Major Hemoptysis Research Articles

Cough-Induced Hemiplegic Migraine with Impaired Consciousness in Cystic Fibrosis

The coughing paroxysms of patients with cystic fibrosis may occasion neurological symptoms. Although cough syncope is well-known, and is associated with headache and paralysis, a migrainous mechanism has not been reported. We reviewed the medical records, autonomic testing results, and responses to treatment in two cystic fibrosis patients with similar presentations of cough-induced impairment of consciousness followed by headache and paralysis. A 24-year-old woman and an unrelated 38-year-old man, both with cystic fibrosis, developed post-tussive neurologic deficits. Both patients reported infrequent dramatic spells, always preceded by major hemoptysis, and associated with left-sided paralysis, transient blindness, nausea, and severe pulsating headaches. Autonomic testing demonstrated only postural tachycardia and a near-vasodepressor episode in the woman, and mild, generalized sympathetic dysfunction in the man. Treatment for presumptive migraine with aura with verapamil nearly eradicated symptoms in both patients. Discontinuation of verapamil in the woman was associated with symptom recurrence and a stroke, with significant persistent residual left hemiparesis. In conclusion, cough-induced neurologic deficits were previously reported with cystic fibrosis, without clear understanding of the mechanism of impairment of consciousness. Based on the hemiparesis, nausea, and throbbing headache, which repeatedly followed the events in both patients, and based on the response to verapamil, we hypothesize a migrainous mechanism in both of our patients. The pathophysiology that links the hemoptysis to the spells deserves further investigation.

Major hemoptysis in adolescents.

The coughing up of blood or blood-tinged sputum in children is unusual but potentially lethal. The etiologies of hemoptyses in children differ from adults and vary among geographic locations. This paper reviews the clinical presentation and radiographic features of massive hemoptysis in adolescents seen in a single tertiary children's hospital in northern Taiwan during a 10-year period. Active pulmonary tuberculosis with cavity formations and dissemination, congenital heart diseases with hypertrophied bronchial artery and local bleeding were the 2 most common causes of major hemoptysis in this single institute experience. Most cases of major hemoptysis due to active pulmonary tuberculosis can be managed conservatively. For patients with respiratory compromise or hemodynamic instability, selective bronchial artery embolization effectively stopped hemoptysis without complications.

Surgical Management of Tuberculosis-Related Hemoptysis

Background Tuberculosis is a disease that is often treated with chemotherapy. However, medical treatment usually fails in the management of tuberculosis-related hemoptysis. In this paper, we review our experience in the surgical treatment of tuberculosis-related hemoptysis. Methods Fifty-nine patients with tuberculosis-related hemoptysis (46 men, 13 women) who underwent surgical treatment were enrolled in this study. A thoracotomy was performed urgently in 21 patients with massive (>600 mL daily) hemoptysis, and within the first 2 days in 24 with major (200 to 600 mL daily) hemoptysis, and within the first 4 days in 14 with persistent minor (<200 mL daily) hemoptysis. Results A chest roentgenogram showed cavitary lesion in all of the patients with massive hemoptysis (21 patients), in 22 of 24 patients with major hemoptysis, and in 3 of 14 patients with persistent minor hemoptysis. Pneumonectomy was performed in 4 patients, lobectomy in 39 patients, and segmentectomy or wedge resection in 16 patients. The average hospitalization period was 13 days. The mortality rate was 6.8% perioperatively. Of the patients deceased, 3 were intubated with a single-lumen endotracheal tube and 1 with a double-lumen endotracheal tube. During the postoperative period, empyema and bronchopleural fistula developed in 3 patients, and no other severe complications occurred. The average postoperative follow-up period was 3 years. The number of thoracotomies for tuberculosis performed in the years from 1995 to 2003 was significantly decreased, compared with the years between 1985 to 1994 ( p = 0.042). Conclusions In tuberculosis-related hemoptysis, thoracotomy with double-lumen endotracheal intubation and resection of the cavity may be curative and lifesaving.

Major haemoptysis in children with cystic fibrosis: a 20-year retrospective study

