Management of life-threatening hemoptysis

Abstract

It is estimated that 5-14% of patients presenting with hemoptysis will have life-threatening hemoptysis, with a reported mortality rate between 9 and 38%. This manuscript provides a comprehensive literature review on lifethreatening hemoptysis, including the etiology and mechanisms, initial stabilization, and management of patients. There is no consensus on the optimal diagnostic approach to life-threatening hemoptysis, so we present a practical approach to utilizing chest radiography, computed tomography, and bronchoscopy, alone or in combination, to localize the bleeding site depending on patient stability. The role of angiography and embolization as well as bronchoscopic and surgical techniques for the management of life-threatening hemoptysis is reviewed. Through case presentation and flow diagram, an overview is provided on how to systematically evaluate and treat the bronchial arteries, which are responsible for hemoptysis in 90% of cases. Treatment options for recurrent hemoptysis and definitive management are discussed, highlighting the role of bronchial artery embolization for recurrent hemoptysis.

Successful coil embolisation for an arterio-bronchial fistula in a child presenting catastrophic haemoptysis

“…This method is used for not only single lung ventilation during thoracotomy but also a temporary haemostatic treatment for haemoptysis. 7,8 It allows us to prevent aspiration into the contralateral lung and to stabilise respiratory and haemodynamic conditions during procedures. An Arndt™ bronchial blocker can be available among small infant because of the variable sizes.…”

The Evolution of Pulmonary Tuberculosis to Pulmonary Aspergiloma in PortHarcourt: A Need for Radiologic Pulmonary Vigilance

“…Aspergiloma is a mass-like collection of fungal hyphae, mixed with mucus and cellular debris, within a cavitary lesion [17]. Aspergillus causes a spectrum of diseases conditions, ranging from colonization to hypersensitivity reactions to chronic necrotizing infections to rapidly progressive angioinvation which often result in death [18].…”

“…In individuals who are immunosuppressed, vascular invasion is much more common and may lead to infarction, hemorrhage, and necrosis of lung tissue [13,18].…”

“…However they can present with Cough (sometimes productive), haemoptysis [19] and wheezing. Occasionally due to surrounding reactive vascular granulation tissue and erosion into the bronchial artery may lead to life-threatening haemoptysis, which may be massive and life threatening, in 40-60% of patients [18].…”

“…Treatment could be medical or surgical [18]. However an asymptomatic aspergilloma does not necessarily require treatment and the cavity is essentially isolated from any systemic administration of anti-fungals [15,18].…”