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PubMed2001

[Threatening hemoptysis. Results of treatment with arterial embolization].

OBJECTIVE: Retrospective analysis the immediate and long-term efficacy of embolization of bronchial and systemic arteries in the treatment of threatening or relapsing hemoptysis. MATERIALS AND METHODS: During the study period 122 arterial embolizations were performed in patients with hemoptysis over 100 ml in 24 hours, relapsing hemoptysis and/or presence of vital risk factors. Embolization was performed with polyvinyl alcohol particles, spongostan and metallic spirals. Seventy patients were included in the study and 47 were excluded as they came from other institutions. RESULTS: Angiographic changes were observed in 100% of patients. The immediate clinical success, defined as hemoptysis control, was obtained in the 70 patients. The mean follow-up time was 21.2 +/- 16.3 months. Relapsing hemoptysis occurred in 17.1% of patients (12 patients), of which 5.7% (4 cases) occurred in the first seven days and in 11.4% (8 patients) after 6 months. In five patients (7.1%) a new embolization was performed and 6 were operated after embolization (5 of them with bronchiectasis). The remarkable complications derived from the procedure included self-limited paraparesis of the lower limbs and severe chest pain. CONCLUSIONS: The embolization of bronchial arteries is an efficient technique for the treatment of threatening hemoptysis and relapses, is associated with a low morbidity rate, and the late relapse is relatively common among patiets with bronchiectasis.

Embolization, Therapeutic↗
PubMed2002

[Life-threatening hemoptysis in cystic fibrosis: clinical characteristics and management in 36 episodes].

BACKGROUND: Our goal was to evaluate the clinical characteristics and management of life-threatening hemoptysis in patients with cystic fibrosis (CF). PATIENTS AND METHOD: We included adult CF patients followed up at the Cystic Fibrosis Units of the Autonomous Community of Madrid who had life-threatening hemoptysis from June 1990 to December 1999. RESULTS: Twelve CF patients (4 females) developed 36 episodes of life-threatening hemoptysis (30 massive and 6 recurrent). Lung disease was moderate to severe. Sputum cultures revealed Pseudomonas aeruginosa in 10 patients. Thirteen episodes (36%) resolved upon antibiotic treatment and 3 (8%) after antibiotic therapy and bronchoscopy. Bronchial artery embolization (BAE) was performed in 20 of 36 events. Immediate technique success was achieved in 80% episodes (16 of 20) after one session, 85% (17/20) after two sessions, and 95% (19/20) after three sessions. No major complications associated with the procedure were seen. The overall recurrence rate per episode was 69% (24 of 35 episodes in 6 patients) with a mean time of recurrence of 13 months. There were no massive hemoptysis-associated deaths during the follow-up. CONCLUSIONS: Life-threatening hemoptysis is a frequent complication in CF patients who have moderate or severe lung disease. When conservative therapeutic measures (including antibiotics) fail to control it, BAE should be performed. When performed by expert professionals, BAE is effective and safe to immediate control of life-threatening hemoptysis in patients with CF.

Adolescent↗
PubMed1995

Management of hemoptysis in a Third World city hospital: a retrospective study.

BACKGROUND: Massive hemoptysis (defined as blood loss greater than 600 ml/24h) is said to have a fatal outcome in up to 85% of patients when managed only medically. METHODS: A retrospective patient chart study was undertaken to analyse underlying pathology, management and outcome of hemoptysis patients in a hospital with no thoracic surgical, bronchoscopic or embolisation facilities. RESULTS: 63 patients were admitted for hemoptysis during a 2.5 year study period. Tuberculosis and sequelae of previous tuberculosis accounted for 65% of the cases. The patients with expectoration of more than 600 ml/24h had a shorter duration of hemoptysis (P = 0.033) and more often a history of tuberculosis (P = 0.023). The mortality rate was 6% (4/63 patients). Recurrent bleeding was not frequent (11%) and never severe enough for admission. CONCLUSIONS: Hemoptysis in a Third World city hospital is mainly caused by infectious disease. Under the above-mentioned circumstances, in view of a low mortality and recurrence rate, conservative treatment of hemoptysis in in-patients seems justified.

Adult↗
PubMed2003

The role of surgery in hemoptysis caused by thoracic actinomycosis; a forgotten disease.

