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PubMed1990

[A case of massive hemoptysis occurring after lung injury due to a torn segment of pleural calcification].

A 64-year-old man was referred to our hospital because of little improvement of hemoptysis lasting three days after drug therapy. A chest roentgenogram and fiberoptic bronchoscopic examination performed on the second hospital day when the patient experienced a massive hemoptysis of about 2,000 ml revealed arterial bleeding from the left upper lobe. Even after extensive embolizations of the left upper bronchial, the first, second, third and 4th intercostal arteries, the patient's hemoptysis did not improve. On the 73rd hospital day the patient underwent left upper lobectomy. Macroscopic and microscopic examinations in the resected specimen revealed lung injury due to a torn segment of pleural calcification after tuberculous pleuritis, resulting in the massive hemoptysis. Although physicians encounter many patients complaining of hemoptysis and/or hemosputum, this case is considered to be very rare.

Calcinosis↗
PubMed1990

[Preoperative therapeutic embolization for massive hemoptysis from bronchial collaterals in tetralogy of Fallot--a case report successfully treated by total correction].

Hemoptysis from bronchial collateral arteries in cyanotic heart diseases is a troublesome complication. We report a case of Tetralogy of Fallot presented with massive hemoptysis which was successfully treated with transcatheter therapeutic embolization prior to the radical operation. A 28-years old man was admitted to our hospital because of hemoptysis and dyspnea. On the day of admission, he had a massive hemoptysis and became asphyxic. Diagnostic cardiac catheterization performed next day revealed Tetralogy of Fallot. Bronchial arteriogram demonstrated large bronchial collateral arteries with heavy staining around the right lower lobe bronchus. Therapeutic embolization with Gelfoam was performed and the hemostasis was obtained. The radical operation was performed 4 months later. Before cardiopulmonary bypass, the right bronchial artery was ligated. He was weaned from the extracorporeal circulation under the stable circulatory condition, and respirator on the first post operative day without any complications, and he was discharged on the 57th day after the operation. We emphasize the efficacy of therapeutic embolization of the well developed bronchial collateral arteries as a pretreatment of hemoptysis in the cyanotic heart disease.

Adult↗
PubMed1983

Massive hemoptysis in cystic fibrosis.

Massive hemoptysis occurs in 5% to 7% of patients with cystic fibrosis. Approximately 11% of these patients will die within 48 hours of manifestation because of uncontrolled hemoptysis and asphyxiation. If conservative medical treatment fails to control hemoptysis, fiberoptic or rigid bronchoscopy is the least risky and most accurate method of localizing the source of hemoptysis. Acute control of hemoptysis can be obtained in up to 100% of patients with endobronchial Fogarty balloon tamponade and in up to 88% of patients with bronchial artery embolization. Emergency thoracotomy can be performed if the above fail, but only in patients with mild cystic fibrosis and adequate pulmonary reserve.

Bronchoscopy↗
PubMed1993

[A case of old pulmonary tuberculosis with repeated hemoptysis which presented therapeutic difficulties].

A 74-year-old male who had been infected with pulmonary tuberculosis since 1938 underwent thoracoplasty in 1955. After the operation, no symptoms manifested until 1988 when he developed hemosputum and hemoptysis in association with a cold with fever. Although he was admitted to a hospital, the symptoms could not be controlled, so he was referred to our department. The lesion causing the hemorrhage was considered to be in the upper lobe of the left lung. However, it would have been difficult to preserve respiratory function in the case of left upper lobectomy, because he had already undergone thoracoplasty on the right side. Therefore, bronchial artery embolization (BAE) using Spongel was performed. Second embolization was performed because hemoptysis referred after one month. However, the hemoptysis recurred again, so that two branches of the left subclavian artery and the left internal thoracic artery were ligated. No hemoptysis and hemosputum occurred for a while, but 2 years and 9 months after the operation, the patient was admitted due to hemoptysis with fever and coughing. Since the bronchial artery was embolized twice with spongel and twice with platinum coil, the patient's course has been good for 5 months.

Aged↗
PubMed1995

Hemoptysis and pseudohemoptysis: the patient expectorating blood.

Patients expectorating blood seek evaluation and treatment from a variety of clinicians. Although the bleeding may arise either from the lungs (hemoptysis) or from the upper aerodigestive tract (pseudohemoptysis), the evaluation commonly focuses on exclusion of a pulmonary neoplastic source. Likewise, most literary reviews only focus on hemoptysis as it relates to pulmonary malignancies. The present retrospective review identifies 471 patients with the diagnosis of hemoptysis over a six-year period, and 10% were ultimately found to have UAT etiologies for their bleeding. UAT cancers were identified as the source in 2.1% of all patients, either due to primary lesions or via metastases. The majority of UAT cancers had been previously diagnosed prior to this episode of hemoptysis. This review indicates that a thorough UAT history and exam is warranted in the hemoptysis patient because of the significant occurrence of UAT causes. However, the likelihood of finding an occult UAT cancer in this patient population is very low with the only risk factor being a previous history of a UAT neoplasm.

