Management Considerations for the Treatment of Idiopathic Massive Hemoptysis with Endobronchial Occlusion Combined with Bronchial Artery Embolization

Adachi, Takashi; Oki, Masahide; Sasaki, Hideo

doi:10.2169/internalmedicine.55.5261

Cited by 13 publications

(12 citation statements)

References 10 publications

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“…In view of her elderly age with poor reserve and haemodynamic instability, she was deemed very high surgical risk. However, using EWS endobronchial embolization as a radical definitive treatment for hemoptysis had been reported in literature, and was proven successful in our case as well [8]. This is important as BAE service is not readily available in many regions and all massive hemoptysis patients are usually of high surgical risk in view of hemodynamic instability and multiple comorbidities.…”

Section: Discussionmentioning

confidence: 64%

Endobronchial embolization for life-threatening hemoptysis with Endobronchial Watanabe Spigot

et al. 2017

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BackgroundMassive hemoptysis is a common encounter in respiratory medicine. Bronchoscopy plays an important role in localizing the origin of bleeding, as well as endoscopic treatment of centrally located lesions. Endobronchial embolization is a novel technique enabling the management of hemoptysis arising even from peripheral lesions, via occlusion of the culprit bronchus, thereby securing the airway. Endobronchial Watanabe Spigot had been advocate in the treatment of bronchopleural fistula and the use of this novel technique had since then been expanded into the management of massive hemoptysis. To the best of our knowledge, this is the first reported case in Malaysia.Case presentation78-year-old lady who presented with life-threatening hemoptysis leading rapidly to cardiac arrest upon arrival. Spontaneous circulation was restored after resuscitation with an urgent thoracic computed tomography angiogram revealed bleeding likely from the posterior basal segment of left lower lobe, with bronchiectatic changes. Urgent flexible bronchoscopy revealed airway flooding, with bleeding originating from the lingular and posterior-basal segment of the left lower lobe. Airway toileting was performed and two 7 mm Endobronchial Watanabe Spigots were plugged into the culprit bronchi. Urgent bronchial artery embolization was then attempted, but was unsuccessful. She was managed conservatively, as surgical resection was deemed high risk. The spigots were removed 4 days later uneventfully. There was no recurrence of hemoptysis, and patient remained well during 1-month follow up.ConclusionsThe utmost priority in managing life-threatening hemoptysis is to prevent airway flooding. Endobronchial embolization with Endobronchial Watanabe Spigot is useful as a temporary measure before definitive therapy, or can itself be the main therapeutic player in the hemoptysis armament for high-risk patients.

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Section: Discussionmentioning

confidence: 64%

Endobronchial embolization for life-threatening hemoptysis with Endobronchial Watanabe Spigot

et al. 2017

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“…Although bronchial blockade with bronchial blockers or balloon catheters is useful for isolating the bleeding lobe or lung and maintaining airway stabilization, these are temporary measures and it can be difficult to occlude two or more peripheral bleeding lesions with these methods. However, bronchial occlusion using EWSs is durable and can be used to treat patients with multiple lesions; thus, it has recently been reported as a definitive therapy for massive hemoptysis (5).…”

Section: Discussionmentioning

confidence: 99%

Bronchial Occlusion with Endobronchial Watanabe Spigot for Hemoptysis in a Mechanically Ventilated Patient with Extracorporeal Circulation

et al. 2019

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Bronchial occlusion with endobronchial Watanabe spigots (EWSs) can be an essential therapeutic measure for treating massive hemoptysis in intensive care patients when no other conventional options are available. A 68-year-old-man on mechanical ventilation and extracorporeal circulation after cardiovascular surgery presented massive hemoptysis. He was deemed unfit for bronchial artery embolization (BAE) and surgery while in the intensive care setting; thus, bronchial occlusion was performed using EWSs. His hemoptysis ceased, and he was successfully weaned from mechanical ventilation and extracorporeal circulation. Bronchial occlusion by EWSs may be considered an optimal, and at times, definitive treatment for obtaining hemostasis in these situations.

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“…In these reports, bronchial occlusion using EWS was performed for temporary hemostasis in conjunction with definitive surgery and BAE, and in most cases, silicone spigots were removed within 2 weeks of BAE. Meanwhile, in one case, bronchial occlusion using EWS was effective for the treatment of massive hemoptysis that could not be stopped with BAE ( 11 ). Additionally, bronchial occlusion using EWS can be applied in combination with BAE or as a definitive treatment in some situations.…”

Section: Discussionmentioning

confidence: 99%

Successful Long-term Management of Two Cases of Moderate Hemoptysis Due to Chronic Cavitary Pulmonary Aspergillosis with Bronchial Occlusion Using Silicone Spigots

et al. 2018

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Chronic pulmonary aspergillosis is a major cause of life-threatening hemoptysis. In symptomatic patients with simple aspergillomas, surgery is the main therapeutic method for preventing or treating life-threatening hemoptysis. However, the risks of both death and complications are higher in chronic cavitary pulmonary aspergillosis than in simple aspergilloma. We herein report two patients with persistent moderate hemoptysis due to chronic cavitary pulmonary aspergillosis who were not indicated for surgery, but were able to undergo successful long-term management with bronchial occlusion using silicone spigots. In diseases with a high recurrence rate of hemoptysis, the continuous placement of silicone spigots might therefore be effective to prevent rebleeding.

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Management Considerations for the Treatment of Idiopathic Massive Hemoptysis with Endobronchial Occlusion Combined with Bronchial Artery Embolization

Cited by 13 publications

References 10 publications

Endobronchial embolization for life-threatening hemoptysis with Endobronchial Watanabe Spigot

Endobronchial embolization for life-threatening hemoptysis with Endobronchial Watanabe Spigot

Bronchial Occlusion with Endobronchial Watanabe Spigot for Hemoptysis in a Mechanically Ventilated Patient with Extracorporeal Circulation

Successful Long-term Management of Two Cases of Moderate Hemoptysis Due to Chronic Cavitary Pulmonary Aspergillosis with Bronchial Occlusion Using Silicone Spigots

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