Pulmonary Resection in the Treatment of Life-Threatening Hemoptysis

Abstract

Purpose: Massive hemoptysis is a life threatening situation with high mortality rates. Surgery is effective, however generally an avoided treatment. We report our experience with patients undergoing lung resection for life-threatening hemoptysis. Methods: Records of all surgically treated patients for hemoptysis between June 2009 and June 2012 were reviewed and analyzed retrospectively. Results: Anatomical resection was performed on 31 (15.3%) patients out of 203 patients referred to our intensive care unit for life-threatening hemoptysis. 25 (80.6%) were male and six (19.4%) were female; with mean age of 46.4 ± 13.7 (21-77). Pneumonectomy was performed in four (12.9%), lobectomy in 24 (77.4%), segmentectomy in two (6.5%) and bilobectomy in one case. Postoperative complications developed in eight (25.8%), and mortality was observed in two (6.5%) patients. Etiology was bronchiectasis in 13 (42.0%), tuberculosis in eight (25.8%), carcinoma in four (12.9%), aspergilloma in four (12.9%), hydatid cyst in one (3.2%) and lung abscess in one (3.2%) of the cases. Conclusions: Although lung resection in the treatment of massive hemoptysis is accompanied with high morbidity and mortality rates, surgery is the only permanent curative modality. Acceptable results can be achived in the company of a multidisciplinary approach, through avoidance of pneumonectomy and urgent surgery.

Is Anatomic Lung Resection Necessary in Surgical Treatment of Giant Lung Hydatid Cysts in Childhood?

“…10,[14][15][16] Perforation of the cyst can cause hemoptysis, pneumothorax, hydro pneumothorax, empyema, pleural thickening, secondary pleural hydatid disease, and destruction of parenchyma. [17][18][19][20][21] Therefore, some publications suggest more radical surgical procedures such as decortication, segmentectomy, or lobectomy in these patients. 20,22) Also perforated hydatid cysts have higher resection rates (0%-7%) than intact cysts (19%-32%).…”

Endosonography of a Pulmonary Artery Obstruction in Echinococcosis

“…In case of PA, localization surgical resection of echinococcal cysts by arteriotomy with or without the need of pneumonectomy or pulmonary endarterectomy can be considered. Surgical treatment of PA echinococcosis has been reported but is considered high risk [11,12,13]; therefore, this decision must be taken very carefully. To our knowledge, percutaneous drainage of the PA has not yet been performed.…”

Pulmonale Tuberkulose – ist die Chirurgie noch notwendig?

“…Die systemische Gabe antimykotischer Substanzen kann die intrapulmonale Aspergillose und mögliche Blutungskomplikationen nicht dauerhaft beseitigen, da die Substanzen den kaum vaskularisierten Raum einer Kaverne im Lungenparenchym schlecht und die notwendige Hemmstoffkonzentration nicht erreichen [21]. Klinisch manifestiert sich das pulmonale Aspergillom meist durch Hämoptysen [22,23]. Diese entstehen möglicherweise durch die Produktion von proteolytischen und fibrinolytischen Enzymen durch Reibung des Pilzballs in Kavernenwänden [24].…”

“…Die Resektion eines Aspergilloms zur Prävention von Hämoptysen bei unzureichenden konservativen Maßnahmen wird hingegen kontrovers diskutiert [18]. Führt die systemische Therapie nicht zu einer deutlichen Befundbesserung, sollte eine chirurgische Therapie bei guter Lungenfunktion jedoch frühzeitig erwogen werden [20,23]. Aufgrund der komplexen Pathologie sollte eine chirurgische Sanierung jedoch individuell und sorgfältig geplant werden.…”