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PubMedDate not supplied

Superselective bronchial artery embolization for hemoptysis with a coaxial microcatheter system.

PURPOSE: To compare the effectiveness and safety of superselective bronchial artery embolization with that of nonsuperselective embolization in the control of hemoptysis. MATERIALS AND METHODS: Retrospective case analysis was done for 47 patients with hemoptysis originating from a variety of causes. In 22 patients, embolization was performed superselectively using a microcatheter inserted into the bronchial artery beyond the spinal or mediastinal branches (superselective group). In the remaining 25 patients, embolization was performed at the opening of the bronchial artery with a 5-F catheter (nonsuperselective group). RESULTS: Initial hemoptysis control rates were 96% (21 of 22) in the superselective group and 88% (22 of 25) in the nonsuperselective group. Cumulative hemoptysis control rates of the superselective and nonsuperselective groups were 80% and 67% at 6 months, 79% and 56% at 1 and 2 years, and 79% and 48% at 3 years, respectively (not significant; generalized Wilcoxon test). One major complication (spinal infarction) occurred in the nonsuperselective group. CONCLUSIONS: Superselective embolization is safer and more effective way to control hemoptysis than the ordinary (nonsuperselective) method.

Adult↗
PubMed2006

Imaging and interventional radiological treatment of hemoptysis.

Hemoptysis is coughing up blood originating from the lower respiratory tract. There are multiple causes of hemoptysis, from airway diseases, parenchymal diseases, cardiovascular diseases, and other causes. Hemoptysis may cease temporarily, but a possible life-threatening condition may still be present, requiring complete evaluation and probably treatment. Massive hemoptysis (>300 ml blood in 24 hours) seldom occurs but has high mortality. Diagnostic examinations include patient history, physical examination, bronchoscopy, laboratory tests, chest X-ray, computed tomography (CT) of the chest, pulmonary angiography, aortography, and angiography of the bronchials and other thoracic systemic arteries. Bronchoscopy together with clinical and radiological examinations indicates from which part of the lung the bleeding is occurring, yet the cause of hemoptysis cannot be determined in 20-30% of cases. One of the therapeutic measurements may be embolization of the bleeding vessel such as in pulmonary arteriovenous malformations or in bronchial or other systemic arterial branches supplying the bleeding lung segment. Systemic bronchial and non-bronchial collateral artery anatomy is very complex and variable, and it may be difficult to recognize how the systemic arteries or pulmonary arteries may be involved as a source of bleeding. Interventional treatments are effective and safe therapeutic methods which reduce the need for acute thoracic surgery. Embolization may be life saving, or it may postpone surgery and, in some situations, should be the treatment of choice.

Aorta↗
PubMed2003

Massive hemoptysis caused by endobronchial schwannoma in a patient with neurofibromatosis 2.

Neurogenic tumor of the lung is very uncommon. To the best of our knowledge, endobronchial schwannoma complicated by massive hemoptysis in a patient with neurofibromatosis 2 has not been reported previously. We report a case of endobronchial schwannoma complicated by massive hemoptysis in an 18-year-old man with neurofibromatosis 2. The diagnosis of neurofibromatosis 2 was established by demonstration of bilateral vestibular schwannomas on magnetic resonance imaging of the brain and pathologic examination of the resected brain tumors. Massive hemoptysis developed after surgical removal of the brain tumors in this patient. Bronchoscopy was done immediately after the first episode of hemoptysis and a tumor protruding from the orifice of the right lower lobe bronchus was found. Despite 2 additional bronchoscopies to stop bleeding and ameliorate airway obstruction in the consecutive 2 days, hemoptysis recurred rapidly and caused profound oxygen desaturation. The patient was subjected to right lower lobectomy and endobronchial schwannoma was evidenced pathologically.

Adolescent↗
PubMed2006

A rare cause of hemoptysis: factitious disorder.

