a cause of recurrence after successful BAE. Knowledge of the bronchial artery anatomy, together with an understanding of the pathophysiologic features of massive hemoptysis, are essential for planning and performing BAE in affected patients. In addition, interventional radiologists should be familiar with the techniques, results, and possible complications of BAE and with the characteristics of the various embolic agents used in the procedure.

Bronchial Arteries↗
PubMed2000

Prognosis of bronchial artery embolization in the management of hemoptysis.

BACKGROUND: Bronchial artery embolization (BAE) is a well-accepted and widely used treatment modality for the management of massive and recurrent hemoptysis. However, few reports have previously investigated the long-term results. OBJECTIVES: To investigate the prognosis of patients with hemoptysis who had undergone BAE. METHODS: Twenty-two patients with hemoptysis underwent BAE. The underlying diseases included bronchiectasis in 9, aspergillosis in 3, chronic bronchitis in 2, idiopathic bronchial bleeding in 4, and other diseases in 4. The follow-up period ranged from 25 to 88 months (median 47 months). RESULTS: After the initial BAE, 11 of 22 (50%) patients had re-bleeding (5 patients with hemoptysis and 6 patients with minor hemosputa). Among them, 1 patient suffered from recurrent massive hemoptysis and died from airway obstruction within 1 month after BAE. In addition, 10 of these 11 (90.9%) patients experienced recurrent airway bleeding within 3 years after BAE. Recurrent cases of hemoptysis were seen in 6 of 22 patients (27.3%) within 3 years and no case recurred later than 3 years after BAE. A recurrence of hemoptysis was frequently seen in patients with either bronchiectasis or pulmonary-bronchial artery (P-B) shunt. Although BAE is an effective treatment for the immediate control of hemoptysis, 5 of the patients experienced recurrent bleeding in the long-term follow-up. CONCLUSIONS: It is important to follow-up such patients until 3 years after initial BAE, especially when either ectatic changes of the bronchi on a CT scan or a P-B shunt on angiographic findings are detected.

Adult↗
PubMed2006

A prospective analysis of 184 hemoptysis cases: diagnostic impact of chest X-ray, computed tomography, bronchoscopy.

BACKGROUND: The clinical presentation of hemoptysis often raises a number of diagnostic possibilities. OBJECTIVES: This study was designed to evaluate the relative frequency of different causes of hemoptysis and the value of chest radiography, computed tomography (CT) scanning and fiber-optic bronchoscopy in the evaluation of a Greek cohort population. METHODS: We prospectively followed a total of 184 consecutive patients (137 males/47 females, 145 smokers/39 nonsmokers) admitted with hemoptysis between January 2001 and December 2003 to the University Hospital of Heraklion. Follow-up data were collected on August 2005. RESULTS: The main causes of hemoptysis were bronchiectasis (26%), chronic bronchitis (23%), acute bronchitis (15%) and lung cancer (13%). Bronchiectasis was significantly more frequent in nonsmokers (p < 0.02). Among nonsmokers, patients with moderate/severe bleeding or a history of tuberculosis were more likely to have bronchiectasis (OR 8.25; 95% CI 1.9-35.9, p = 0.007 and OR 16.5; 95% CI 1.7-159.1, p = 0.007, respectively). Nonsmokers with normal or abnormal X-rays were equally likely to have bronchiectasis (OR 2.5; 95% CI 0.66-9.39, p = 0.2). Lung cancer was only found in smokers. Smokers with normal X-rays were less likely to have lung cancer compared to smokers with abnormal X-ray (OR 5.4; 95% CI 1.54-19.34, p = 0.004). There were no smokers with normal CT and lung cancer. Follow-up data were collected in 91% of patients. Lung cancer did not develop in any patient assumed to have hemoptysis of another origin than lung cancer on initial evaluation. CONCLUSIONS: Bronchiectasis is the main diagnosis in patients admitted with hemoptysis to a Greek University Hospital and it is more frequent among nonsmokers with moderate/severe bleeding and/or previous tuberculosis infection. Nonsmokers with moderate/severe hemoptysis and/or a history of tuberculosis should be evaluated with high-resolution CT. Smokers with hemoptysis are at increased risk for lung cancer and need to be extensively evaluated with chest CT and bronchoscopy.

