Episode Of Massive Hemoptysis Research Articles

Which Is the Best Way to Treat Massive Hemoptysis? A Systematic Review and Meta-Analysis of Observational Studies.

Hemoptysis is one of the most common symptoms of respiratory system diseases. Common causes include bronchiectasis, tumors, tuberculosis, aspergilloma, and cystic fibrosis. The severity of hemoptysis varies from mild to moderate to massive hemoptysis and can easily lead to hemodynamic instability and death from suffocation or shock. Nevertheless, the most threatening hemoptysis that is presented to the emergency department and requires hospitalization is the massive one. In these cases, today, the most common way to manage hemoptysis is bronchial artery embolization (BAE). A systematic literature search was conducted in PubMed and Scopus from January 2017 (with the aim of selecting the newest possible reports in the literature) until May 2023 for studies reporting massive hemoptysis. All studies that included technical and clinical success rates of hemoptysis management, as well as rebleeding and mortality rates, were included. A proportional meta-analysis was conducted using a random-effects model. Of the 30 studies included in this systematic review, 26 used bronchial artery embolization as a means of treating hemoptysis, with very high levels of both technical and clinical success (greater than 73.7% and 84.2%, respectively). However, in cases where it was not possible to use bronchial artery embolization, alternative methods were used, such as dual-vessel intervention (80% technical success rate and 66.7% clinical success rate), customized endobronchial silicone blockers (92.3% technical success rate and 92.3% clinical success rate), antifibrinolytic agents (50% clinical success rate), and percutaneous transthoracic embolization (93.1% technical success rate and 88.9% clinical success rate), which all had high success rates apart from antifibrinolytic agents. Of the 2467 patients included in these studies, 341 experienced rebleeding during the follow-up period, while 354 other complications occurred, including chest discomfort, fever, dysphagia, and paresis. A total of 89 patients died after an episode of massive hemoptysis or during the follow-up period. The results of the meta-analysis showed a pooled technical success of bronchial artery embolization equal to 97.22% and a pooled clinical success equal to 92.46%. The pooled recurrence was calculated to be 21.46%, while the mortality was 3.5%. These results confirm the ability of bronchial artery embolization in the treatment of massive hemoptysis but also emphasize the high rate of recurrence following the intervention, as well as the risk of death. In conclusion, massive hemoptysis can be treated with great clinical and technical success using bronchial artery embolization, reducing mortality. Mortality has now been reduced to a small percentage of cases.

Lung Allocation Score Exceptions in Persons with Cystic Fibrosis Undergoing Lung Transplant.

Rationale: Lung transplantation can extend the lives of individuals with advanced cystic fibrosis (CF). Until March 2023, the Lung Allocation Score (LAS) was used in the United States to determine transplant priority. Certain clinical events or attributes ("risk events") that are not included in the LAS (e.g., massive hemoptysis) are relatively common and prognostically important in CF and may prompt an exception request to increase priority for donor lungs. The new Lung Composite Allocation Score (CAS) also allows for exceptions based on the same principles. Objectives: To evaluate the frequency of LAS exceptions in persons with CF (PwCFs) listed for lung transplantation and assess whether LAS exceptions are associated with improved waitlist outcomes for PwCFs compared with similarly "at-risk" individuals without LAS exceptions. Methods: A merged dataset combining data from the CF Foundation Patient Registry and the Organ Procurement and Transplantation Network (2005-2019) was used to identify PwCFs listed for lung transplantation. We compared waitlist outcomes between PwCFs with a LAS exception versus those without an exception despite having a risk event. Risk events were defined as an episode of massive hemoptysis, pneumothorax, at least three moderate/severe pulmonary exacerbations, and/or a decrease in forced expiratory volume in 1 second by ⩾30% predicted (absolute) in the prior 12 months. Analyses were performed using competing risk regression with time to transplantation as the primary outcome and death without a transplant as a competing risk. Results: Of 3,538 listings from 3,309 candidates, 2% of listings (n = 81) had at least one exception. Candidates with an exception and those with a risk event but no exception received lung transplants more slowly than people without an exception or risk event (subdistribution hazard ratio [95% confidence interval]: LAS exception cohort, 0.66 [0.52-0.85]; risk event cohort without exceptions, 0.79 [0.72-0.86]). There was no difference between those with LAS exceptions and those at risk without LAS exceptions: subdistribution hazard ratio, 0.84 (0.66-1.08). Conclusions: LAS exceptions are rare in PwCFs listed for lung transplantation. LAS exceptions resulted in a similar time to transplantation for PwCFs compared with similarly at-risk individuals. As we enter the CAS era, these LAS-based results are pertinent to improve risk stratification among PwCFs being considered for lung transplantation.