Hemoptysis is an important symptom that requires broad evaluation, including invasive procedures. Nevertheless, in a considerable number of patients, the cause of hemoptysis may not be adequately determined despite extensive investigations. Factitious hemoptysis is a manifiestation of Munchausen syndrome that describes a group of patients who intentionally produce or feign symptoms or disabilities. Although the disorder is rare, it is believed to be under recognized and under reported. Therefore, there is an urgent need for increased awareness of the disease in order to avoid unnecessary, expensive and sometimes dangerous medical treatment and manipulations. We report a case of Munchausen hemoptysis as a reminder that factitious origins should be added in the differential diagnosis of hemoptysis of unclear etiology.

Adult↗
PubMed2006

Effective use of corticosteroids in treatment of plastic bronchitis with hemoptysis in Chinese adults.

AIM: To investigate whether corticosteroids are effective in the treatment of plastic bronchitis with hemoptysis. METHODS: A retrospective, clinical study was undertaken. Thirty two patients with only first episodes of plastic bronchitis with hemoptysis were divided into a steroid group (n=18) treated with glucocorticoids, and a non-steroid group (n=14). The supportive therapy was uniformly applied to both groups, except for glucocorticoids. Variables such as temperature and white blood cell counts were determined. Furthermore, the volume of hemoptysis and bronchial casts were evaluated in detail daily. RESULTS: There was no difference in the demographic data and variables at baseline between both groups (all P>0.05). On days 5, 6, 7 and 8, the volume of hemoptysis was significantly decreased in the steroid group compared with the non-steroid group (43+/-15 mL vs 117+/-33 mL on d 5, 29+/-12 mL vs 97+/-23 mL on d 6, 18+/-10 mL vs 80+/-20 mL on d 7, and 13+/-8 mL vs 66+/-14 mL on d 8; all P<0.05), and on d 10 after fibreoptic bronchoscopy, the cases with bronchial casts was reduced evidently in the steroid group in comparison with the non-steroid group (OR=5.69, 95% CI=1.76-43.6; P=0.005). There was no significance in mechanical ventilation and mortality between both groups. CONCLUSION: Despite some limitations of this study, it has been demonstrated that, on the basis of common supportive therapy, corticosteroids would be effective and safe for the treatment of plastic bronchitis with hemoptysis.

Adrenal Cortex Hormones↗
PubMed2001

Treatment of recurrent severe hemoptysis in cystic fibrosis with tranexamic acid.

Major hemoptysis is a potentially life-threatening complication of cystic fibrosis (CF) lung disease. Bronchial artery embolization (BAE) along with treatment of a CF pulmonary exacerbation has become the most widely used therapeutic approach for major hemoptysis in CF. However, BAE has been associated with severe complications, especially when bronchial artery to spinal artery anastomoses are present. This case study describes the successful treatment of major hemoptysis in CF with tranexamic acid, in an individual in whom 12 previous BAE procedures had been performed and further procedures were contraindicated secondary to bronchial artery to spinal artery collaterals. Recurrence of the hemoptysis occurred after attempts had been made to withdraw the tranexamic acid. Tranexamic acid was resumed with resolution of the hemoptysis, and the therapy has been used continuously for 13 months without any complications.

Adult↗
PubMed1981

Clinical efficacy of early and delayed fiberoptic bronchoscopy in patients with hemoptysis.

We analyzed the records of 129 consecutive patients with hemoptysis to evaluate whether or not early (during hemoptysis or during the 48 h after hemoptysis stopped) fiberoptic bronchoscopy (FB) more frequently localized and/or diagnosed the source of bleeding and influenced clinical outcome than delayed FB (48 h or more after hemoptysis stopped). Patients were divided into 3 groups on the basis of their final diagnoses: neoplasm (31 patients), bronchitis/bronchiectasis (52 patients), and miscellaneous (46 patients). Although the likelihood of visualizing active bleeding (41 versus 8%) or its site (34 versus 11%) was significantly higher with early versus delayed FB, respectively, neither active bleeding nor a bleeding site were visualized in at least 60% of the 92 patients who underwent early FB. Definitive (endoscopic) diagnoses by early or delayed FB occurred primarily in patients with neoplasm. Clinical outcome based on the results of FB was not significantly different between the early and delayed groups. Thus, early, single FB was generally neither diagnostic nor therapeutically decisive in these patients with hemoptysis.

