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Thoracic Surgery Clinics Aug 2021Hemoptysis, defined as bleeding into the tracheobronchial tree, is a serious symptom that can cause asphyxiation if inadequately treated. Massive hemoptysis carries a... (Review)
Review
Hemoptysis, defined as bleeding into the tracheobronchial tree, is a serious symptom that can cause asphyxiation if inadequately treated. Massive hemoptysis carries a very high mortality risk, and therefore, a prompt multidisciplinary approach to hemoptysis is highly encouraged. Bronchial artery embolization has evolved as the mainstay of treatment in control of hemoptysis. It is a low-risk procedure that carries high initial clinical success rates. Despite relatively high recurrence rates, it can be repeated until the underlying disease process can be definitively treated.
Topics: Bronchial Arteries; Embolization, Therapeutic; Hemoptysis; Hemorrhage; Humans; Treatment Outcome
PubMed: 34304841
DOI: 10.1016/j.thorsurg.2021.04.012 -
Chest Jan 2020Massive hemoptysis is a medical emergency with high mortality presenting several difficult diagnostic and therapeutic challenges. The origin of bleeding and underlying... (Review)
Review
Massive hemoptysis is a medical emergency with high mortality presenting several difficult diagnostic and therapeutic challenges. The origin of bleeding and underlying etiology often is not immediately apparent, and techniques for management of this dangerous condition necessitate an expedient response. Unlike hemorrhage in other circumstances, a small amount of blood can rapidly flood the airways, thereby impairing oxygenation and ventilation, leading to asphyxia and consequent cardiovascular collapse. Of paramount importance is early control of the patient's airway and immediate isolation of hemorrhage in an attempt to localize and control bleeding. A coordinated team response is essential to guarantee the best chances of patient survival. Prompt control of the airway and steps to limit the spread of hemorrhage take precedence. Bronchial artery embolization, rigid and flexible bronchoscopy, and surgery all serve as potential treatment options to provide definitive control of hemorrhage. Several adjunctive therapies described in recent years may also assist in the control of bleeding; however, their role is less defined in life-threatening hemoptysis and warrants additional studies. In this concise review, we emphasize the steps necessary for a systematic approach in the management of life-threatening hemoptysis.
Topics: Bronchoscopy; Checklist; Diagnosis, Differential; Diagnostic Imaging; Electrocoagulation; Embolization, Therapeutic; Fibrinolytic Agents; Hemoptysis; Humans; Iatrogenic Disease; Intubation, Intratracheal; Prognosis
PubMed: 31374211
DOI: 10.1016/j.chest.2019.07.012 -
The Surgical Clinics of North America Jun 2022Massive hemoptysis is appropriately defined as life-threatening hemoptysis that causes airway obstruction, respiratory failure, and/or hypotension. Patients with this... (Review)
Review
Massive hemoptysis is appropriately defined as life-threatening hemoptysis that causes airway obstruction, respiratory failure, and/or hypotension. Patients with this condition die from asphyxiation, not hemorrhagic shock. Any patient who presents with life-threatening hemoptysis requires immediate treatment to secure the airway and stabilize hemodynamics. Early activation and coordinated response from a multidisciplinary team is critical. Once the airway is secure and appropriate resuscitation is initiated, priorities are to localize the source of the bleeding and gain hemorrhage control. Nonsurgical control of hemorrhage is superior to surgery in the acute situation.
Topics: Bronchoscopy; Diagnostic Imaging; Embolization, Therapeutic; Hemoptysis; Hemorrhage; Humans
PubMed: 35671767
DOI: 10.1016/j.suc.2021.11.002 -
Deutsches Arzteblatt International Jun 2017Hemoptysis, i.e., the expectoration of blood from the lower airways, has an annual incidence of approximately 0.1% in ambulatory patients and 0.2% in inpatients. It is a... (Review)
Review
BACKGROUND
Hemoptysis, i.e., the expectoration of blood from the lower airways, has an annual incidence of approximately 0.1% in ambulatory patients and 0.2% in inpatients. It is a potentially life-threatening medical emergency and carries a high mortality.
METHODS
This review article is based on pertinent publications retrieved by a selective search in PubMed.
RESULTS
Hemoptysis can be a sign of many different diseases. Its cause remains unknown in about half of all cases. Its more common recognized causes include infectious and inflammatory airway diseases (25.8%) and cancer (17.4%). Mild hemoptysis is self-limited in 90% of cases; massive hemoptysis carries a worse prognosis. In patients whose life is threatened by massive hemoptysis, adequate oxygenation must be achieved through the administration of oxygen, positioning of the patient with the bleeding side down (if known), and temporary intubation if necessary. A thorough diagnostic evaluation is needed to identify the underlying pathology, site of bleeding, and vascular anatomy, so that the appropriate treatment can be planned. The evaluation should include conventional chest x-rays in two planes, contrastenhanced multislice computerized tomography, and bronchoscopy. Hemostasis can be achieved at bronchoscopically accessible bleeding sites with interventionalbronchoscopic local treatment. Bronchial artery embolization is the first line of treatment for hemorrhage from the pulmonary periphery; it is performed to treat massive or recurrent hemoptysis or as a presurgical measure and provides successful hemostasis in 75-98% of cases. Surgery is indicated if bronchial artery embolization alone is not successful, or for special indications (traumatic or iatrogenic pulmonary/vascular injury, refractory asper gilloma).