OBJECTIVE: Thoracic actinomycosis is a relatively uncommon anaerobic infection caused by Actinomyces israelii. Rarely, it may be complicated by an unusual but significant hemoptysis manifestation. We describe our experiences of surgical treatment for hemoptysis in patients with pulmonary actinomycosis. METHODS: From 1984 to 2002, 14 patients with thoracic actinomycosis and hemoptysis were diagnosed after thoracotomy. There were 11 male and three female patients with a mean age of 53.6 years. They all had non-specific symptoms and radiographic findings, and no case was an accurate diagnosis made at the time of hospital admission, including echo-guide aspiration, serial bronchoscopic biopsy and computed tomography biopsy. The indications of surgical intervention in our patients were for treating complications such as hemoptysis, chronic sinus discharge, or empyema, also limited to diagnostic purposes. Preoperative embolization was performed in seven cases; however, none was successful. RESULTS: Among the 14 patients, all the lesions were unilateral. The disease was confined to the lung in all patients; and chest wall involvement in one patient. The surgical procedures included were as follows: pneumonectomy (n=1), bilobectomy (n=1), lobectomy (n=10), wedge resection (n=2), and lung lesion with concomitant chest wall resection and chest wall reconstruction (n=1). Mean intraoperative and postoperative blood loss within the first 24 h was 192.3 ml, and five patients required blood transfusion. All of the specimens from the lesion site showed histological evidence of Actinomyces infection. All patients regularly took 12 million units per day of intravenous crystalline penicillin G during their hospitalization, and oral procaine penicillin for up to 2 months. During the follow-up, all patients had an uneventful postoperative course. CONCLUSIONS: A high index of suspicion for this disease is advised for the surgeon engaged in the treatment of hemoptysis. Surgical resection of pulmonary actinomycosis is effective in preventing recurrence of hemoptysis. After diagnosis, it is treated using penicillin chemotherapy for at least 2 months.

Actinomycosis↗
PubMed1987

Major and massive hemoptysis: reassessment of conservative management.

The etiologic factors of major (greater than or equal to 200 ml/24 hr) and massive (greater than or equal to 1,000 ml/24 hr) hemoptysis may well affect the outcome and, therefore, the treatment of this often life-threatening problem. the decline in the incidence of tuberculosis (TB) and bronchiectasis, along with the increase in bronchitis and neoplasia, have led to a strong institutional bias against operating on patients with major and massive hemoptysis. A retrospective case study and an extensive literature review were undertaken to critically evaluate this policy. Fifty-nine consecutive patients with major hemoptysis, 26 of whom had massive hemoptysis, were identified from 887 patients seen in our institution over a 10-year period. Only four of these 59 patients underwent surgery, while 55 were managed conservatively. Etiologic factors, operability, and bleeding rate all appeared to play a major role in outcome. No patients with bronchitis, bronchiectasis, tuberculosis, or who were on anticoagulation therapy died compared to a mortality rate of 59% in patients with carcinoma (CA) of the lung and 71% in patients with leukemia. Eleven percent of operable patients treated conservatively died compared to a 46% mortality rate for nonoperable patients. And, 9% of patients with bleeding rates less than 1,000 ml/24 hr died compared to 58% of those with greater than or equal to 1,000 ml/24 hr. Conservative management appears to have a low mortality in patients with non-tuberculosis-related major hemoptysis as well as in many patients with massive hemoptysis, especially those patients who are operable and those without neoplastic disease.

Adolescent↗
PubMed2000

Clinical assessment and management of massive hemoptysis.

OBJECTIVE: Massive hemoptysis is a potentially lethal condition that deserves to be investigated thoroughly and brought under control promptly. The mortality rate depends mainly on the underlying etiology and the magnitude of bleeding. Although the diagnosis of hemoptysis may be established by chest radiograph, many pathologies may be missed. Because bronchoscopy and computed tomography are complementary, they may indicate pathologies not detectable by chest radiograph. Finding the etiology and site of the hemoptysis is imperative. INVESTIGATIONS: Urgent bronchoscopy should be performed in unstable patients because it exacts a paramount role in the diagnostic search and therapy. It can be used to facilitate the introduction of balloon-tip catheters into the bleeding bronchus for tamponade of the hemorrhagic artery, protecting de facto the contralateral lung or nonbleeding bronchi from blood aspiration. Endobronchial tamponade should only be used as a temporary measure until a more specific treatment is instituted. In stable patients, computed tomography should be ordered before any bronchoscopic exploration. INTERVENTIONS: Surgery was once regarded as the treatment of choice in operable patients with massive hemoptysis. Bronchial artery embolization (BAE) is an excellent nonsurgical alternative; it is proven to be very effective and lacks the mortality and morbidity encountered in surgical interventions. Nevertheless, surgery is recommended in patients with massive hemoptysis caused by thoracic vascular injury, arteriovenous malformation, leaking thoracic aneurysm with bronchial communication, hydatid cyst, and other conditions in which BAE would be inadequate. MEDICAL MANAGEMENT: Conservative medical therapy may suffice in certain conditions, like bronchiectasis, coagulopathies, Goodpasture's syndrome, and acute bronchopulmonary infections. Preparation for other interventions (endobronchial tamponade, BAE, or surgery in eligible candidates) should be undertaken if the bleeding fails to respond to conservative measures. Supportive therapy should be applied vigorously to all patients with massive hemoptysis.