Aged↗
PubMed1998

Bronchial artery embolization for the treatment of hemoptysis in patients with cystic fibrosis.

Hemoptysis is common in patients with cystic fibrosis (CF). Bleeding may vary in severity, ranging from minor blood-streaking of sputum to expectoration of significant quantities of blood. Major hemoptysis, defined as bleeding greater than 240 ml/24 h, represents a medical emergency. Bronchial artery embolization (BAE) is one of the treatment options for hemoptysis. We reviewed the 10-yr experience at the University of North Carolina Hospitals in the treatment of hemoptysis by BAE. Eighteen patients with CF were hospitalized on 29 occasions and underwent 36 BAE procedures for the control of hemoptysis. Most patients (n = 11) had very severe lung disease (FEV1 < 35%) with a high incidence (n = 9, 50%) of multi-drug-resistant bacteria. Fifteen patients (n = 33 procedures) were followed for a mean of approximately 22 mo after BAE. The overall efficacy of BAE for initial control of hemoptysis was 75% (n = 22) after one session, 89% (n = 26) after two sessions, and 93% (n = 27) after three sessions. The overall recurrence rate per episode was 46% (12/26 presentations in four patients) with a mean time for recurrence of approximately 12 mo. There was a high incidence (75%) of bleeding from nonbronchial systemic collateral vessels among patients (n = 7) who had undergone a previous BAE. There were two deaths associated with massive hemoptysis despite BAE. Three patients had transient neurologic deficits during BAE. We concluded that BAE is a relatively safe and effective means of treating significant hemoptysis in patients with CF.

Adolescent↗
PubMed1999

Immediate and long-term results of bronchial artery embolization for life-threatening hemoptysis.

STUDY OBJECTIVES: Bronchial artery embolization (BAE) has been established as an effective technique in the emergency treatment of life-threatening hemoptysis, but few data concerning long-term results and complications of the procedure are available. The aim of this study was to analyze retrospectively the experience of BAE in our center with particular emphasis on medium-term and long-term results and on morbidity. SETTING: University hospital. PATIENTS: Fifty-six patients underwent bronchial arteriography from 1986 to 1996 in our center for the management of life-threatening hemoptysis. Of them, BAE was performed in 46 patients. Their mean age was 51 years (range, 19 to 89 years). The most frequent etiologies of hemoptysis were active or inactive tuberculosis, bronchiectasis, or idiopathic hemoptysis. RESULTS: BAE resulted in an immediate cessation of hemoptysis in 43 of the initial 56 patients (77%). During the first month after BAE, four patients who died from causes other than hemoptysis or who were referred to surgery were excluded from follow-up and in the 39 remaining patients, a complete cessation of hemoptysis was observed in 32 patients. A remission was noted in 28 of the 29 patients followed up between 30 and 90 days after BAE. Long-term control of bleeding was achieved in 25 of the initial 56 patients (45%) followed up beyond 3 months after BAE (median follow-up of 13 months; range, 3 to 76 months). Overall, complications of BAE consisted of two episodes of mediastinal hematoma and three episodes of neurologic damage, two of which improved without permanent sequelae. CONCLUSION: We conclude that BAE may result in long-term as well as immediate control of life-threatening hemoptysis but that complications are not unusual.

Adult↗
PubMed2001

Endobronchial argon plasma coagulation for treatment of hemoptysis and neoplastic airway obstruction.