Adult↗
PubMed1987

Pulmonary artery agenesis presenting as massive hemoptysis--a case report.

Massive hemoptysis is the expectoration of approximately 600 ml of blood in twenty-four hours. Major causes of massive hemoptysis are tuberculosis, bronchiectasis, pulmonary neoplasm, fungus ball, bronchial adenomas, lung abscess, intrabronchial rupture of an aortic aneurysm, cystic fibrosis, pulmonary infarction, and pulmonary trauma. Other, less common causes include Goodpasture's syndrome, broncholiths, pulmonary varix, A-V malformation, and bleeding disorders. Agenesis of the pulmonary artery usually occurs in association with congenital cardiac anomalies, and isolated unilateral absence of the pulmonary artery is uncommon. About 10% of the patients with pulmonary artery agenesis develop inconsequential hemoptysis, but massive hemoptysis is a very rare complication of this anomaly. The following is a case report of a twenty-nine-year-old man with agenesis of the left pulmonary artery, who presented with massive hemoptysis requiring embolization and, eventually, pneumonectomy.

Adult↗
PubMedDate not supplied

Hemoptysis in children.

Hemoptysis is uncommon in the pediatric age group. There is little mentioned regarding this problem in either the pediatric or the otolaryngologic literature. A review of the past ten years' experience at the Children's Hospital of Philadelphia identified 40 patients whose presenting symptoms included hemoptysis. Causes of the hemoptysis included tumor, infection, trauma, and foreign bodies, as well as a variety of other conditions. Based on these findings, a systematic approach to the diagnostic evaluation of the pediatric patient with hemoptysis has been developed. A thorough endoscopic examination of the upper aerodigestive tract is essential in most cases, and can have both diagnostic and therapeutic value. Particular attention is directed toward airway management in patients with massive hemorrhage. Close cooperation among the bronchoesophagologist, pediatrician, and anesthesiologist is mandatory for optimal care of the child with hemoptysis.

Adolescent↗
PubMed1977

Death-producing hemoptysis in tuberculosis.

Massive hemoptysis in patients with tuberculosis is reported infrequently and then virtually always in association with cavitary disease or aspergilloma. In contrast, we describe herein five cases characterized by hemoptysis on admission, bilateral pulmonary disease, samples of sputum positive for acid-fast bacilli by Ziehl-Neelsen stain, and no obvious cavitary disease. In each, hemoptysis subsided and then suddenly recurred in prodigious amounts, leading to death, probably from asyphyxiation. In patients hospitalized with tuberculous hemoptysis of any amount, with or without an obvious cavity, aggressive diagnostic evaluation, including bronchoscopic examination, may define the site of bleeding, thus permitting rapid surgical intervention if the hemoptysis increases.

Adult↗
PubMed1985

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

We reviewed the charts of 48 consecutive patients who had fiberoptic bronchoscopy performed in the evaluation of hemoptysis with a normal chest roentgenogram. Fiberoptic bronchoscopy provided a diagnosis other than endobronchial inflammation in only four patients--benign fibromuscular polyp in one patient, Mycobacterium tuberculosis in 1 patient, and carcinoma in two others. A literature review revealed an overall 3 percent incidence of bronchogenic carcinoma in patients with hemoptysis and normal findings on chest roentgenogram. Other than abnormal findings on chest roentgenogram, risk factors for carcinoma in patients with hemoptysis include: (1) age greater than 40; (2) significant smoking history; and (3) duration of hemoptysis for longer than one week. We concluded that in patients with hemoptysis and normal chest x-ray film findings, routine fiberoptic bronchoscopy may not always be indicated to rule out malignancy.

