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PubMed2002

Manifestations of hemoptysis. How to manage minor, moderate, and massive bleeding.

Hemoptysis is a frightening symptom for patients and often is a manifestation of significant underlying disease. The chest radiograph, history and examination findings, comorbid illnesses, and demographic factors guide evaluation of patients with minor hemoptysis. Massive hemoptysis occurs in less than 5% of patients with hemoptysis and is almost always due to serious pulmonary or systemic illness. Massive hemoptysis is a life-threatening event that requires ICU admission and urgent bronchoscopic evaluation for lateralization or localization of the bleeding site. Management should be individualized and requires prompt consultation with appropriate cardiothoracic surgery, pulmonary medicine, anesthesia, and interventional radiology staff. The availability of endobronchial techniques and bronchial arterial embolization has enhanced our ability to control massive bleeding short-term and decreased the need for emergency surgical treatment. Massive hemoptysis may recur without warning. Prompt workup and treatment are required for all patients.

Algorithms↗
PubMed1999

[Life-threatening hemoptysis. Treatment with transcatheter embolization].

OBJECTIVE: To evaluate the immediate and long-term efficacy of transcatheter embolization of bronchial, systemic and pulmonary arteries to treat life-threatening hemoptysis. Likewise, we propose the systematic treatment of life-threatening hemoptysis by means of transcatheter embolization. MATERIAL AND METHODS: One hundred seven angiographies were performed on the same number of patients experiencing life-threatening hemoptysis with bleeding exceeding 150 ml in 24 hours. Before angiography, we rinsed the vessels with cold saline solution and adrenalin through the catheter. Thirty-three patients were female and 74 were male. Mean age was 52.3 years (range 12 to 75 years). Embolization was performed in 104 (3 in patients with recurrent hemoptysis) using polyvinyl alcohol and micro-coils. Bronchial and systemic arteries of the affected hemithorax (mammary and lateral thoracic arteries) were checked in all patients. If findings were negative or bleeding was recurrent, we also performed pulmonary arteriography. RESULTS: In two cases we were unable to catheterize the artery theoretically responsible for bleeding. Examination of both arterial and systemic vessels proved normal in one patient. The embolization technique was successful in 99% (103/104) of the cases and the rate of immediate clinical success was 95.1% (99/104). The mean time of follow-up was 43.2 months (range 3 to 66 months). Hemoptysis recurred in 15.3% (16 cases) within a mean 8.3 months (range 15 days to 48 months); embolization was repeated in 14 of these patients with satisfactory results, while two underwent surgery. In five patients (4.8%) we observed complications requiring no additional medical treatment: one instance of coil migration to the deep femoral artery, from which the coil was removed in a basket; two cases of bronchial artery extravasation with small mediastinal hematomas; and two hematomas at the points of puncture. CONCLUSION: Selective or supra-selective embolization of the arteries that feed the bronchi provides effective management of life-threatening hemoptysis. No additional medical treatment is usually required.

Adolescent↗
PubMed1992

Hemoptysis in rheumatic heart disease.

107 Consecutive patients with rheumatic valvular heart disease (41 males, 66 females, average age 24.2 years) being followed at an Ethiopian cardiology referral clinic were examined and questioned about their experience of hemoptysis. 51 Patients (48%) gave a history of hemoptysis; 11 described their usual hemoptysis as frank blood, 40 as blood-streaked sputum. 29 patients had frequent hemoptysis, 13 had several episodes, and 9 only 1 occurrence. Prevalence of hemoptysis did not vary significantly by sex, physical findings, New York Heart Association classification, or valvular lesion, including the presence or absence of mitral stenosis. A majority (64) had been tested for tuberculosis, with 5 having been treated for active disease. Hemoptysis is a common manifestation of rheumatic heart disease, and is usually well tolerated.

Adolescent↗
PubMed2005

Hemoptysis: diagnosis and management.

Hemoptysis is the spitting of blood that originated in the lungs or bronchial tubes. The patient's history should help determine the amount of blood and differentiate between hemoptysis, pseudohemoptysis, and hematemesis. A focused physical examination can lead to the diagnosis in most cases. In children, lower respiratory tract infection and foreign body aspiration are common causes. In adults, bronchitis, bronchogenic carcinoma, and pneumonia are the major causes. Chest radiographs often aid in diagnosis and assist in using two complementary diagnostic procedures, fiberoptic bronchoscopy and high-resolution computed tomography, which are useful in difficult cases and when malignancy is suspected. The goals of management are threefold: bleeding cessation, aspiration prevention, and treatment of the underlying cause. Mild hemoptysis often is caused by an infection that can be managed on an outpatient basis with dose monitoring. If hemoptysis persists, consulting with a pulmonologist should be considered. Patients with risk factors for malignancy or recurrent hemoptysis also require further evaluation with fiberoptic bronchoscopy or high-resolution computed tomography. In up to 34 percent of patients, no cause of hemoptysis can be found.

