Etiology and an Integrated Management of Severe Hemoptysis Due to Pulmonary Tuberculosis

Song Yang,Xiangzhen Zheng,Yueling Qiu,Zhuanying Mai

doi:10.4236/jtr.2015.31002

Abstract

Background: It is very important to enhance the therapeutic effect and prognosis of severe tuberculous hemoptysis after the determining of its etiological cause and the source of bleeding. The etiology and integrated curative effect of severe hemoptysis due to pulmonary tuberculosis among 112 inpatients were analyzed. Materials and Methods: The cause was retrospectively analysed. The integrated management effect after the follow-up of mean three years in 112 cases with severe hemoptysis being resulted from pulmonary tuberculosis from June 2008 to July 2012 was described. Active pulmonary tuberculosis ranked the first cause of lower respiratory tract bleeding (32/112, 28.5%), followed by old pulmonary tuberculosis (28/112, 25.0%), tuberculous bronchiectasis (25/112, 22.3%), purified tuberculous cavity (12/112, 10.7%), fungal infection in old pulmonary tuberculosis cavity (9/112, 7.1%), or broncholithiasis (6/112, 5.4%). Almost all suffers with severe hemoptysis were treated by an integrated management, including psychology, anticoagulants, vasoconstrictor agents. Etiological treatment including anti-tuberculosis and anti-infection was simultaneously or subsequently involved. Sixty-four inpatients with severe hemoptysis being failed to be cured by medical treatment were then received selective bronchial artery embolization. Four patients were received surgical wedge resection, lobectomy or pneumonectomy. The total cure rate added up to 98.2% after mean three years’ follow-up. The mortality was 1.8%. Conclusions: Active pulmonary tuberculosis was still responsible for the severe hemoptysis in the southeast region of China. Severe hemoptysis of pulmonary tuberculosis was also resulted from stable tuberculosis, tuberculous bronchiectasis, tuberculosis cavity, fungal infection, or broncholithiasis. Better clinical therapeutic effect could be attained by early etiological diagnosis and comprehensive treatment strategy.

Highlights

Hemoptysis is a relatively common presenting acute respiratory symptom in patients seen by pulmonary specialists [1]
Among 112 invalids with severe hemoptysis due to pulmonary tuberculosis, active tuberculosis ranked the first cause of lower respiratory tract bleeding (32/112, 28.5%), followed by old tuberculosis (28/112, 25.0%), tuberculous bronchiectasis (25/112, 22.3%), tuberculosis purified cavity (12/112, 10.7%), fungal infection in old tuberculosis cavity (9/112, 7.1%), or broncholithiasis (6/112, 5.4%) (Table 1)
Active pulmonary tuberculosis was responsible for the severe hemoptysis in the southeast region of China, followed by old tubefculosis and tuberculous bronchiectasis

Summary

Introduction

Hemoptysis is a relatively common presenting acute respiratory symptom in patients seen by pulmonary specialists [1]. Severe hemoptysis may be fatal, which requires emergent and appropriate treatment. It may present as a life-threatening symptom with a mortality rate of up to 50% - 100% in the absence of adequate and prompt management [2] [3]. Severe hemoptysis includes major or massive hemoptysis. The etiology and integrated curative effect of severe hemoptysis due to pulmonary tuberculosis among 112 inpatients were analyzed. The integrated management effect after the follow-up of mean three years in 112 cases with severe hemoptysis being resulted from pulmonary tuberculosis from June 2008 to July 2012 was described. Severe hemoptysis of pulmonary tuberculosis was resulted from stable tuberculosis, tuberculous bronchiectasis, tuberculosis cavity, fungal infection, or broncholithiasis. Better clinical therapeutic effect could be attained by early etiological diagnosis and comprehensive treatment strategy

Methods

Results

Discussion

Conclusion