Adult↗
PubMed2006

Hemoptysis and breath-holding diving.

OBJECTIVE: We aim to present one case with hemoptysis. Pulmonary barotrauma of descent (lung squeeze) has been described in breath-hold divers when the lung volume becomes smaller than the residual volume, with the effect of increased ambient pressure. METHODS: We report one case of hemoptysis in a breath-hold diver who dove for exercise of military action. RESULTS: The patient's hemoglobin and hematocrit levels were 7.3 g/dL and 26%, respectively. The computed tomography of thorax obtained 5 hours after the diving event revealed images suggestive of hemoptysis. The diagnosis of hemoptysis was made based on the diver's history and computed tomography findings. All of the divers performed voluntary diaphragmatic contractions at the beginning of their ascent, while their mouths and noses were closed. CONCLUSION: We suggest that the negative intrathoracic pressure attributable to the forced attempt to breathe along with voluntary diaphragmatic contractions contributes to hemoptysis, since it may damage the pulmonary capillaries.

Adult↗
PubMed1999

[Vasculo-Behcet's disease with fatal massive hemoptysis].

A 39-year-old man was admitted to our hospital because of hemoptysis. A chest X-ray film on admission showed a patchy shadow in the left lower lung field. Computed tomography revealed nodular opacities in the left pulmonary artery. The patient had history of oral ulcers, erythema nodosum, pustular lesions, and genital ulcers. Furthermore, the needle reaction was positive. Our diagnosis was an incomplete type of Behcet's disease. A radionuclide-venography and lung-perfusion study disclosed deep-vein thrombosis. Combined therapy with prednisolone, colchicine, and indomethacin farnesil was initiated, but the patient died of massive hemoptysis. Pathological examination revealed a ruptured aneurysm in the bronchus segmentalis apacalis and thrombotic angitis in the inferior vena cava. Behcet's disease is rarely a cause of hemoptysis. However, the prevalence of hemoptysis due to pulmonary vasculitis in patients with Behcet's disease has been reported to be 5 to 10% which is not so rare. Because of the poor prognosis, we want to emphasize Behcet's disease as a cause of hemoptysis.

Adult↗
PubMed2000

Catamenial hemoptysis: report of a case treated with thoracoscopic wedge resection.

Catamenial hemoptysis is a rare form of hemoptysis. It is a term for the condition of hemoptysis associated with menses. Few cases have been reported in the literature. Only one case, treated by video-assisted thoracoscopic wedge resection, has been described. We report the case of a 26-year-old woman who suffered from catamenial hemoptysis for 7 months and was treated successfully with a video-assisted thoracoscopic (VATS) wedge resection of the lesion. No evidence of recurrence was noted in the postoperative follow-up period of 48 months. We suggest that VATS is the good choice for single focus catamenial hemoptysis.

Adult↗
PubMed2000

Management of massive hemoptysis: a single institution experience.

BACKGROUND: Massive hemoptysis is a life threatening condition. Several therapeutic strategies have been applied in the clinical setting, with variable results. We reviewed our recent experience on this subject. MATERIAL AND METHODS: In a 5-year period, fifty-four patients (41 males, mean age 57.9 years) were treated for massive hemoptysis in our unit. The underlying pathology included bronchiectasis (n=31), active tuberculosis (n=9), pneumoconiosis (n=3), lung cancer (n=2) and pulmonary angiodysplasia (n=1). These patients often present with continuous bleeding with large volume of hemoptysis, or with recurrent episodes of bleeding. Bronchoscopic assessment and interventions were performed upon admission in all patients. Surgery was considered if the patient had acceptable pulmonary reserve and a bleeding source was clearly identified. If the patient was not considered fit for surgery, bronchial artery embolization was attempted. RESULTS: Hemoptysis ceased with conservative management in 7 patients (13%) only. Twenty seven (50%) patients received surgical resection. The procedures included lobectomy (n=21), bilobectomy (n=4) and pneumonectomy (n=2). The in-hospital mortality after surgery was 15%. Postoperative morbidity occurred in 8 patients, including prolonged ventilatory support, bronchopleural fistulae, empyema and myocardial infarction. Twenty-one patients not suitable for surgery were treated with bronchial artery embolisation, which was successful in 17 patients without any complications. CONCLUSION: The clinical outcome for massive hemoptysis reflects the generalized nature of a destructive disease process involving both lungs and a limited respiratory reserve. Surgery is associated with high risk of morbidity and mortality, and should be performed only in selected patients. Meanwhile, aggressive conservative therapy including bronchial artery embolization should be pursued.