STUDY OBJECTIVE: To evaluate the usefulness of endobronchial argon plasma coagulation (APC) for the treatment of hemoptysis and neoplastic airway obstruction. DESIGN: Retrospective study. SETTING: Bronchoscopy unit of a university hospital. PATIENTS: A total of 60 patients with bronchogenic carcinoma (n = 43), metastatic tumors affecting the bronchi (n = 14), or benign bronchial disease (n = 3). Indications for intervention were hemoptysis (n = 31), symptomatic airway obstruction (n = 14), and both obstruction and hemoptysis (n = 25). Hemoptysis was stratified as a volume of > 200 mL/d (n = 6), > 50 to 200 mL/d (n = 23), or < or = 50 mL/d but persistence for > 1 week (n = 27). The mean (+/- SD) duration of hemoptysis was 16.5 +/- 16.1 days before intervention. Obstruction sites were the trachea (n = 8), mainstem bronchi (n = 21), and lobar bronchi (n = 30). In 24 cases, the patient had obstructions at multiple sites. The mean size of the pretreatment obstruction was 76 +/- 24.9%. INTERVENTIONS: APC, a noncontact form of electrocoagulation, was performed via flexible bronchoscopy. Sixty patients underwent 70 procedures. Conscious sedation without endotracheal intubation was used in all patients except four, who were mechanically ventilated because of underlying respiratory failure. MEASUREMENTS AND RESULTS: All patients with hemoptysis experienced a resolution of bleeding immediately after APC. Hemoptysis from treated sites did not recur during a mean follow-up duration of 97 +/- 91.9 days. Patients with endoluminal airway lesions had an overall decrease in mean obstruction size to 18.4 +/- 22.1%. All patients with obstructive lesions, except one who died of sepsis, experienced symptom improvement. In these patients, symptom control was maintained during a median follow-up period of 53 days (range, 18 to 321 days). There were no complications related to the procedure. CONCLUSIONS: APC is effective for the treatment of endoluminal hemoptysis and airway obstruction. The procedure can be performed in an outpatient setting or at the bedside in the ICUs. APC provides a simpler, lower-risk alternative to other interventional endobronchial techniques.

Airway Obstruction↗
PubMed2005

Massive hemoptysis in cystic fibrosis.

BACKGROUND: Massive hemoptysis is a complication commonly reported in patients with cystic fibrosis (CF). An understanding of the pathophysiology of this complication and its consequences is important for the management of patients with CF. OBJECTIVES: To identify risk factors associated with massive hemoptysis, and to determine the prognosis of patients following an episode of massive hemoptysis. DESIGN: A retrospective, observational cohort study of the National CF Patient Registry between the years 1990 to 1999. PATIENTS: The Registry contained data on 28,858 patients with CF observed over 10 years at CF centers across the United States. RESULTS: Massive hemoptysis occurred with an average annual incidence of 0.87% and in 4.1% of patients overall. There was no increased occurrence by sex, but it was more prevalent in older patients (mean age, 24.2 +/- 8.7 years [+/- SD]) with more severe pulmonary impairment (nearly 60% of patients who had an episode of massive hemoptysis had FEV1 < 40% predicted). The principal risks associated with an increased occurrence of massive hemoptysis included the presence of Staphylococcus aureus in sputum cultures (odds ratio [OR], 1.3) and diabetes (OR, 1.1). There was an increased morbidity (eg, increased hospitalizations and hospital days) and an increased 2-year mortality following massive hemoptysis. CONCLUSION: Massive hemoptysis is a serious complication in CF patients, occurring more commonly in older patients with more advanced lung disease. Nearly 1 in 100 patients will have this complication each year. There is an attributable mortality to the complication and considerable morbidity, resulting in increased health-care utilization and a measurable decline in lung function.

Adolescent↗
PubMed2004

[The long-term effect and associated factors of double embolization of bronchial artery in patients with lung tuberculosis and hemoptysis].