Adult↗
PubMed2006

Analysis of patients with hemoptysis in a reference hospital for chest diseases.

Chest physicians frequently come across with the symptom hemoptysis, an alerting symptom which may result from a wide variety of disorders. In this study, we aimed to determine the main causes of hemoptysis in a reference hospital for chest diseases. All the patients who admitted to our emergency clinic with hemoptysis during three months of study period were included in the study. The mean age of 143 patients (106 males, 37 females) who were included in this study was 48 +/- 17 years. Medical history, physical examination and chest radiography were performed for each patient. Sputum examination for acid fast bacilli, computed tomography of thorax, fiberoptic bronchoscopy, ventilation-perfusion scintigraphy, echocardiography, ear-nose-throat examination and upper gastrointestinal system endoscopy were the further diagnostic investigations for selected patients. Bronchiectasis was the most common cause of hemoptysis (22.4%), followed by lung cancer (18.9%), active tuberculosis (11.2%), and inactive tuberculosis (10.5%). Sputum smear for acid fast bacilli was performed in 102 patients and were positive in 15.6% of them. Computed tomography of thorax was performed in 102 patients and was pathologic in 81.3% of them. Fiberoptic bronchoscopy was performed in 46 patients and localized the bleeding site in 67.4% of them. In conclusion, the most common causes of hemoptysis were bronchiectasis, lung cancer and tuberculosis in our hospital. Based on this finding, we suggest that, the diagnostic approach to the patients presenting with hemoptysis should include first a detailed medical history, physical examination, and chest radiography; second sputum smear for acid fast bacilli; third computed tomography of thorax and lastly fiberoptic bronchoscopy.

Adolescent↗
PubMed2006

[A case of successful bronchial artery embolization for primary racemose hemangioma with massive hemoptysis].

We encountered a case of primary racemose hemangioma treatment with successful bronchial artery embolism for massive hemoptysis. A 56-year-old woman with massive hemoptysis was transported to our hospital. The source of the massive hemoptysis was observed to be from around a non-pulsatile polyp covered by normal mucosa occluding the truncus intermedius by fiberoptic bronchoscopy. We stopped the bleeding temporarily using differential lung ventilation, and then bronchial artery angiography was performed. The main right bronchial artery was enlarged, and enlarged and convoluted right peripheral bronchial vessels were also observed. We diagnosed the massive bleeding to be due to racemose hemangioma. A successful bronchial artery embolization (BAE) was performed with gelforms and metallic coils for the treatment of racemose hemangioma. There has been no recurrence of hemoptysis for one year after BAE. There have been many reports on massive hemoptysis as in this patient who were treated by lobectomy, nevertheless we would like to state BAE should be considered as a suitable treatments for primary racemose hemangioma with hemoptysis if there is no recognizable shunt artery.

Bronchial Arteries↗
PubMed1991

A reappraisal of the causes of hemoptysis.

We reviewed the records of 264 patients who underwent fiberoptic bronchoscopy for unexplained hemoptysis to determine the various causes of hemoptysis. Bronchogenic carcinoma (29%), bronchitis (23%), and idiopathic hemoptysis (22%) accounted for the majority of causes of hemoptysis. In contrast to older studies, the incidence of hemoptysis secondary to tuberculosis and bronchiectasis has decreased. Although our patient population is predominantly male and elderly, our data may well be representative of more recent epidemiologic trends in causes of hemoptysis.

Adult↗
PubMed1991

[Bronchial and non-bronchial systemic artery embolization for hemoptysis due to non-neoplastic lung diseases. Immediate effect and long-term results].

Forty-four patients with massive or repeated hemoptysis due to nonneoplastic lung diseases were treated by embolization of the bronchial and non-bronchial systemic arteries with Ivalon particles or a mixture of Ivalon and gelatin sponge particles during the past five and a half years. Immediate control of hemoptysis was achieved in 43 patients (98%), and no spinal cord ischemia was observed. Among 30 patients followed for more than 12 months, successful control of hemoptysis was obtained in 22 (73%). Hemoptysis recurred in eight patients (27%); four underwent repeated embolotherapy alone, two underwent surgery alone, and two underwent repeated embolization and surgery. Successful control of hemoptysis was achieved after repeated embolization and/or surgery in all eight patients. It is concluded that embolization of bronchial and non-bronchial systemic arteries is an effective initial treatment for hemoptysis, and good long-term results can be obtained in combination with surgery.

