Emergency Pneumonectomy: A Life-Saving Measure for Severe Recurrent Hemoptysis in Tuberculosis Cavitary Lesion

Abstract

Hemoptysis constitutes a common and urgent medical problem. Swift and effective management is of crucial importance, especially in severe, life-threatening cases. Because of bronchial artery or a branch of pulmonary artery erosion due to cavitary infiltration, bronchiectasis, fungus ball, broncholithiasis, or destroyed lung, the bleeding can lead to highly compromised gas exchange or sometimes can be a life-threatening situation. Chest computerized tomography and bronchoscopy remain the methods of choice for lateralization of the disease. Some patients can be treated successfully with endobronchial interventions. Bronchial artery embolization can be rewarding in some patients but the recurrence rate is higher in tuberculosis than other etiologies of hemoptysis. Surgical resection of the lung, mainly lobectomy, remains a life-saving procedure but it should be performed very selectively to avoid higher postoperative morbidity and mortality.

Intracavitary nodule in active tuberculosis: differential diagnosis of aspergilloma

“…Hemoptysis in the presence of tuberculosis is frequently due to erosion of the bronchial artery or of a branch of the pulmonary artery; it can result from numerous conditions, such as bronchiectasis, aspergilloma, tuberculosis reactivation, scar carcinoma, chronic bronchitis, broncholithiasis, microbial colonization within a cavity, and RA. 1 , 2 Contrast-enhanced CT of the chest and bronchoscopy remain the methods of choice for the evaluation of pulmonary hemorrhage.…”

“…A hemoptise na presença de tuberculose é frequentemente devida à erosão da artéria brônquica ou de um ramo da artéria pulmonar; pode ser resultante de inúmeras condições, tais como bronquiectasias, aspergiloma, reativação de tuberculose, carcinoma cicatricial, bronquite crônica, broncolitíase, colonização microbiana dentro de uma cavidade e AR. 1 , 2 A TC de tórax com contraste e a broncoscopia continuam sendo os métodos de escolha para a avaliação da hemorragia pulmonar.…”

Application of preoperative embolization during surgery for the destroyed lung

“…Patients with destroyed lungs who develop aspergilloma usually present with hemoptysis, and interventional embolization of the bronchial artery is a temporary treatment for the control of bleeding under this condition (1,2). However, surgical intervention is the ultimate treatment for the destroyed lung (3)(4)(5)(6). Notably, pneumonectomy of the destroyed lung has been a challenge in clinical practice, mainly due to the presence of intraoperative adhesions, bleeding as a result of adhesion separation, the incarceration and calcification of lymph nodes in the hilar and portal areas and changes in the anatomical location of the lung due to a mediastinal Original Article Application of preoperative embolization during surgery for the destroyed lung shift.…”

Efficacy of regional arterial embolization before pleuropulmonary resection in 32 patients with tuberculosis-destroyed lung

“…Pathological changes such as extensive fibrosis, bronchial stenosis, and bronchiectasis are commonly observed in the TB-destroyed lung (TDL) [ 1 ]. Erosion of a pulmonary artery branch due to TDL can cause bleeding, resulting in gas exchange disorder or sometimes a life-threatening situation [ 2 ]. Management options of TDL include the use of anti-TB agents (for active-TB cases), antibiotics (for inactive-TB cases), or surgical intervention.…”

“…The most common surgical procedure for patients with TDL is pleuropulmonary resection [ 2 , 5 – 7 ]. TDL affected areas are usually extensive with severe adhesions.…”