CONCLUSION
The successful treatment of hemoptysis requires thorough diagnostic evaluation and close interdisciplinary collaboration among pulmonologists, radiologists, and thoracic surgeons.
Topics: Adult; Angiography; Bronchial Arteries; Bronchoscopy; Embolization, Therapeutic; Hemoptysis; Humans; Prospective Studies; Retrospective Studies
PubMed: 28625277
DOI: 10.3238/arztebl.2017.0371 -
Archivos de Bronconeumologia Jul 2016Hemoptysis is the expectoration of blood from the tracheobronchial tree. It is commonly caused by bronchiectasis, chronic bronchitis, and lung cancer. The expectorated... (Review)
Review
Hemoptysis is the expectoration of blood from the tracheobronchial tree. It is commonly caused by bronchiectasis, chronic bronchitis, and lung cancer. The expectorated blood usually originates from the bronchial arteries. When hemoptysis is suspected, it must be confirmed and classified according to severity, and the origin and cause of the bleeding determined. Lateral and AP chest X-ray is the first study, although a normal chest X-ray does not rule out the possibility of malignancy or other underlying pathology. Multidetector computed tomography (MDCT) must be performed in all patients with frank hemoptysis, hemoptoic sputum, suspicion of bronchiectasis or risk factors for lung cancer, and in those with signs of pathology on chest X-ray. MDCT angiography has replaced arteriography in identifying the arteries that are the source of bleeding. MDCT angiography is a non-invasive imaging technique that can pinpoint the presence, origin, number and course of the systemic thoracic (bronchial and non-bronchial) and pulmonary arterial sources of bleeding. Endovascular embolization is the safest and most effective method of managing bleeding in massive or recurrent hemoptysis. Embolization is indicated in all patients with life-threatening or recurrent hemoptysis in whom MDCT angiography shows artery disease. Flexible bronchoscopy plays a pivotal role in the diagnosis of hemoptysis in patients with hemoptoic sputum or frank hemoptysis. The procedure can be performed rapidly at the bedside (intensive care unit); it can be used for immediate control of bleeding, and is also effective in locating the source of the hemorrhage. Flexible bronchoscopy is the first-line procedure of choice in hemodynamically unstable patients with life-threatening hemoptysis, in whom control of bleeding is of vital importance. In these cases, surgery is associated with an extremely high mortality rate, and is currently only indicated when bleeding is secondary to surgery and its source can be accurately and reliably located.
Topics: Angiography; Antifibrinolytic Agents; Bronchoscopy; Diagnosis, Differential; Diagnostic Techniques, Respiratory System; Embolization, Therapeutic; Hematemesis; Hemoptysis; Hemostatic Techniques; Humans; Lung Diseases; Lung Neoplasms; Multidetector Computed Tomography; Practice Guidelines as Topic; Pulmonary Medicine; Shock, Hemorrhagic; Societies, Medical; Spain
PubMed: 26873518
DOI: 10.1016/j.arbres.2015.12.002 -
Journal of Vascular and Interventional... Jul 2020To explore the safety and effectiveness of bronchial artery (BA) embolization (BAE) in children with pulmonary hemorrhage.
PURPOSE
To explore the safety and effectiveness of bronchial artery (BA) embolization (BAE) in children with pulmonary hemorrhage.
MATERIALS AND METHODS
Between February 2016 and February 2019, 41 patients (median age, 4 y; interquartile range, 2.3-8 y; median weight, 17.6 kg; interquartile range, 12.3-23.6 kg) underwent BAE. The indication of BAE included massive hemoptysis in 10 patients (24.4%), recurrent hemoptysis in 18 patients (43.9%), and refractory anemia in 13 patients (31.7%). The main etiology of pulmonary hemorrhage included pulmonary hemosiderosis (58.5%), congenital heart disease (17.1%), and infection (14.6%). A retrospective review was conducted of clinical outcomes of BAE.
RESULTS
There were 44 embolization sessions, with a total of 137 embolized vessels. Pulmonary hemorrhage was caused by BAs in 30 cases, nonbronchial systemic arteries plus BAs in 10, and nonbronchial systemic arteries in 1. Embolic particles were used in 30 cases (24 polyvinyl alcohol [PVA] and 6 microsphere), coils in 9 cases, and particles plus coils in 5 cases (4 PVA and 1 microsphere). Technical success (ability to embolize abnormal vessel) was achieved in 97.6% of patients (40 of 41), and clinical success (complete or partial resolution of hemoptysis within 30 days of embolization) was achieved in 90.2% (37 of 41). There was 1 procedure-related complication (2.4%) of cerebral infarction and 1 death from multiple-organ dysfunction (2.4%). Bleeding-free survival rates at 6, 12, 24, and 36 months were 92.5%, 83.9%, 83.9%, and 70.8%, respectively.