Adult↗
PubMed1995

[Pulmonary endometriosis with recurrent catamenial hemoptysis].

A 32-year-old woman with a history of dilation and curettage for missed abortion at 31 years old had sudden hemoptysis during menstruation on May 25, 1993. She had catamenial hemoptysis again, and was admitted to our hospital on July 21, 1993. After admission, catamenial hemoptysis occurred, and a nodular shadow was noted in the right S4 area on chest roentgenogram and computed tomogram. A few days after menstruation, hemoptysis and the abnormal shadow on chest roentgenogram disappeared. Pulmonary endometriosis was diagnosed by clinical course, past history, and chest roentgenographic findings. During the next menstruation, hemoptysis and a nodular shadow in the right S4 area on chest roentgenogram recurred, so transbronchial lung biopsy and laparoscopy were done. TBLB specimens revealed macrophages with phagocytosed hemosiderin, and laparoscopy revealed pelvic endometriosis. She was treated with buserelin acetate. Catamenial hemoptysis and the nodular shadow on the chest roentgenogram disappeared after treatment.

Adult↗
PubMed1993

Management and prognosis of massive hemoptysis. Recent experience with 120 patients.

A retrospective analysis was done of 120 consecutive patients with life-threatening hemoptysis (greater than 200 ml of discharge per 24 hours) cared for between 1983 and 1990 at our institution. Seventy-nine percent of the patients (95/120) had hemoptysis exceeding 500 ml/24 hr. Inflammatory lung disease was the underlying cause in at least 85% of cases (n = 103); and of these, pulmonary tuberculosis was the primary diagnosis in 85% (88/103). Fifty-two patients (43%) had had a prior episode of massive hemoptysis, usually within 3 months of their admission. Urgent examination with rigid endoscope in 97 patients (81%) localized the bleeding in only 42 (43%). The overall hospital mortality rate was 10% (12/120) and was similar for those having pulmonary resection (7.1%, 3/42), and those assisted medically (11.5%, 9/78) (p = not significant). However, of these hospital survivors on whom 6-month follow-up was available, 36.4% (20/55) of those with medical management and none (0/39) (p < 0.001) of those with surgical management had recurrent massive hemoptysis. Forty-five percent of these cases were fatal. Current management of massive hemoptysis has resulted in improved hospital outcome. However, the high risk of recurrent and often fatal hemoptysis mandates the definitive management of the bronchial arteries before discharge from the hospital. Recent reports suggest that percutaneous embolization may be effective in nonsurgical candidates.

Adolescent↗
PubMed1998

[Management of hemoptysis in invasive pulmonary aspergillosis].

Invasive pulmonary aspergillosis is an opportunistic infection occurring in a background of severe immune depression. The majority of cases occur in patients who have malignant hematologic disease, particularly during chemotherapy induction or consolidations phases for acute non-lymphocytic leukemia. The principal risk factors are profound (PN < 500 per mm3) and prolonged (very high risk beyond 20 days) neutropenia, perturbed phagocyte function and cellular immune deficiency (AIDS, immunosuppressive treatment in organ and bone marrow recipients). Clinically, invasive pulmonary aspergillosis presents as acute non-specific pneumonia with cough, chest pain and fever. The severe infection rapidly becomes life-threatening. The development of massive hemoptysis is a major risk. We report four cases of invasive pulmonary aspergillosis in patients who had hemoptysis. All four patients developed non-specific pneumonia resistant to broad-spectrum antibiotics during post-chemotherapy aplasia. Computed tomography of the thorax and bronchoscopy with bronchoalveolar lavage was performed due to the occurrence of hemoptysis. In the first two cases, the patients were recovering from aplasia. The thoracic CT scan showed evidence of a cavitating mass with peripheral vessels. Bronchoscopy findings suggested mucosal lesions. The patients were managed surgically. Pathology confirmed the diagnosis of invasive pulmonary aspergillosis with the presence of ischemic necrosis of the pulmonary parenchyma harboring numerous aspergillus filaments. Outcome was favorable and chemotherapy was re-initiated in one case. These two patient died from their hematological disease a few months later. The other two patients remained in aplasia. A CT of the thorax showed multifocal infiltration with vascular contact. Bronchoscopy was again suggestive. One patient developed massive hemoptysis with respiratory distress. Embolization was performed but the patient died two days after onset of hemoptysis. In the last case, embolization was successful and outcome was favorable enabling a bone marrow allograft; the patient died a few months later from the hematological disease. The potential gravity of hemoptysis in the course of invasive pulmonary aspergillosis should lead to early treatment with emergency CT scan and, if possible, bronchoscopy with bronchoalveolar lavage to establish the therapeutic strategy based on surgical excision or embolization of the pulmonary or bronchial arteries.