Bronchial Arteries↗
PubMed2004

Association of presence of Aspergillus antibodies with hemoptysis in patients with old tuberculosis or bronchiectasis but no radiologically visible mycetoma.

Old tuberculosis and bronchiectasis are the two most important causes of chronic structural changes of lungs in our locality. In the absence of radiologically visible mycetoma, the cause of hemoptysis in these two groups of patients is largely unknown. A 17-month prospective study was carried out to compare the prevalence of Aspergillus fumigatus and Aspergillus flavus antibodies in hemoptysis patients with old tuberculosis or bronchiectasis but no radiologically visible mycetoma (cases, n = 38), hemoptysis patients with other diagnosis (control group 1, n = 29), and patients with old tuberculosis or bronchiectasis but no hemoptysis (control group 2, n = 47) by a recently developed sensitive and specific A. fumigatus and A. flavus antibody assay. There were a significantly larger number of patients with antibody against A. fumigatus or A. flavus among the cases than among the patients in control groups 1 and 2 (P < 0.05 in both comparisons). Molds were not recovered from any of the patients. Among the 10 cases with Aspergillus antibody, eight and two had antibody against A. flavus and A. fumigatus, respectively. We conclude that there was an association between the presence of Aspergillus antibodies and hemoptysis in patients with old tuberculosis or bronchiectasis, suggesting that these patients probably had occult infections caused by the corresponding fungi. Development of serological tests against other Aspergillus species as well as other causes of mycetoma will probably increase the detection of occult mold infections in patients with existing parenchymal lung diseases, and treatment of fungal microinvasion may help to alleviate hemoptysis in these patients with bronchiectasis or old tuberculosis who have Aspergillus antibodies.

Aged↗
PubMed2006

Hemoptysis, a developing world perspective.

BACKGROUND: Hemoptysis is a significant clinical presentation in respiratory medicine. Often a life threatening emergency, it mandates prompt assessment and intervention. Various investigations and management protocols are proposed globally, to advocate a standardized approach towards patients presenting with hemoptysis. It is the etiology, however, that has been known to influence clinical outcome and prognosis. With marked contrast in geographical patterns of pulmonary pathologies, etiological agents for hemoptysis vary over the world. Studies in West, usually demonstrate neoplastic and non-granulomatous causes to be the leading agents for hemoptysis. The diagnostic accuracy of various investigations and efficacy of management alternatives has been established there. Developing nations differ in their burden of diseases of lung. Lack of health resources and initiative often prevent quality research in critical areas. DESIGN: This is a retrospective observational study with a cross-sectional design in which charts of all patients admitted with the presentation of haemoptysis in the past ten years will be reviewed, at Aga Khan University Hospital, Karachi, Pakistan. A series of variables, based on previous literature on haemoptysis related to the objectives of present study, will be determined in the study. Demographics, co-morbids and etiology will be determined. Findings of various investigation modalities and their accuracy in localizing the bleeding site will be determined. Efficacy of different management strategies will also be observed. Also observed will be any complications and follow-up. DISCUSSION: Pakistan is a third world nation of over 150 million, established as highly endemic for pulmonary tuberculosis. To date no study has been generated to look into hemoptysis patterns, in this nation. Lack of evidence based medicine poses a major hindrance towards confident decision-making in the approach towards a patient presenting with hemoptysis in this country. This study is devised to obtain the first insight in this direction, from this part of the world. The etiologies, accuracy of various investigations and efficacy of treatment options will be investigated. The results and conclusions will prove to be of value not just for health administrators in this country, but many other regions that share similarities in patterns of pulmonary pathologies.

Cross-Sectional Studies↗
PubMed1994

Factitious hemoptysis. Adding to the differential diagnosis.