Adolescent↗
PubMed1996

Hemoptysis in children: the hospital for sick children experience.

Causes of hemoptysis in children have not been well documented in the paediatric otolaryngology literature. The aim of this retrospective review is to determine the commonest causes of hemoptysis in the paediatric age group presenting to an otolaryngologist. We reviewed the charts of patients presenting to an otolaryngologist at The Hospital for Sick Children, Toronto, Ontario, over a 10-year period. A total of 37 inpatients beyond the neonatal period were referred for further assessment of hemoptysis. Thirty-two patients (86.5%) underwent bronchoscopy to determine the cause, the hemoptysis resolving spontaneously in the remaining five patients without a diagnosis. Four patients who had a bronchoscopy also had no identifiable pathology. Tracheobronchitis was the commonest diagnosis (19%), followed by tracheotomy-related problems (15.5%) Other causes included bronchiectasis, aspiration of blood, pulmonary hemorrhage, foreign-body aspiration, cystic fibrosis, A-V malformation, tracheobronchial hemangioma, hereditary telangiectasia, laceration of a vocal cord, and pneumonia. Otolaryngologists need to be aware of the etiology of hemoptysis in children. The commonest causes are infection and trauma, and not vascular anomalies or neoplasms as often perceived.

Bronchitis↗
PubMed1996

[A case of catamenial hemoptysis (pulmonary endometriosis) cured by VATS lobectomy].

We report here a case in which for hemoptysis during menstruation (catamenial hemoptysis) right middle lobectomy was performed thoracoscopically under a preoperative diagnosis of pulmonary endometriosis with a successful outcome. The patient was a 27-year-old housewife who from the age of 24 years experienced hemoptysis during menstruation, and was diagnosed as having pulmonary endometriosis on the basis of detailed examinations including bronchoscopy and chest CT. From the age of 26 years hormone therapy was administered, but the hemoptysis recurred with the menstruation following its cessation. After admission to this department bronchoscopy performed at the time of menstruation revealed bleeding from right B4 while chest CT showed an abnormal shadow in right S4 b. Right middle lobectomy was then performed thoracoscopically under a diagnosis of right middle lobe endometriosis. In the resected specimen findings of pulmonary hemosiderosis, granulomatous phlebitis and micrometastases from a thyroid cancer were noted. The postoperative course was favorable with no further episodes of hemoptysis occurring. In this case histological proof of endometriosis could not be obtained, but the diagnosis of pulmonary endometriosis was strongly suggested by the clinical course and objective findings such as pulmonary hemosiderosis.

Adult↗
PubMed1997

[Usefulness of computed tomography of the chest in the evaluation of patients with massive hemoptysis].

BACKGROUND: The role of chest CT scan in the assessment of patients with hemoptysis is uncertain. AIM: To evaluate the usefulness of CT scan in patients with non massive hemoptysis. PATIENTS AND METHODS: Ninety six patients, 60 male, aged 23 to 76 years old, who presented with hemoptysis to an University Hospital, were studied. All patients were studied with a chest radiograph, a fiberoptic bronchoscopy and a high resolution CT scan. RESULTS: The final causes of hemoptysis were bronchiectasis in 27 cases, bronchogenic carcinoma in 24 cases and lung infections in nine. The source of bleeding was not identified in 18 patients (19%). CT scan clarified abnormalities seen in the chest radiograph in 30 patients (31%) and provided new diagnostic information in 13 (14%). CT scan correctly localized the source of bleeding found by fiberoptic bronchoscopy in 35 of 43 patients (81%), whereas chest radiograph did so in 27 (77%). All patients with bronchogenic carcinoma were identified by chest radiograph or bronchoscopy. Twenty of the 27 patients with bronchiectasis had radiological abnormalities in the chest radiograph. In only two patients, with lung metastases and non conclusive chest radiograph and bronchoscopy, CT scan provided information that significantly modified clinical management. CONCLUSIONS: CT scan was useful to stage patients with bronchogenic carcinoma and to assess the extension of bronchiectasis, but its impact in the management and clinical evolution of patients was limited. Therefore we do not recommend the routine use of CT scan in the assessment of patients with hemoptysis.