Adult↗
PubMed2002

Massive hemoptysis requiring intensive care.

OBJECTIVES: Massive hemoptysis can cause airway or hemodynamic compromise requiring intensive care. We reviewed the management and outcome of this group of patients in our institution. DESIGN: Retrospective analysis. SETTING: Medical intensive care unit (MICU) in a tertiary care hospital. PATIENTS: Patients (29 patients with 31 episodes) who were admitted to the MICU for massive hemoptysis (greater than 300 ml/24 h or requiring intubation) between August 1997 and April 2001. MANAGEMENT: Patients were intensively monitored and electively intubated if there was danger of airway compromise. Fiberoptic bronchoscopy was performed to assess the site of bleeding and patients had bronchial artery embolisation if deemed suitable. Patients in whom bleeding could not be controlled were referred for emergency surgery. RESULTS: In 26/31 (84%) episodes, patients required intubation. Bronchoscopy was more helpful in localising the bleeding (site of bleeding identified in 90%) than chest X-ray alone (identified site of bleeding in 64%). Bleeding was stopped with medical therapy in 8/31 (26%) patient; 16/31(51%) patients were successfully treated with embolisation. Only four (13%) patients went for emergency surgery, of whom one died. Overall in-hospital mortality was 4/31 patients (13%). Over a 2 year follow-up, 6/27 (22%) survivors had recurrent hemoptysis and another 4 (15%) died of unrelated causes. CONCLUSIONS: Intensive care and monitoring with endotracheal intubation, when necessary, are useful in massive hemoptysis. Bronchoscopy should be performed to help localise the bleeding site. Embolisation is a suitable first-line treatment for massive hemoptysis, reserving emergency surgery for cases where the above measures are insufficient to control bleeding.

Adult↗
PubMed2003

Life-threatening hemoptysis in adults with community-acquired pneumonia due to Panton-Valentine leukocidin-secreting Staphylococcus aureus.

Three new consecutive cases of life-threatening hemoptysis in adults with community-acquired pneumonia due to Panton-Valentine leukocidin-secreting Staphylococcus aureus are presented, focusing on the particular clinical presentation of this new entity. Between December 1999 and March 2001, three adults aged from 23 to 67 years were admitted to our respiratory intensive care unit for massive hemoptysis and septic shock associated with community-acquired Staphylococcus aureus pneumonia. Isolates were sent to the Centre National de Référence des Toxémies Staphylococciques in Lyon, France, where they were found to secrete Panton-Valentive leukocidin. The clinical course was similar in the three patients, with massive hemoptysis and septic shock necessitating mechanical ventilation. Two patients died rapidly; necropsy showed pulmonary vascular necrosis in one of them. The third patient recovered after appropriate antibiotic therapy. Leukocidin/neutrophil interactions in the pulmonary vasculature may cause severe hemoptysis in patients with community-acquired Staphylococcus aureus pneumonia secreting Panton-Valentine leukocidin. Adult patients with massive hemoptysis and suspected community-acquired pneumonia should receive antibiotic regimens covering Staphylococcus aureus.

Adult↗
PubMedDate not supplied

Management of severe hemoptysis from pulmonary aspergilloma using endovascular embolization.

PURPOSE: To determine the effectiveness of endovascular embolization as a temporizing measure in the management of severe hemoptysis caused by intracavitary pulmonary aspergilloma. METHODS: Patients presenting with hemoptysis, estimated to be more than 300 ml in the preceding 24 hr, in whom a radiological diagnosis of pulmonary aspergilloma was made on chest radiographs and/or computed tomography of the chest were subjected to bronchial and systemic arteriography and embolization using triacryl microspheres. RESULTS: Twelve patients with upper lobe intracavitary aspergillomas were managed with embolization. In 11 patients hemoptysis stopped within 24 hr and with no recurrence over the next 4 weeks. In 1 patient hemoptysis persisted and an upper lobe lobectomy was performed. CONCLUSION: Embolization of bronchial and systemic arteries is an effective method for treating acute severe hemoptysis from intracavitary aspergillomas, allowing the patient time to recover for definitive surgical management.

Acute Disease↗
PubMed2006

Natural history and therapeutic implications of patients with catamenial hemoptysis.

