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At least 19 recordsLinked to original sources
PubMed1996

[Two cases of recurrent, massive hemoptysis with contralateral, concurrent hemoptysis].

Bilateral, concurrent massive hemoptysis with respiratory failure is rare and difficult to manage. We encountered two patients with this condition. One was a 51-year-old woman and one was a 63-year-old woman. Both had inactive pulmonary tuberculosis and episodes of hemoptysis. Home oxygen therapy was prescribed to the former patient and bronchial artery embolization was done in the latter. The sites of initial bleeding were in the left basal segment and in the lingular segment. Bleeding was well controlled by endobronchial tamponade with a Fogarty balloon catheter in the left main bronchus, contralateral intubation, and systemic artery embolization. Use of water instead of air in the balloon was more effective in over the long term. Concurrent bleeding from the contralateral upper lobe bronchus was controlled by compression with a tracheal tube cuff at the bronchial orifice. Afterward, an infiltrative shadow was seen on the chest X-ray film and hemoptysis occurred in case 2 occurred in case 2. Treatment with erythromycin and antituberculosis drugs brought about improvement of chest X-ray findings and disappearance of the hemoptysis.

Antitubercular Agents↗
PubMed1989

[Bronchoscopy in monosymptomatic hemoptysis--hemoptysis in bronchial carcinoma].

Blood in sputum, haemoptysis, is a common symptom in mucous membrane disorders of the respiratory tract--it is often seen in conjunction with inflammation but may also be associated with malignant tumours of the respiratory tract. In a survey of 422 patients with monosymptomatic haemoptysis, 15 patients with bronchogenic carcinoma were identified. A cytological examination of the sputum of these 15 patients was carried out, and in 9 of these cases suspected malignant cells were observed. From these and other observations it is concluded that with patients of over 40 years of age who are smokers with haemoptysis, but who display a normal X-ray examination of the thorax, it would be prudent to carry out a cytological examination of the sputum before bronchoscopy.

Adult↗
PubMed2001

Risk factors for massive hemoptysis after endobronchial brachytherapy in patients with tracheobronchial malignancies.

BACKGROUND: Massive and mostly fatal hemoptysis is a frequently reported morbidity after endobronchial brachytherapy (EBB) for tracheobronchial malignancies. However, to the authors' knowledge, it remains controversial whether this morbidity is related directly to EBB. To investigate whether massive hemoptysis is related to EBB, the authors retrospectively analyzed risk factors for massive hemoptysis after EBB. METHODS: Thirty-six patients (30 men and 6 women) with a mean age of 70 years underwent high-dose rate EBB for tracheobronchial malignancy using a cobolt-60 (Co-60) afterloading machine. EBB was performed as primary therapy in 6 patients and as salvage treatment for recurrent disease in 30 patients. EBB was delivered to the tracheal lesions in 15 patients and to the main bronchial lesions in 21 patients. EBB was combined with external beam radiation therapy (EBRT) in 24 patients, with laser photocoagulation in 3 patients, and with EBRT plus laser photocoagulation in 5 patients. The dose of EBRT delivered with the EBB ranged from 16-69 grays (Gy), with a mean dose of 37 Gy. RESULTS: At a mean follow-up of 18 months, 33 of the 36 patients had died. Eight of the 33 patients had no evidence of local disease at the time of death. Seven patients died of massive hemoptysis. The cumulative rate of massive hemoptysis was 29.4% at 2 years. According to univariate analysis, no statistically significant correlation with massive hemoptysis was observed for EBRT dose delivered in combination with EBB, EBB fractional and total doses, EBB length, and the sum of all the EBRT doses including that used for the initial treatment. Local failure or persistent malignancy (P = 0.033) and delivery of laser photocoagulation (P = 0.032) were found to be statistically significantly associated with massive hemoptysis. Direct contact between the EBB applicator and the tracheobronchial walls at the vicinity of the great vessels was observed in 16 patients and was found to be statistically significantly associated with massive hemoptysis (P = 0.003). In six patients, the applicator was in direct contact with two or more tracheobronchial walls at the vicinity of the great vessels; all these patients died of massive hemoptysis. CONCLUSIONS: Direct contact between the EBB applicator and the tracheobronchial walls at the vicinity of the great vessels was one of the significant risk factors for massive hemoptysis. To prevent massive hemoptysis, a specific spacer should be employed to maintain a safe distance between the applicator and the bronchial wall.

Aged↗
PubMed1997

The factors related to recurrence after transcatheter arterial embolization for the treatment of hemoptysis.