BACKGROUND: We report a dramatic case of factitious hemoptysis in a 36-year-old black man who presented with hemoptysis and chest pain. METHODS: After an exhaustive evaluation, including many invasive procedures, we discovered that the patient's complaints were fabricated, although the method used to simulate hemoptysis was not determined. Documentation was obtained of at least 23 other hospital admissions with similar complaints. During these hospitalizations, numerous diagnostic procedures were performed, including 16 fiberoptic bronchoscopies and 3 cardiac catheterizations, with negative results. RESULTS: Review of 11 other reported cases of factitious hemoptysis reveals that these patients are generally young (mean age, 32 years; range, 21 to 47 years) and often health-care workers (4 of 12 cases) and that the method of simulating hemoptysis, if discovered, usually involves a self-inflicted wound (5 cases). CONCLUSION: A factitious cause should be considered in the differential diagnosis of hemoptysis of unclear etiology, especially when the medical history or the patient's behavior is unusual.

Adult↗
PubMed1994

Hemoptysis: prospective high-resolution CT/bronchoscopic correlation.

The precise roles of fiberoptic bronchoscopy (FOB) and computed tomography (CT) of the chest in the evaluation of patients presenting with hemoptysis have not been clearly defined. On the assumption that both procedures would likely provide unique and complementary information, a prospective study with blinded interpreters using a modified high-resolution CT technique (HRCT) and FOB was designed to evaluate 57 consecutive patients admitted to Bellevue Hospital with hemoptysis. Etiologies included bronchiectasis (25 percent), tuberculosis (16 percent), lung cancer (12 percent), aspergilloma (12 percent), and bronchitis (5 percent): in an additional 5 percent of cases, hemoptysis proved to be due miscellaneous causes, while in 19 percent hemoptysis proved to be cryptogenic. Patients with lung cancer all were at least 50 years old, smoked an average of 78 pack-years, and had less severe hemoptysis but of longer duration. All had conditions diagnosed both by HRCT and FOB. High-resolution CT proved of particular value in diagnosing bronchiectasis and aspergillomas, while FOB was diagnostic of bronchitis and mucosal lesions such as Kaposi's sarcoma. Fiberoptic bronchoscopy localized bleeding in only 51 percent of cases. The high sensitivity of CT in identifying both the intraluminal and extraluminal extent of central lung cancers in conjunction with its value in diagnosing bronchiectasis suggest that CT should be obtained prior to bronchoscopy in all patients presenting with hemoptysis.

Adult↗
PubMed2000

Seasonal variation in cryptogenic and noncryptogenic hemoptysis hospitalizations in France.

STUDY OBJECTIVE: To determine the potential role of seasonality in hospitalizations for cryptogenic and noncryptogenic hemoptysis in the French population. DESIGN: Retrospective analysis of hospital discharge data from a National Register. SETTING: All 29 French university hospitals, between July 1, 1994, and June 30, 1997. PATIENTS: Two thousand six hundred seventy-seven and 3,672 adult hospitalizations for cryptogenic and other hemoptysis, respectively. MEASUREMENTS: Cumulative monthly averages were determined, expressed as the percentage above or below the average monthly value during the entire study period. RESULTS: The distribution of cumulative monthly hospitalizations for cryptogenic hemoptysis peaked in March (32% above the average) and was lowest in summer (30% below the average; p < 0.001). Hospitalizations for noncryptogenic hemoptysis followed a similar seasonal pattern (p < 0. 001). In the 16- to 34-year-old individuals, cryptogenic hemoptysis, compared with noncryptogenic hemoptysis, showed a higher incidence with a larger seasonal amplitude (p < 0.001). CONCLUSIONS: A better understanding of the fundamental pathophysiologic mechanisms underlying this respiratory and hemorrhagic condition may be helpful in developing preventive measures, especially in patients with a risk of recurrence.

Adolescent↗
PubMed2001

Hemoptysis in patients with renal insufficiency : the role of flexible bronchoscopy.