P.224 A Case Report of Spinal Screws Penetrating the Pulmonary Artery

Background: Spinal instrumentation is commonly utilized to mechanically stabilize the spine in trauma, oncology and degenerative disease. Although several complications have been reported, this is the first case of screw penetration of the pulmonary artery. Methods: We present a case of a 74-year old gentleman who suffered from a thoracic spine chordoma. He underwent a T8 resection with T8-T12 instrumented fusion with subsequent radiation. Recurrence of his disease led to resection of his 3rd and 4th ribs and repeat radiation. He presented 6 years later with 2 episodes of massive hemoptysis. Review of the literature was conducted to search for similar complications. Results: A Chest Computed Tomography scan demonstrated the presence of a pedicle screw tip in the right pulmonary artery. Angiogram revealed no evidence of active arterial extravasation. In the operating room, the patient had a right lower lobectomy, with segmental pulmonary artery sacrifice, as well as replacement of the spinal fixation hardware. Literature review revealed multiple aortic injuries following spinal instrumentation. However, this was the first case of pulmonary artery erosion. Conclusions: Spinal instrumentation has been associated with screw migration and penetration of nearby tissues and vessels. A high incidence of suspicion is required when patients present with delayed and unusual complications.

Aspergiloma como sequela de tuberculose pulmonar: relato de caso

Objetivo: Relatar um caso de aspergiloma como sequela de tuberculose pulmonar em um paciente jovem e imunocompetente. Relato de Caso: Paciente masculino, 24 anos, trabalhador rural. Admitido em hospital para tratamento cirúrgico do aspergiloma pulmonar, apresentando quadro de tosse seca há quatro meses associada a episódios de hemoptise volumosa. Histórico de tuberculose pulmonar no ano anterior adequadamente tratada. Trazia tomografia de tórax revelando lesão escavada de paredes espessas, no segmento apicoposterior do lobo superior esquerdo, contendo nodulação sólida de contornos bocelados no interior, móvel à mudança de decúbito, sugerindo colonização fúngica sobrejacente. Trazia ainda baciloscopia de escarro e sorologias anti-HIV 1 e 2 negativas. Relatou tratamento com Itraconazol 200mg 12/12 horas por 20 dias há cerca de dois meses, sem melhora clínica. Durante internação foi submetido à lobectomia superior esquerda. Admitido em CTI no pós-operatório imediato, onde permaneceu por três dias. Paciente apresentou boa evolução, seguido por alta hospitalar no nono dia pós-operatório. Considerações Finais: O aspergiloma pulmonar deve ser considerado em todos os pacientes com história de alteração da arquitetura pulmonar, especialmente àquelas produzida por tuberculose, que apresentem uma história respiratória caracterizada por hemoptise. Considera-se o tratamento cirúrgico como primeira escolha incluindo em pacientes assintomáticos.

SUCCESSFUL PALLIATIVE CRYOABLATION AND RECANALIZATION OF INVASIVE FOLLICULAR THYROID CARCINOMA ENCROACHING INTO THE TRACHEA