Adult↗
PubMedDate not supplied

Massive hemoptysis from a pulmonary sequestration controlled by embolization of aberrant pulmonary arteries: case report.

A case of massive hemoptysis due to pulmonary sequestration is presented. Initially, the diagnosis of sequestration was unsuspected and bronchial artery embolization was done for management of hemoptysis from the left lower lobe, but 4 days later massive hemoptysis recurred. Repeat arteriography, including a thoracoabdominal aortogram, revealed two large abdominal arteries penetrating the left diaphragm and feeding the lower lung. Embolization of the aberrant artery from the celiac trunk and the left inferior phrenic artery resulted in complete hemostasis until elective surgical ligation of the two arteries was performed 2 months later. The massive hemoptysis from a pulmonary sequestration could only be controlled after embolization of the transdiaphragmatic aberrant pulmonary arteries.

Aged↗
PubMedDate not supplied

Bronchial arteriography and embolotherapy for hemoptysis in patients with cystic fibrosis.

Bronchial arteriography and embolotherapy were performed to control hemoptysis in 11 patients with advanced stages of cystic fibrosis. Two patients suffered massive, 1 moderate, and 8 mild but recurrent hemoptysis. The embolization procedures were performed with Gelfoam, Ivalon, and coils in one to four separate procedures. Altogether, 19 of 20 procedures were successful, with follow-up periods ranging from 9 months to 8 years. No serious complications were encountered except for one femoral artery pseudoaneurysm which required surgical repair. Rapid digital subtraction angiography and "roadmapping" were considered helpful in avoiding the complication of reflux embolization and expediting the procedures. Bronchial embolization is a life-saving procedure for severe hemoptysis in patients with cystic fibrosis and is considered safe enough to include the indications of moderate and mild/recurrent hemoptysis to improve the quality of life in these patients.

Adolescent↗
PubMed2005

Major hemoptysis in adolescents.

The coughing up of blood or blood-tinged sputum in children is unusual but potentially lethal. The etiologies of hemoptyses in children differ from adults and vary among geographic locations. This paper reviews the clinical presentation and radiographic features of massive hemoptysis in adolescents seen in a single tertiary children's hospital in northern Taiwan during a 10-year period. Active pulmonary tuberculosis with cavity formations and dissemination, congenital heart diseases with hypertrophied bronchial artery and local bleeding were the 2 most common causes of major hemoptysis in this single institute experience. Most cases of major hemoptysis due to active pulmonary tuberculosis can be managed conservatively. For patients with respiratory compromise or hemodynamic instability, selective bronchial artery embolization effectively stopped hemoptysis without complications.

Adolescent↗
PubMed2001

Embolization for hemoptysis: a six -year review.

PURPOSE: To review our method of embolization for hemoptysis. METHODS: Between 1993 and 1999, 134 patients were treated in our department for hemoptysis. One hundred and sixteen patients were followed up (18 were lost to follow-up) over a period ranging from 1 to 66 months (median 9.5 months, SD 14.81 months). Most cases were due to tuberculosis (83.6%) and malignancy (9.5%). One hundred and three required embolization. Vascular access was obtained via the femoral route but two cases required a brachial approach for abnormal branches of the subclavian artery. All abnormal vessels found were embolized using polyvinyl alcohol particles alone or in combination with gelfoam. RESULTS: Bronchial artery hypertrophy was found in 88.3% of cases; about a third of which had a nonbronchial systemic contribution. No angiographic abnormalities were found in 11.2%. Our failure rate was 18.4% (58% required surgery while 42% died from massive hemoptysis). Sixteen cases required multiple embolization sessions. No major complications were encountered. CONCLUSION: Embolization is effective for treatment of moderate to massive hemoptysis. The majority of our cases were due to tuberculosis. Approximately one third had nonbronchial systemic artery contributions, indicating that a concerted search for these is mandatory.

Angiography↗
PubMedDate not supplied

Bronchial artery embolization for hemoptysis due to benign diseases: immediate and long-term results.