OBJECTIVES: Massive hemoptysis is a major clinical problem associated with high morbidity and mortality. Transcatheter arterial embolization is widely used for the treatment of massive hemoptysis, but it was reported that the recurrence rate after embolization is 12-54% in the previous studies. We evaluated the therapeutic effect of transcatheter arterial embolization for the treatment of massive hemoptysis and the factors related to recurrence. METHODS: We reviewed 51 patients (M:F = 36:15) of transcatheter arterial embolization for the treatment of massive hemoptysis from Jan 1988 to Dec 1994, retrospectively. RESULTS: After arterial embolization, immediate successful control (< 1 wk) of massive hempotysis was achieved in 48 of 51 patients (94.1%) and recurrence of hemoptysis was observed in 17 of 51 patients (33.3%) during the follow-up period. The patients with non-bronchial artery hemoptysis and multiple artery bleeding had increased tendency of recurrence (77.7%). On the previous history of hemoptysis, the patients with massive hemoptysis (> 400 ml/24hr) or frequent history of hemoptysis had increased tendency of recurrence (87.5%, 72.7%). CONCLUSION: Transcatheter arterial embolization is a useful and safe procedure for immediate control in massive hemoptysis. However, the patients with this procedure had a potentiality for recurrence. We suggest that close follow-up and caution will be needed in the patients with multiple artery bleeding or with large amounts of hemoptysis or with previous episodes more than 3 times.

Adult↗
PubMed2005

Surgical management of tuberculosis-related hemoptysis.

BACKGROUND: Tuberculosis is a disease that is often treated with chemotherapy. However, medical treatment usually fails in the management of tuberculosis-related hemoptysis. In this paper, we review our experience in the surgical treatment of tuberculosis-related hemoptysis. METHODS: Fifty-nine patients with tuberculosis-related hemoptysis (46 men, 13 women) who underwent surgical treatment were enrolled in this study. A thoracotomy was performed urgently in 21 patients with massive (>600 mL daily) hemoptysis, and within the first 2 days in 24 with major (200 to 600 mL daily) hemoptysis, and within the first 4 days in 14 with persistent minor (<200 mL daily) hemoptysis. RESULTS: A chest roentgenogram showed cavitary lesion in all of the patients with massive hemoptysis (21 patients), in 22 of 24 patients with major hemoptysis, and in 3 of 14 patients with persistent minor hemoptysis. Pneumonectomy was performed in 4 patients, lobectomy in 39 patients, and segmentectomy or wedge resection in 16 patients. The average hospitalization period was 13 days. The mortality rate was 6.8% perioperatively. Of the patients deceased, 3 were intubated with a single-lumen endotracheal tube and 1 with a double-lumen endotracheal tube. During the postoperative period, empyema and bronchopleural fistula developed in 3 patients, and no other severe complications occurred. The average postoperative follow-up period was 3 years. The number of thoracotomies for tuberculosis performed in the years from 1995 to 2003 was significantly decreased, compared with the years between 1985 to 1994 (p = 0.042). CONCLUSIONS: In tuberculosis-related hemoptysis, thoracotomy with double-lumen endotracheal intubation and resection of the cavity may be curative and lifesaving.

Adolescent↗
PubMed2004

Hemoptysis: bronchial and nonbronchial systemic arteries at 16-detector row CT.

PURPOSE: To retrospectively evaluate 16-detector row computed tomography (CT) compared with conventional angiography in depiction of bronchial and nonbronchial systemic arteries in patients with hemoptysis. MATERIALS AND METHODS: Institutional review board approval was obtained, and informed consent was not required. Sixteen-detector row helical CT and conventional angiography of the thorax were performed in 22 patients (16 men, six women; age range, 18-75 years; mean age, 50 years) with hemoptysis. Three observers in consensus analyzed retrospectively transverse, multiplanar reconstruction, or three-dimensional CT images for visibility, traceability of bronchial arteries from their origin at the aorta or aortic branches to the hilum, and presence of nonbronchial systemic arteries. CT and angiographic findings of bronchial and nonbronchial systemic arteries causing hemoptysis were compared by two radiologists in consensus. Differences in visibility, traceability, and diameter of bronchial arteries causing and those not causing hemoptysis were tested by using generalized estimating equation method or the mixed model. RESULTS: Fifty-two (30 right and 22 left) bronchial arteries and 33 nonbronchial systemic arteries were visible at CT. Thirty-four (20 right and 14 left) of 52 bronchial arteries were traceable from their origins to the hilum. Thirty-one (16 right and 15 left) of 46 (27 right and 19 left) bronchial arteries and 26 of 64 nonbronchial systemic arteries evaluated at angiography were causing hemoptysis. Forty (87%, 23 right and 17 left) of 46 bronchial arteries seen at angiography were also detected at CT. All 31 bronchial arteries and sixteen (62%) of 26 nonbronchial systemic arteries causing hemoptysis were detected at CT. Twenty-three (74%) of 31 bronchial arteries causing hemoptysis were traceable from their origins to the hilum, and one (11%) of nine bronchial arteries not causing hemoptysis was traceable (P = .002). CONCLUSION: Sixteen-detector row CT provides depiction and traceability of the bronchial arteries in patients with hemoptysis, and in most patients it enables detection of the bronchial and nonbronchial arteries causing hemoptysis.