Adolescent↗
PubMed2001

The causes of massive hemoptysis.

In a group of 656 patients examined for hemoptysis of unknown etiology the average amount of expectorated blood in individual diagnostic groups was evaluated and the patients with massive hemoptysis (> 100 ml/24 hrs) were selected. The hemoptysis was evaluated as massive in 53 patients (8%), being most frequent in patients with chronic anatomical changes of lung parenchyma (22/64) and active tuberculosis (4/26). The fact that massive hemoptysis endangers above all patients with bronchiectasis and other anatomical disorders of the lung parenchyma was evident through the comparison of the average maximal amount of expectorated blood, which was significantly higher in this group (78 ml/24 hrs) than in the majority of other diagnoses (total average 22 ml/24 hrs). In conclusion, the risk of sudden massive hemoptysis should be kept in mind in these patients even if only minimal bleeding occurs and energetic cautionary measures should be implemented right from the onset of bloody expectoration.

Female↗
PubMed2003

[Value of thoracic CT in the management of severe hemoptysis].

PURPOSE: To assess the value of thoracic CT in the management of patients with severe hemoptysis. PATIENTS AND METHODS: Between January 1997 and January 2001, 62 patients were investigated for severe hemoptysis (>300 ml/24H). The protocol, performed before angiography and embolization, included bronchial fiberoptic examination (BFE) followed by thoracic spiral CT-angiography. Data recorded at CT and BFE were the presence and location of bleeding, the etiology of hemoptysis and the therapeutic modality. RESULTS: Nine patients with life-threatening hemoptysis directly underwent bronchial embolization. CT was available in the 53 remaining patients. No abnormality was found in 4 patients. CT assessed the presence (n=49) and the location (n=38) of the bleeding. The etiology was determined in 49 patients. BFE was feasible in 38/53 patients. BFE assessed the presence (n=38) and location (n=15) of the bleeding. The etiology was determined in 12 cases of bronchial tumour. The available findings of CT and BFE for the presence and the location of the bleeding were concordant. Comparing fiberoptic examination and thoracic CT, the percentages of localized bleedings (39% and 72%) and demonstrated etiologies (32% and 92%), were significantly different (p<0,005 and p<0.0001 respectively). CONCLUSION: Although retrospective and limited by the small number of cases, our study provides arguments to perform thoracic CT before bronchial fiberoptic examination for the management of severe hemoptysis.

Adolescent↗
PubMed2004

Two hundred and fifty-eight cases of hemoptysis treated by injection of vitamin K3 into Chize point.

Injection of vitamin K3 into Chize (LU 5) was used from 1980 to 1992 in 258 inpatients suffering from diseases of the respiratory system accompanied with hemoptysis. As a result, the effective rate was 83% for mild hemoptysis and 72.1% for moderate hemoptysis in the treatment group, as compared to 48.5% and 45.2% respectively in control group A, and to 83.8% and 75% in control group B. There was a significant difference between the treatment group and control group A (P < 0.01). However, the effective rate was only 31.8% for severe hemoptysis in the treatment group, as compared to 81.3% in control group B with a significant difference. It is therefor concluded that injection of vitamin K3 into Chize is a good therapy for mild or moderate hemoptysis but not for severe cases.

Acupuncture Points↗