SESSION TITLE: Fellows Procedures Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Follicular Thyroid Carcinoma is a rare malignant tumor with an incidence of 5% of all thyroid carcinoma. Demographic profile for follicular thyroid carcinoma is male gender, age over 45 years, iodine deficiency and radiation exposure. Prognosis of follicular carcinoma are affected by tumor size, presence of distant metastases, age, gender, vascular invasion, and rare histologic type. While most thyroid carcinoma has good prognosis, tracheal invasion is an indicator of poor survival. Lesser invasive palliative procedures such as use of cryotherapy for recanalization and ablation are currently available that shortens hospital stay, reduces postsurgical complications, and improves quality of life. CASE PRESENTATION: A 24 year old female was referred to the Lung Center of the Philippines due to a tracheal mass noted on CT scan of the chest and neck which presented as hoarseness of voice and episodes of massive hemoptysis, started 8 months prior. Patient had poor recollection of a thyroid surgery from a surgical mission for enlarging neck mass 2 years preceding the referral. She noted of progressive exertional dyspnea and weight loss, yet denies fever and dysphagia. A repeat CT scan of the neck and chest showed a lobulated enhancing mass of about 2.3 x 2.6 cm at the right thyroidectomy bed encroaching into the trachea with 70% luminal narrowing. There were multiple non-calcified pulmonary nodules on both lungs. Patient underwent rigid bronchoscopic cryotherapy biopsy, ablation and recanalization of the tracheal mass by general anesthesia, total intravenous anesthesia via jet ventilation. On rigid bronchoscopy, there was noted a wide-base smooth mass attached to the anterior surface of the second and third tracheal ring, obstructing 70% the tracheal lumen. Frozen section of mass revealed atypical follicular cells favors thyroid carcinoma. Tracheal mass was signed out as invasive follicular thyroid carcinoma. Thyroid function test showed significant elevation of TSH at 31.927 IU/L, FT3 and T4 were within normal limits. Completion cryoablation was performed after a week. Patient was discharged stable, comfortable and non-oxygen requiring after 10 days of confinement. Patient underwent radioactive iodine treatment as outpatient. As of this writing, 10 months post cryotherapy, patient is still alive, up and about, no report of recurrence of hemoptysis, and non-dyspneic. DISCUSSION: Patient presented wilth metastic invasive follicular thyroid carcinoma. Palliative recanalization done for this patient has severed its purpose of relief of shortness of breath. Cryotherapy has been an adjunct to radioiodine therapy as palliative treatment. CONCLUSIONS: A 24 year old female with advanced invasive follicular thyroid carcinoma enchroaching to the tracheal lumen successfully underwent a palliative coring out and ablation of the tracheal mass using cryotherapy. Reference #1: Ito Y, Miyauchi A. Prognostic factors and therapeutic strategies for differentiated carcinomas of the thyroid. Endocr J 2009; 56(2): 177–9. Reference #2: Filipović A, et al. Invasive Follicular thyroid carcinoma infiltrating the trachea.Vojnosanit Pregl 2011; 68(10): 891–894. DISCLOSURES: no disclosure on file for Joven Gonong; No relevant relationships by Portia Maria Tanyag, source=Web Response

A Novel Technique for the Management of Massive Hemoptysis: The Customized Endobronchial Silicone Blocker.

Massive hemoptysis (MH) has a high mortality rate. Therapeutic options include bronchoscopy for endobronchial lesions, bronchial artery embolization (BAE), and emergency surgery. Scant options exist for patients who are not candidates for these modalities. Culprit bronchial segment occlusion is an option to prevent "spillover flooding → hypoxia." Applying this concept, we describe a case series of MH control using a novel bronchoscopically inserted customized endobronchial silicone blocker (CESB). We analyzed the safety and efficacy of CESBs in a select subset of patients with MH. Inclusion criteria were patients with MH who were unstable for surgery/BAE, failed BAE, or relatively contraindicated/refused BAE. CESBs were manufactured on-site by modifying silicone stents, inserted using rigid bronchoscopy and reinforced with glue. The CESB was removed after 6 weeks when possible. A successful outcome was defined as immediate bleeding control with no recurrence after removal. Over 4.5 years, 13 episodes of MH in 12 patients meeting the criteria specified earlier were treated with CESBs. Seven of 12 patients had tuberculosis, 4 active and 3 inactive. One patient had mucormycosis, 1 post-lobectomy, 1 endobronchial renal cell carcinoma, 1 fibrosing mediastinitis, and 1 patient had metastatic laryngeal Ca. Eight of 12 patients were taken for primary-CESB placement. Four of 12 patients were sent for BAE, which was unsuccessful, and rescue-CESB was done for definitive management. The success rate, as defined earlier, was 92.3%, with no deaths from MH. Innovative bronchoscopically inserted CESBs are an effective strategy in MH when patients are unstable or fail conventional management.