STUDY OBJECTIVES: To assess the indications, yield, and therapeutic impact of flexible bronchoscopy (FB) in patients with hemoptysis and renal insufficiency. DESIGN: Retrospective cohort analysis. SETTING: Tertiary-care university hospital. PATIENTS: Thirty-four patients over a 7.5-year period who underwent FB to evaluate hemoptysis in the setting of renal insufficiency (ie, serum creatinine level, > 1.5 mg/dL). MEASUREMENTS AND RESULTS: The etiology of hemoptysis was undetermined in 41% of cases. Defined causes of bleeding included infections (29%), pulmonary renal syndromes (15%), airway injury (9%), and pulmonary embolism (6%). No specific bleeding site was identified, but FB lateralized hemorrhaging to one lung in 24% of patients. FB results influenced therapy in 29% of patients overall and in 8% of patients without respiratory tract infection. The hospital survival rate was 47% and did not differ based on the presence or absence (presence vs absence) of the following variables: a defined etiology for hemoptysis (45% vs 50%); lateralized bleeding (38% vs 50%); or management alterations prompted by other FB findings (50% vs 46%). Factors associated with survival included the onset of bleeding prior to hospital admission (80% vs 33%; p = 0.02), the absence of respiratory failure requiring mechanical ventilation at the time of FB (90% vs 29%; p = 0.002), and lack of prohemorrhagic factors (other than uremia) such as disseminated intravascular coagulation, recent treatment with warfarin, heparin, or antiplatelet agents (78% vs 33%; p = 0.05). During the 6 months following hospital discharge, hemoptysis recurred in 14% of patients, and 5 patients died, for an overall mortality rate of 62%. CONCLUSIONS: These data suggest that FB in hospitalized patients with hemoptysis and renal insufficiency, and without radiographic findings suggesting neoplastic disease, has a low yield and limited impact. Whether FB influences outcome in selected patients in this setting requires prospective investigation.

Bronchoscopy↗
PubMed2001

Long-term outcome and lung cancer incidence in patients with hemoptysis of unknown origin.

STUDY OBJECTIVE: To provide current data on the long-term outcome and incidence of lung cancer in a large cohort of patients with hemoptysis of unknown origin. DESIGN: A retrospective chart review followed by a telephone interview for follow-up. SETTING: A university-affiliated tertiary referral center for pulmonary diseases. PATIENTS: Seven hundred twenty-two patients who presented with hemoptysis from January 1990 to December 1993. One hundred thirty-five patients were identified as having hemoptysis of unknown origin. RESULTS: One hundred thirty-five patients (19%) had hemoptysis of unknown origin; follow-up data were obtained in 115 patients, of whom 100 were still alive. The mean time of observation was 6.6 years after initial presentation. Lung cancer developed in 7 of 115 patients (6%) and was unresectable once detected; all of these patients were smokers > 40 years old, and malignancy developed within 3 years after first presentation. CONCLUSIONS: Hemoptysis of unknown origin is present in a minority of patients presenting with hemoptysis if evaluated at a referral center for pulmonary diseases. Lung cancer seems to be increasing in these patients compared to previous studies, and closer follow-up or additional testing may be indicated in the defined population at risk.

Adult↗
PubMed1988

Factors associated with fatal hemoptysis in cancer patients.

We reviewed the clinical outcome of 58 patients with hemoptysis associated with either a hematologic or solid malignancy. Pulmonary hemorrhage causing death (fatal hemoptysis) occurred in 36 percent of these patients. Fatal hemoptysis occurred in six of eight patients with a hematologic malignancy and a fungal pneumonia. Examination of pathologic specimens from five of these patients revealed fungal invasion of blood vessels. An inflammatory response was absent in three, suggesting that granulocytes are not required for fungal-induced tissue destruction. In patients with a bronchogenic tumor, fatal hemoptysis occurred in six of seven patients with a necrotic squamous cell carcinoma. In contrast, hemoptysis was fatal in only two of ten patients with metastatic lung disease. We conclude that hemoptysis in cancer patients with a fungal pneumonia is an ominous sign that may warrant aggressive interventions to prevent a fatal complication.

Aged↗
PubMed1990

Recurrent bleeding after arterial embolization in patients with hemoptysis.

Thirty-three patients with hemoptysis caused by nonmalignant diseases underwent arterial embolization. In seven (21.2 percent) of 33 patients, hemoptysis recurred after initial embolization in a follow-up period ranging from one day to four years. Although there was no difference in age and daily quantity of bleeding among patients with and without recurrences, those with mycetoma suffered the highest recurrence of bleeding after initial embolization (three [75 percent] of four patients). In the initial arteriograms of the seven patients were found six cases of markedly increased vascularity, three of increased vascularity in the bilateral lung, and three of nonbronchial systemic arterial supply to the diseased lung. Of six patients who received reexamination at the time of recurrent bleeding, the arteriogram demonstrated recanalization of previously embolized artery in five and revascularization by collateral circulation in five. In addition, hemoptysis recurred in three (60 percent) of five patients after second embolization and in one (50 percent) of two after third embolization. Four patients underwent surgical therapy: two after the initial embolization, one after the second, and one after the third, and these patients had no recurrence. While arterial embolization as initial treatment of hemoptysis is a highly useful procedure, this is a palliative procedure and potential for recurrence of hemoptysis exists as the lesion that has initially caused hemoptysis is not cured by the embolization. We emphasize that a combination therapy of repeated embolization and surgery will probably improve the efficacy of treatment of recurrent bleeding after initial embolization.