OBJECTIVE: To investigate the long-term effect and the key factors associated with relapse of double embolization of bronchial artery in patients with lung tuberculosis and hemoptysis. METHODS: Fifty patients with lung tuberculosis and hemoptysis receiving the radiography and double embolization of bronchial artery (BAG + BAE) had been followed up for two years. The causes for hemoptysis relapse was determined, followed by specific treatment, and the effect was evaluated. Among them, 37 were males, 13 females, with the age of 8-75 years (mean age 47.6 years). RESULTS: The 2 year follow-up showed that the cure rate and the effective rate were 62% (31/50) and 94% (47/50) respectively. In a short term after embolization, hemoptysis relapsed in 9 cases, the major causes being active tuberculosis and secondary bronchiectasis complicated with infection. Other responsible factors included missed-embolization of bronchial artery and remaining blood supply from systemic circulation. In mid and long term follow-up, hemoptysis relapsed in 10 cases, the major causes being secondary pulmonary mycotic infection and recurrence of tuberculosis. CONCLUSIONS: The long term result of double embolization of bronchial artery in patients with lung tuberculosis and hemoptysis was significant. It could prevent the danger from massive hemoptysis, and therefore allows the medical therapy for tuberculosis. Embolization of bronchial artery is effective for hemostasis, while etiologic therapy aimed at removing the infection leading to chronic inflammation is the cure for tuberculosis and hemoptysis.

Adolescent↗
PubMed1987

Hemoptysis in sarcoidosis.

The medical records of 433 patients with sarcoidosis were reviewed to determine the prevalence and significance of hemoptysis in this disease. Twenty-five patients (6%) were found to have hemoptysis. Nineteen of the 25 patients had mild hemoptysis, four had moderate, and two had massive hemoptysis. The clinical, roentgenographic, and laboratory features in patients with hemoptysis were compared with those from an age, race, and sex matched control group of sarcoidosis patients without hemoptysis. With the exception of eye involvement which occurred with greater frequency in control patients, no significant differences were found between the two groups. While bronchoscopy may be useful in establishing a diagnosis of endobronchial sarcoidosis, identification of a specific bleeding site is not likely in the absence of massive hemoptysis or localized radiographic abnormalities. Corticosteroid therapy may be useful to control hemoptysis in some patients.

Adult↗
PubMed1983

Comparison of medical v surgical treatment of major hemoptysis.

One hundred thirteen patients hospitalized with substantial hemoptysis were studied. Thirty-one patients underwent surgery and 82 were treated medically, and the two groups had similar diagnoses and bleeding patterns. There were four deaths in the surgical group and 18 deaths in the medical group. Of these, eight patients had a sudden first hemoptysis with instantaneous death. Ten patients had a terminal hemoptysis after prior bleeding, but nine of these patients had absolute contraindications for surgery. In 64 patients hemoptysis was controlled with medical treatment. Most patients showed a steady decrease of bleeding, with cessation of hemoptysis after four days. Our experience indicates that the majority of patients with serious hemoptysis can be successfully treated conservatively. Massive hemoptysis, aspiration, or recurrence of bleeding in and of themselves are not indications for surgery. Where the hemoptysis remains uncontrolled in spite of a trial of adequate medical care or where the aspiration is severe and progressive, surgery may be indicated and can be lifesaving.

Adolescent↗
PubMed1998

Role of bronchial artery embolization in the management of hemoptysis.

OBJECTIVE: To assess the modern morbidity of hemoptysis and the contribution of therapeutic bronchial artery embolization to its management. METHODS: Medical record review of patients admitted for the treatment of hemoptysis from January 1991 to November 1995 and of patients who had therapeutic bronchial artery embolization from June 1986 to August 1995. Hemoptysis was labeled major or minor. RESULTS: A total of 138 patients were admitted with hemoptysis, 31 with major and 107 with minor hemoptysis. No emergency pulmonary resections were required. Mean follow-up was 13.5 months. Mortality was 29.7% (41/138) but was caused by bronchial bleeding in only 4.3% (6/138). Twenty-six patients underwent therapeutic bronchial artery embolization (mean follow-up [range], 14 months [0.3-69.0 months]). The initial success rate (no further bleeding during the initial admission) was 85% (22/26). The long-term success rate (no further bleeding during follow-up) was 58% (15/26). Only 2 patients with therapeutic bronchial artery embolization died of further hemoptysis. CONCLUSIONS: Hemoptysis signals life-threatening diseases. Therapeutic bronchial artery embolization is a good treatment adjunct to control bronchial bleeding and reduces the need for high-risk emergency lung resections.

Bronchial Arteries↗