RECURRENT AND MASSIVE HEMOPTYSIS: A CONSEQUENCE OF A RARE ETIOLOGY

SESSION TITLE: Wednesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Fibrosing mediastinitis is an inflammatory reaction that results in excessive fibrous tissue formation in the mediastinum. It is usually attributed to histoplasmosis. It may affect the airways, great vessels, and other mediastinal structures secondary to robust inflammatory reaction to fungal antigens including granuloma formation and calcifications. The clinical presentation depends on which mediastinal structures being involved and the extent of the damage. Hemoptysis in fibrosing mediastinitis can be the result of bronchial invasion, necrotizing pneumonia, pulmonary or bronchial venous or arterial invasion. CASE PRESENTATION: 68-year-old Caucasian female with past medical history of chronic sinusitis, paroxysmal atrial fibrillation and fibrosing mediastinitis who presented to the emergency room (ER) complaining of three episodes of hemoptysis for 6 hours. The hemoptysis was estimated to be around 100 ml each time, bright red blood and associated with mild shortness of breath. Initial vitals were 104/54 mm Hg, heart rate of 110 bpm, respiratory rate of 22 cpm and Spo2 95% on 4L nasal cannula. The patient received one unit of PRBC for acute drop in hemoglobin from 14 gm/dl to 11 gm/dl. The patient was admitted to the intensive care unit (ICU) due to a concern of airway compromise and potential need for endotracheal intubation. The patient had episodes of massive hemoptysis over the last year and received corticosteroids intermittently without significant improvement. In the ICU, The clinical condition was relatively stable with normal vital signs yet continued to have hemoptysis. CT scan of the chest revealed mediastinal widening with diffuse calcified lymph nodes, broncholith extending into right main stem bronchus, superior vena cava stent and dilated main pulmonary arteries. Conventional angiography demonstrated dilatation of the two right sided intercostal bronchial trunks and multiple dilated intercostal arteries. Successful embolization of the above-mentioned arteries with microspheres was performed until achieving hemostasis. Subsequently, the patient did not experience further episodes of hemoptysis. The patient was discharged home in a stable clinical condition. DISCUSSION: Recurrent and massive hemoptysis is a consequence of numerous etiologies. We are reporting a rare case of fibrosing mediastinitis that presented as recurrent and massive hemoptysis. Diagnostic approach indicated the involvement of the bronchial and intercostal arteries. The involved vessels were treated successfully by embolization CONCLUSIONS: Recurrent massive hemoptysis is an uncommon clinical feature in these patients and associated with poor prognosis along with other local invasive process by the calcified mediastinal masses. Reference #1: Mediastinal fibrosis complicating histoplasmosis, Loyd JE1, Tillman BF, Atkinson JB, Des Prez RM. Reference #2: Chronic fibrous mediastinitis and superior vena caval obstruction due to histoplasmosis, Dis Chest. 1959 Apr;35(4):364-77. DISCLOSURES: No relevant relationships by Mukhtar Al-Saadi, source=Web Response No relevant relationships by Sai Katta, source=Web Response

Genç Erişkin Bir Olguda Konjenital Bronşiyal Arter - Pulmoner Arter Fistülü

Primary vascular malformations such as connection between bronchial artery and pulmonary artery or pulmonary vein are quite rare. A 18-year-old male patient with the first episode of massive hemoptysis was found to have bronchial artery-pulmonary artery fistula, a rare vascular anomaly, on selective bronchial angiography. Since medical history revealed no acquired cause, it is considered congenital. He underwent bronchial artery embolization and hemoptysis was completely resolved after endovascular treatment. The presence of such vascular anomalies should be suspected in patients with massive hemoptysis. Bronchial artery embolization is a safe and effective nonsurgical treatment option for such patients.

Bronchial artery–pulmonary artery malformation as a cause of cryptogenic hemoptysis

A 12-year-old girl with two episodes of massive hemoptysis was found to have a localized pulmonary hemorrhage on bronchoscopy. Multiple investigations including a computed tomography (CT) angiogram failed to identify the cause. Catheterization of the pulmonary and bronchial vessels uncovered a bronchial artery to pulmonary artery fistula, which was embolized by interventional radiology. This is the first pediatric case of this type of anomaly and it illustrates the importance of angiography in the investigation of cryptogenic hemoptysis.

Delayed sternal closure after vacuum-assisted closure therapy for tracheo-innominate artery fistula repair

We report a case of successful innominate artery resection with delayed sternal closure after vacuum-assisted closure (VAC) therapy for a tracheo-innominate artery fistula (TIF). A 42-year-old woman with cerebral palsy underwent tracheostomy for respiratory assistance. On postoperative day 14, she was transferred to our hospital after an episode of massive hemoptysis. TIF was diagnosed based on the findings of multidetector computed tomography. Thus, we resected the innominate artery and started VAC therapy to control the postoperative local infection. The patient recovered uneventfully, without any infectious sequelae. Our strategy, which includes VAC therapy, for TIF repair may eliminate postoperative infective problems that could induce sequential bleeding and sternal compromise. To our knowledge, this is the first report of using VAC therapy for TIF.