Adolescent↗
PubMed1998

Hemoptysis in children.

BACKGROUND: Hemoptysis is rare in children, yet is one of the most frightening manifestations of cardiopulmonary disease. A wide spectrum of diseases has been reported to cause hemoptysis in children, but the search for a specific cause can be tedious and unrewarding. Early diagnosis and interventions of hemoptysis are extremely important for the successful management of this potentially lethal process in children. METHODS: From July 1994 to June 1996, 15 pediatric patients ranging from 1 month to 15 years of age were admitted to the Pulmonology division for the investigation of hemoptysis. We retrospectively reviewed the clinical records and diagnostic evaluations of these patients. RESULTS: Six (40%) of the patients investigated were infectious in origin, only one patient had tuberculous infection. Three patients had a traumatic cause and 2 patients had foreign bodies in the airway. Two cases had no obvious contributing cause of hemoptysis despite extensive investigations. One patient had hematemesis because bleeding from esophageal ulcerations was misinterpreted as hemoptysis. One patient had varicosed tracheal and bronchial collaterals causing massive hemoptysis due to portal vein obstruction and hypertension. CONCLUSION: Pulmonary infection was the leading cause of hemoptysis in the 15 children we studied, but Mycobacterium tuberculosis is an uncommon causative agent. Bronchoscopy is an extremely useful tool for the diagnosis and localization of hemoptysis. Hematemesis may be misinterpreted as hemoptysis, particularly when an accurate history is not possible in children, therefore, bleeding from the upper aerodigestive tract should be studied meticulously and excluded adequately using endoscopy.

Adolescent↗
PubMed1996

Significance of hemoptysis following thrombolytic therapy for acute myocardial infarction.

PURPOSE: To describe the occurrence, cause, and significance of hemoptysis following thrombolytic therapy for acute myocardial infarction. PATIENTS AND METHODS: We retrospectively reviewed 2,634 patients presenting with acute myocardial infarction who received thrombolytic therapy to determine the incidence of hemoptysis. Chart and radiographic review included the type, dose, and route of thrombolytic therapy. In addition, the onset, duration, and severity of hemoptysis were recorded and correlated with radiographic and bronchoscopic findings. RESULTS: Eleven patients (0.4%) developed hemoptysis following administration of thrombolytic therapy for an acute myocardial infarction. The duration and severity had a wide range, although no patient had significant hemodynamic compromise. The source of hemoptysis was identified in only one patient who had a tongue laceration following cardiopulmonary resuscitation, and blood was seen within the oropharynx and trachea. No definitive cause was identified in all other patients. There was no correlation between the different types or doses of thrombolytic therapy and the duration or severity of hemoptysis. Chest radiographs were nonspecific and demonstrated resolution within 11 days following hemoptysis. CT of the thorax in one patient and bronchoscopy in two patients confirmed chest radiographic findings and in no patient was an underlying pulmonary abnormality identified. CONCLUSIONS: Pulmonary hemorrhage and hemoptysis are unusual complications of thrombolytic therapy in patients with acute myocardial infarction. Although hemoptysis may be the first indicator of an underlying pulmonary abnormality, we found no case in which a significant abnormality was unmasked. This study suggests that follow-up chest radiographs are recommended and further evaluation may be unnecessary if complete resolution is demonstrated.

Aged↗
PubMed1996

Hemoptysis in HIV-infected patients.

STUDY OBJECTIVE: To define the causes and clinical features of hemoptysis in HIV-infected patients. DESIGN: Retrospective analysis of inpatient medical records for patients with HIV infection and hemoptysis. SETTING: A large New York City teaching hospital and tertiary referral center. PATIENTS: Fifty HIV-infected adult patients with 51 episodes of hemoptysis. RESULTS: The incidence of hemoptysis was 1.9%. A definite or presumptive etiology was identified for most (78%) episodes, with infection being the leading cause (80% of episodes with identified etiology). Hemoptysis was most often (40% of episodes with a definite or presumptive etiology) attributed to bacterial pneumonia. Mycobacterium tuberculosis was infrequently the cause of hemoptysis (6%). Mortality attributed to hemoptysis was 8%. In most patients, hemoptysis was mild (77%) and resolved (78%) without specific treatment. CONCLUSIONS: Our retrospective series of HIV-infected patients hospitalized for short-term care in New York City suggests that hemoptysis in this group has diverse causes but usually is infectious in etiology and most often due to bacterial pneumonia. Bleeding is typically mild and resolves without specific treatment, but can occasionally be fatal. Differential diagnosis should be approached with specific reference to this patient population and its unique features.

Adult↗
PubMed1997

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

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

Bronchiectasis↗
PubMed2002

Percutaneous embolotherapy for life-threatening hemoptysis.

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

Adult↗
PubMed1997

Hemoptysis: a 10-year retrospective study.

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

Adolescent↗