Role of Bronchoscopy in Hemoptysis

Abstract

Hemoptysis is a common and alarming symptom. There are no accepted volume-based definitions of non-massive or massive hemoptysis. For practical purposes, massive hemoptysis is better defined on the basis of magnitude of effect rather than the amount of expectorated blood. Acute bronchitis is the most common cause of non-massive hemoptysis. The common causes of massive hemoptysis include bronchiectasis, tuberculosis, lung cancer, and mycetoma. Bronchoscopy plays a central role in the evaluation and management of hemoptysis. Direct inspection allows localization of the bleeding site and isolation of bleeding segment to prevent flooding of non-bleeding lung and asphyxiation. Rigid bronchoscope is preferred over flexible bronchoscope for management of massive hemoptysis but its utility is limited by lack of trained personnel in majority of medical centers. In the absence of facilities for rigid bronchoscopy, it is prudent to secure airway with a large endotracheal tube, perform early flexible bronchoscopy, and initiate aggressive resuscitative measures. Several bronchoscopic techniques such as balloon tamponade, topical application of cold saline, vasoconstrictors, and pro-coagulant substances may be applied for temporary control of bleeding. Interventional techniques such as laser photoresection and argon plasma coagulation may be helpful in selected cases. Temporary control of bleeding may facilitate institution of definitive therapies such as bronchial artery embolization and surgery in selected patients.KeywordsHemoptysisBronchoscopyRigid bronchoscopyMassive hemoptysisBronchial artery embolization