A case of an airway obstruction secondary to blood clot formation after an episode of massive hemoptysis in a smear positive pulmonary tuberculosis pregnant lady

Here we report an interesting case of airway obstruction secondary to blood clot formation after an episode of massive hemoptysis in a pregnant lady and removal of clot with rigid bronchoscopy after an attempt of faliure with flexible bronchoscopy with review of literature.

Rasmussen's Aneurysm

This 54-year-old man presented with hemoptysis and a remote history of tuberculosis. He then had an episode of massive hemoptysis.

Massive Hemoptysis in Cystic Fibrosis

Massive hemoptysis is a complication commonly reported in patients with cystic fibrosis (CF). An understanding of the pathophysiology of this complication and its consequences is important for the management of patients with CF. To identify risk factors associated with massive hemoptysis, and to determine the prognosis of patients following an episode of massive hemoptysis. A retrospective, observational cohort study of the National CF Patient Registry between the years 1990 to 1999. The Registry contained data on 28,858 patients with CF observed over 10 years at CF centers across the United States. Massive hemoptysis occurred with an average annual incidence of 0.87% and in 4.1% of patients overall. There was no increased occurrence by sex, but it was more prevalent in older patients (mean age, 24.2 +/- 8.7 years [+/- SD]) with more severe pulmonary impairment (nearly 60% of patients who had an episode of massive hemoptysis had FEV1 < 40% predicted). The principal risks associated with an increased occurrence of massive hemoptysis included the presence of Staphylococcus aureus in sputum cultures (odds ratio [OR], 1.3) and diabetes (OR, 1.1). There was an increased morbidity (eg, increased hospitalizations and hospital days) and an increased 2-year mortality following massive hemoptysis. Massive hemoptysis is a serious complication in CF patients, occurring more commonly in older patients with more advanced lung disease. Nearly 1 in 100 patients will have this complication each year. There is an attributable mortality to the complication and considerable morbidity, resulting in increased health-care utilization and a measurable decline in lung function.

Massive hemoptysis in a young man

A 29-year-old man presented to the Emergency Department (ED) with an episode of massive hemoptysis. A patch-graft repair of an aortic coarctation 22 years earlier was the only history of note. Three weeks prior he had presented to the ED of another hospital due to two similar episodes. The chest radiograph did not show parenchymal lesions. A bronchoscopy revealed normal airways and a blood clot in the left upper lobe bronchus. The patient was discharged without any therapy.

Inflammatory pseudotumour of the lung

Inflammatory pseudotumours of the lungs have rarely been reported. These have been described as a benign entity of unknown origin and are often locally invasive requiring extensive pulmonary resection. We present a 12-year-old boy with fever and massive haemoptysis who was found to have a well defined left-sided paracardiac mass lesion on chest X-ray and CT scan thorax. A CT-guided fine needle aspiration cytology was reported as inflammatory pseudotumour. As a result of recurrent episodes of massive haemoptysis during admission the child underwent an emergency left posterolateral thoracotomy and excision of the mass along with a left pneumonectomy. The biopsy of the mass was conclusive. Postoperatively the child was ventilated over night and was extubated the next day. He has been doing well on follow-up. Based on our case report and on other similar reports it would appear that the primary treatment of inflammatory pseudotumors of the lung is surgical. Complete resection is the key to prevent recurrence and the prognosis is excellent following surgery.

Fibreoptic bronchoscopy based bronchial infusion therapy in treating haemoptysis

Massive Haemoptysis is a potentially life-threatening condition which often requires treatment in an emergency room environment. This problem becomes more alarming in patients when fibreoptic bronchoscopy (FOB) is used as a diagnostic tool. In this study 49 cases were included who either had constant blood mixed sputum (16 cases), or had one or more episodes of massive haemoptysis within 24 hours or during the FOB procedure (33 cases). Various non surgical therapies evolved in the past have been used by us to stop the bleeding in such cases using FOB. This study reports the results of fibreoptic bronchoscopy based procedures for lung extract (Hemoplastin) and botropase infusion therapy (BIT), as an alternative to thrombin and fibrinogen which are not commercially available in India. The method was very effective in 33 cases, effective in 11 cases and ineffective in 5 cases. We conclude that BIT using botropase and hemoplastin infusion therapy is safer and an effective alternative to Bronchial artery embolization BAE for the treatment of massive haemoptysis. We recommend their use as topicalhemostatic agents.