CONCLUSIONS
BAE is a safe and effective procedure in children with pulmonary hemorrhage.
Topics: Age Factors; Bronchial Arteries; Child; Child, Preschool; Embolization, Therapeutic; Female; Hemoptysis; Hemorrhage; Humans; Male; Retrospective Studies; Risk Factors; Treatment Outcome
PubMed: 32457013
DOI: 10.1016/j.jvir.2019.11.007 -
Chest Apr 2016Bronchial thermoplasty has been found to be a safe and effective therapy for severe asthma. We report the case of a mediastinal hematoma and hemothorax developing in a...
Bronchial thermoplasty has been found to be a safe and effective therapy for severe asthma. We report the case of a mediastinal hematoma and hemothorax developing in a 66-year-old woman several days after an uneventful bronchial thermoplasty of the right lower lobe. Evaluation revealed a bleeding right bronchial artery pseudoaneurysm. Pseudoaneuryms have been reported in association with other procedures involving the therapeutic application of thermal energy, and a single case of hemoptysis requiring bronchial artery embolization occurred in a clinical trial of bronchial thermoplasty. However, bronchial artery pseudoaneurysm with hemomediastinum and hemothorax has not previously been reported after bronchial thermoplasty.
Topics: Aged; Aneurysm, False; Angiography; Asthma; Bronchi; Bronchial Arteries; Bronchoscopy; Catheter Ablation; Embolization, Therapeutic; Female; Hemorrhage; Hemothorax; Humans; Mediastinal Diseases; Postoperative Complications; Tomography, X-Ray Computed
PubMed: 27055718
DOI: 10.1016/j.chest.2015.09.016 -
Thoracic Surgery Clinics Aug 2015Massive hemoptysis is not an uncommon surgical problem. A systematic yet flexible and multidisciplinary approach leads to optimal outcomes. The initial focus should be... (Review)
Review
Massive hemoptysis is not an uncommon surgical problem. A systematic yet flexible and multidisciplinary approach leads to optimal outcomes. The initial focus should be on stabilizing patients and securing the airway, which should be followed by methods to stop the bleeding, preferably nonsurgical methods. Consideration for definitive therapy should ensue, including surgical therapy for appropriate patients. This review outlines the management of patients with massive hemoptysis from benign and malignant causes.
Topics: Algorithms; Blood Loss, Surgical; Bronchoscopy; Embolization, Therapeutic; Hemoptysis; Hemostatic Techniques; Humans; Radiology, Interventional
PubMed: 26210922
DOI: 10.1016/j.thorsurg.2015.04.009 -
Techniques in Vascular and... Jun 2009Massive hemoptysis is a life-threatening emergency. Chest radiograph, computed tomography, and bronchoscopy play a complementary role in diagnosing the underlying cause... (Review)
Review
Massive hemoptysis is a life-threatening emergency. Chest radiograph, computed tomography, and bronchoscopy play a complementary role in diagnosing the underlying cause of hemorrhage and localizing the bleeding site. Bronchial artery embolization remains the primary and most effective method in controlling massive hemoptysis. Bronchial and nonbronchial systemic arteries are the main source of bleeding and are embolized with polyvinyl alcohol particles or gelatin sponge. Immediate cessation of bleeding occurs in more than 75% of patients; however, long-term recurrences are common in patients with progressive lung disease. Complications are infrequent except for a rare occurrence of spinal cord ischemia.
Topics: Bronchial Arteries; Bronchoscopy; Embolization, Therapeutic; Hemoptysis; Humans; Radiography, Interventional; Severity of Illness Index; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 19853230
DOI: 10.1053/j.tvir.2009.08.006 -
Lung Apr 2021Diffuse alveolar hemorrhage (DAH) is a rare condition with reported mortality ranging between 20 and 100%. There are many etiologies of DAH. Cardiac diseases are likely... (Review)
Review
Diffuse alveolar hemorrhage (DAH) is a rare condition with reported mortality ranging between 20 and 100%. There are many etiologies of DAH. Cardiac diseases are likely underreported causes of DAH. Heart failure and mitral valve diseases are the most common cardiac causes of DAH. The DAH results from pulmonary venous hypertension leading to stress failure of the pulmonary capillaries. There is also a contribution of the bronchial circulation. The Alveolar-capillary membrane or blood-gas barrier is an extremely thin structure that allows rapid and passive diffusion of oxygen from the inhaled air to the pulmonary capillaries while preventing pulmonary edema and DAH with chronic elevation of the transmural hydrostatic pressure. The purpose of this manuscript is to inform the clinician about this rare cause of DAH, which may be overlooked unless specifically sought after. We also discuss the pathophysiologic aspects of DAH and the safety mechanisms in place to prevent such occurrences.
Topics: Heart Diseases; Hemorrhage; Humans; Lung Diseases; Pulmonary Alveoli
PubMed: 33709230
DOI: 10.1007/s00408-021-00433-x