Evidence as to whether clinician has to give specific treatment in all patients of catamenial hemoptysis is unclear. We considered that the current treatment such as long-term usage of hormonal agent or surgery might be excessive for the catamenial hemoptysis. Therefore, we developed prospective observation study with observation strategy and follow-up for the patients. In sequential four patients of catamenial hemoptysis between December 2000 and November 2001, physical examination, chest X-ray, pelvic ultrasonogram and chest CT scan were taken at both the diagnosis and last follow-up. All patients were only observed without specific treatment within the limit of the possibility and followed for average 58 months. Mean age of patients was 23.5years (range, 22-25years). All patients have a history of undertaking one or two dilatations and curettages before diagnosis. The chest CT scans of all patients presented with ground-glass opacities of peripheral location that were disappeared without any residual lesion at last follow-up. Hemoptysis of two patients was spontaneously disappeared after 6 months. In the other two patients, it was greatly lessened in amount and frequency, then clinically insignificant in one. It was disappeared after subsequent 2 months and then relapsed two times in the late of follow-up of another patient. This study suggests that observation only may be an alternative option in the treatment of catamenial hemoptysis.

Adult↗
PubMed1981

Massive hemoptysis: control by transcatheter bronchial artery embolization.

Massive hemoptysis (600 ml in 48 hours) has an ominous prognosis with a mortality of 50 to 100% in medically treated patients and up to 35% in patients undergoing operation. Surgical resection has been the procedure of choice in patients with massive hemoptysis. Those with a contraindication to operation present a particularly frustrating problem. We have treated 7 such patients with massive hemoptysis by transcatheter bronchial artery embolization. In all 7, the bleeding was arrested. Two patients died of recurrent hemoptysis, 1 ten days and the other 2 months following embolization, and 5 are well 1 month to one year later. Transcatheter bronchial artery embolization is a valuable therapeutic modality in patients with massive hemoptysis. However, the procedure is palliative, and, therefore, elective resection must be considered as definitive treatment in those patients who have no contraindication to operation.

Adult↗
PubMed2001

Role of physiological lung exclusion in difficult lung resections for massive hemoptysis and other problems.

OBJECTIVES: Pulmonary tuberculosis and bronchiectasis are the major causes of massive hemoptysis in developing countries. Lung resection remains the surgical treatment of choice. This may not always be possible and may even be hazardous in some patients due to fibrosis and dense vascular adhesions between the lung and the chest wall. This leads to marked blood loss and control of hilar vessels becomes dangerous. METHODS: A series of 20 cases is described here. Nineteen presented with massive hemoptysis where control of bleeding was obtained by physiological lung exclusion. One patient had traumatic left main bronchus transection not suitable for repair or resection. Physiological lung exclusion was performed by surgical interruption of the bronchus and pulmonary artery of the involved lobe or lung, keeping pulmonary veins intact. RESULTS: Hemoptysis could be controlled in all these patients without any significant morbidity. There was no mortality. There was no postoperative empyema and recurrence of hemoptysis on long-term follow-up. No patient required anatomical lung resection later on. CONCLUSIONS: Physiological lung exclusion is a safe and effective method for control of massive hemoptysis in cases where lung resection is technically hazardous or difficult. This should be kept as an alternative or adjunct to anatomical lung resection.

Adolescent↗
PubMed2003

Management of massive hemoptysis in a thoracic surgical unit.

OBJECTIVE: Massive hemoptysis is a life-threatening condition. Surgery is effective but we are sometimes reluctant to operate on patients with this condition. We reviewed our experience with patients who underwent emergency surgery for massive hemoptysis to verify the indications for non-emergency surgical intervention. METHODS: We reviewed chest computed tomography (CT) and angiographic and pathological findings and the postoperative course of 25 patients who underwent emergency pulmonary resection in our department between 1979 and 2001 due to life-threatening hemoptysis. RESULTS: CT revealed a persistent cavity within the radiological opacity before massive hemoptysis in 12 patients (48%). Of the 21 patients who underwent angiography, nine showed focal bleeding in one bronchial branch and the others showed bleeding in multiple branches. Of these nine patients, seven did not undergo embolotherapy mainly due to minor vascularity. In the remaining patients, embolotherapy was not indicated in six due to multiple bleeding feeders and recurrence after embolotherapy was seen in six. Pathological findings showed that eight of the 12 patients with multiple systemic shunts had a fungal infection. Operative morbidity and hospital mortality were 32 and 4%, respectively. There was no recurrence in patients who underwent surgical treatment. CONCLUSIONS: Early pulmonary resection is indicated in patients with hemoptysis of multiple branches from the cavity and chest wall, such as in fungal infections. When a bronchial branch is the only bleeding focus, superselective embolotherapy should be considered prior to surgery even if the localized focus of the bronchial branch shows minor vascularity on the angiography.

Adult↗