PURPOSE: To clarify the immediate effect and long-term results of bronchial artery embolization (BAE) for hemoptysis due to benign diseases and the factors influencing the outcomes. METHODS: One hundred and one patients (aged 34-89 years) received bronchial artery embolization with polyvinyl alcohol particles and gelatin sponge for massive or continuing moderate hemoptysis caused by benign pulmonary diseases and resistant to medical treatment. RESULTS: After BAE, bleeding stopped in 94 patients (94%). The immediate effect was unfavorable in cases where feeder vessels were overlooked or the embolization of the intercostal arteries was insufficient. Long-term cumulative hemoptysis nonrecurrence rates after the initial embolization were 77.7% for 1 year and 62.5% for 5 years. In bronchitis (n = 9) and active tuberculosis (n = 4) groups, an excellent (100%) 5-year cumulative nonrecurrence rate was obtained. The rate was lower in groups with pneumonia/abscess/pyothorax (n = 8) or with pulmonary aspergillosis (n = 9) (53.3%, 1-year cumulative nonrecurrence). There were higher incidences of early recurrence among patients with massive hemorrhage or more marked vascularity and systemic artery-pulmonary artery shunt in angiography: however, these trends were not statistically significant CONCLUSIONS: BAE can yield long-term benefit in patients with hemoptysis due to benign diseases. Technical problems in the procedure had an impact on the short-term effect. The degree of hemorrhage or the severity of angiographical findings were not significant factors affecting the outcome. The most significant factor affecting long-term results was whether the inflammation caused by the underlying disease was medically well controlled.

Adult↗
PubMed2005

Hemoptysis from collateral arteries 12 years after a fontan-type operation.

A 20-year-old patient who had a single ventricle and pulmonary stenosis presented with recurrent hemoptysis 12 years after a Fontan-type operation. He was referred to us because of unsuccessful treatment with a tentative diagnosis of lung tuberculosis for 3 months. He had been relatively well for the prior 12 years, although he had attacks of paroxysmal supraventricular tachycardia and had underwent successful catheter ablation 3 years ago. Aortography revealed multiple collateral arteries as a cause of hemoptysis and coil embolization of these collateral arteries successfully stopped the hemoptysis. This case illustrates that collateral arteries may stay open or develop, and these collateral arteries can become a source of hemoptysis long after a Fontan-type operation.

Abnormalities, Multiple↗
PubMed2003

Massive hemoptysis caused by tracheal hemangioma treated with interventional radiology.

Capillary hemangiomas of the tracheobronchial tree are extremely rare in adults, with hemoptysis being one of the most serious forms of presentation. An operation has been the treatment of choice, although it does involve high rates of morbidity and mortality, especially in emergency situations such as massive hemoptysis, which has led to the search for other therapeutic alternatives. There is no experience with embolization by interventional radiology when the hemoptysis is tracheal in origin, caused partly because the infrequency of this pathology; however, the foundations for it have been laid with the development of embolization for bronchopulmonary pathology. We report a case of a tracheal capillary hemangioma in a 66-year-old woman diagnosed with idiopathic thrombopenic purpura, which began as a massive hemoptysis and was treated successfully with embolization by interventional radiology. There has been no recurrence of the bleeding after 1 year's follow-up, and the patient's control fibrobronchoscopy is normal.

Aged↗
PubMed1999

Role of bronchoscopy in massive hemoptysis.

Massive hemoptysis accounts for a minority of all patients with hemoptysis but poses a major challenge for the acute and long-term treatment. Massive hemoptysis can lead to asphyxiation and airway obstruction, shock, and exsanguination. Bronchoscopy plays an integral part in managing massive hemoptysis in diagnosis and treatment (Table 5). Specifically, bronchoscopy allows lateralization and more specific localization of bleeding that is critically important for effective management. Furthermore, acute control of bleeding can sometimes be achieved with instruments and catheters placed through the bronchoscope or by agents instilled into the airways through the bronchoscope.

Bronchoscopy↗
PubMed1994

[Massive hemoptysis in a patient with an aortic pseudoaneurysm].

We present a case of non-fistulated, non-fissured arteriosclerotic pseudoaneurysm of the aorta in a patient with massive hemoptysis. The condition was resolved by resection, with the breach repaired with a Dacron patch. The diagnosis of thrombotic false aneurysm of the aorta was suspected after inspection of the digital angiograph and aortograph obtained by computed axial tomography. A review of the literature revealed 89 cases of non-surgically removable thoracic aortic aneurysm with hemoptysis; 72 of these cases involved aortobronchial fistulas. In only 1 case was the wall of the aneurysm intact, showing no fissures in spite of hemoptysis. The absence of fissuring or tearing in our patient may be accounted for by the delay of 10 days between the last bout of hemoptysis and surgical resection.

Acute Disease↗
PubMedDate not supplied

Mediastinal teratoma presenting as massive hemoptysis in an adult.

Massive hemoptysis is a rare but potentially life-threatening presentation in the emergency department (ED). We describe a case of massive hemoptysis caused by a mediastinal teratoma in an otherwise healthy young man. The teratoma had invaded into a bronchus and was resected successfully. The literature regarding massive hemoptysis due to mediastinal teratoma is reviewed. A differential diagnosis for massive hemoptysis is presented. The initial management of these patients in the ED and the diagnostic options are discussed.

Adult↗