Adult↗
PubMed1993

Treatment of hemoptysis in patients with cavitary aspergilloma of the lung: value of percutaneous instillation of amphotericin B.

OBJECTIVE: Surgery has been the primary choice of treatment for cavitary aspergillomas of the lung, but it is associated with relatively high morbidity and mortality. The effectiveness of percutaneous intracavitary instillation of an antifungal agent in seven patients with hemoptysis caused by cavitary aspergilloma was evaluated. SUBJECTS AND METHODS: All patients had hemoptysis associated with a cavitary pulmonary aspergilloma. In four patients who had aspergillomas without lung interposed between the cavity and the chest wall, 50 mg of amphotericin B in 10 ml of 5% dextrose in water and then 8 mg of bromhexine (a mucolytic agent) mixed with 10 ml of normal saline were instilled into the cavity through an 8-French catheter daily for 15 days. In three patients who had lung interposed between the cavity and the chest wall, the treatment was administered twice at 3-day intervals through a 20-gauge needle. The presence or absence of hemoptysis was recorded after each instillation of amphotericin B, and the size of aspergilloma was assessed with follow-up radiographs. RESULTS: Hemoptysis ceased within 5 days after instillation of amphotericin B in all patients. In the four patients treated through a catheter, the aspergillomas resolved completely in three patients and resolved partially in one. In the three patients treated through a fine needle, the aspergillomas resolved partially. Mild hemoptysis during the procedure, a small pneumothorax, and subcutaneous emphysema occurred in one patient each. CONCLUSION: Our results suggest that percutaneous intracavitary instillation of amphotericin B is a safe and effective method of treating hemoptysis caused by aspergillomas.

Adult↗
PubMed2003

Added benefit of thoracic aortography after transarterial embolization in patients with hemoptysis.

OBJECTIVE: The purpose of this study was to examine the usefulness of thoracic aortography performed after transarterial embolization in identifying additional arteries responsible for causing hemoptysis. SUBJECTS AND METHODS: Between March 2000 and November 2001, we prospectively performed thoracic aortography after transarterial embolization in 76 patients with hemoptysis. Underlying diseases included tuberculosis (n = 34), bronchiectasis (n = 30), emphysema (n = 4), bronchitis (n = 4), aspergillosis (n = 3), and lung cancer (n = 1). Initially, angiography of bronchial and other systemic arteries possibly contributing to hemoptysis was performed with embolization. After completion of the embolization, thoracic aortography was performed, with the tip of the catheter located just distal to the origin of the left subclavian artery. RESULTS: A total of 200 arteries (52 right bronchial, 40 left bronchial, six common bronchial, 76 intercostal, 11 inferior phrenic, six thoracodorsal, eight internal mammary, and one thyrocervical) were identified either at the initial embolization or on thoracic aortography as being responsible for causing hemoptysis. Among them, 29 arteries (14.5%) that were not included on the initial selection for embolization were later identified on postembolization thoracic aortography. There were two right bronchial, three left bronchial, eight inferior phrenic, and 16 intercostal arteries. CONCLUSION: The inferior phrenic and intercostal arteries were often missed on routine transarterial embolization in patients with hemoptysis. Postembolization thoracic aortography is useful for monitoring the effectiveness of embolization and for improving the detection of arteries contributing to hemoptysis.

Adult↗
PubMed2002

Massive hemoptysis after generalized tonic clonic seizure requiring mechanical ventilation.

A 38-year-old woman presented with massive hemoptysis (>200 mL/ 24 hours) occurring abruptly after generalized tonic clonic seizure. She experienced similar episodes of hemoptysis on three later occasions. Although the coexistence of hemoptysis and seizure has been reported, albeit rarely, as a clinical manifestation of postictal neurogenic pulmonary edema, massive hemoptysis after seizure is an extremely rare event with no recurrent cases of such episodes having ever been reported. The coexistence of hemoptysis and seizure increases the difficulty in diagnosis for the clinician. We describe the differential diagnosis among the diseases capable of causing seizure and hemoptysis.

Adult↗