Background: Major haemoptysis occurs in approximately 1% of children with cystic fibrosis (CF). This report describes management and follow-up of these children at a tertiary centre in Australia. Methods: Retrospective review of medical records from 1980–1999. Results: Fifty-one children (45% female) had major haemoptysis (102 episodes). Mean age at first episode was 15 years (range 7–19) and mean FEV 1 was 56% predicted (range 14–98). Massive life-threatening haemoptysis was not confined to those with severe lung disease (FEV 1<50% predicted). Bronchial artery embolisation (BAE) was more likely to be the initial treatment for those with massive haemoptysis and chronic recurrent bleeding tended to be treated conservatively ( P=0.01). Overall, 52 BAE were performed in 28 children with an immediate success rate of 98%; 13 children (46%) had repeated BAE. Four patients died as a direct result of severe haemoptysis. Mean follow-up was 54 months (range 0.5–183). Median survival time (Kaplan–Meier estimate) after first haemoptysis was 70 months, with a significantly longer survival for male patients independent of age (RR 3.8; 95% CI 1.7–8.8; P=0.001). Median survival time following initial treatment with BAE was longer (103 months) compared to conservative treatment (52 months, P=0.09). Conclusions: Massive haemoptysis was unrelated to the severity of lung disease and was more likely to be treated with embolisation. BAE was highly effective, however, 46% of the children required re-embolisation at some time, which is similar to the recurrence risk for major hemoptysis treated conservatively on longer term follow-up.

Fistule aortobronchique à partir d'un anévrisme infectieux de l'aorte thoracique

Aortobronchial fistula presenting as massive haemoptysis is a rapidly fatal process if not promptly diagnosed and repaired. It's an unusual complication of thoracic aneurysm. We report the case of a 61-year-old woman with rupture of a thoracic aortic infectious aneurysm secondary to an Escherichia coli infection. Aortobronchial fistula diagnosis should be considered in patients who have minor or major haemoptysis and correct diagnostic procedures shoud be performed early. An aggressive surgical approach is often necessary.

Invasive mechanical ventilation for acute respiratory failure in children with cystic fibrosis: outcome analysis and case-control study.

The outcome for cystic fibrosis (CF) patients requiring intubation and invasive mechanical ventilation (IMV) due to acute respiratory failure (ARF) has been poor. Mortality rates have been reported as high as 60-90%. However, a review of mortality in children has not been published in 20 years. Our objectives were to study outcomes in CF patients requiring IMV due to ARF between 1988-1998, compare recent outcomes with those previously reported, and identify risk factors associated with poor outcome. We additionally attempted to identify factors suggesting an increased risk of developing ARF requiring IMV. A retrospective cohort study design was used, comparing IMV survivors and nonsurvivors with a nested case-control study to identify risk factors for ARF leading to IMV. All patients cared for at our Center who required IMV for ARF between 1988-1998 were identified. Outcome, age, steroid use, forced vital capacity (FVC), forced expired volume in 1 sec (FEV(1)), microbiology, nutritional status, CF-related diabetes (CFRD), liver dysfunction, and history of major hemoptysis (HEM) or pneumothorax (PTX) were recorded. Cases were matched for gender and age with CF controls identified through a clinical database.Thirty-eight episodes of IMV due to ARF were reported in 33 patients. Three subjects underwent IMV on two or more occasions, but only the first episode was included in analysis. Older age was the only factor that was significantly associated with mortality: 9 subjects were <5 years of age (mortality, 22%), while 24 were 5-34 years old (mortality, 75%) (P = 0.013). There was an increased risk of having an episode of ARF requiring IMV in malnourished subjects (OR = 4.2; 95% CI = 1.66-10.51) and in those with a history of HEM (OR = 6.3; 95% CI = 1.75-22.65). Infants and young children with CF requiring IMV due to ARF have a favorable prognosis, whereas those >or=5 years of age suffer significantly higher mortality. Malnutrition and a history of HEM are important risk factors for having an episode of ARF requiring IMV.

Management of exsanguinating hemoptysis during cardiopulmonary bypass

Background. Large-volume hemoptysis during cardiopulmonary bypass is an infrequent, but life-threatening event. Rapid airway clearance and control are the primary prerequisites for successful management. Methods. The cases of 3 patients with different sources of exsanguinating hemoptysis during cardiopulmonary bypass managed initially with rigid bronchoscopy were reviewed. Results. In all patients, airway control was rapidly established and weaning from cardiopulmonary bypass CPB was accomplished. Two patients survived the operative procedure. The other patient died in the operating room of unremitting bilateral pulmonary hemorrhage. Conclusions. Major hemoptysis during cardiopulmonary bypass is best dealt with initially by rapid airway control and cessation of bypass in an expeditious manner. An algorithm for suggested management is provided. The rigid bronchoscope is the optimal tool for initial management and it should always be available. Definitive treatment is determined by the cause and the persistence of hemorrhage once these maneuvers have been performed.

Bronchial artery embolization for the treatment of hemoptysis in patients with cystic fibrosis.

Hemoptysis is common in patients with cystic fibrosis (CF). Bleeding may vary in severity, ranging from minor blood-streaking of sputum to expectoration of significant quantities of blood. Major hemoptysis, defined as bleeding greater than 240 ml/24 h, represents a medical emergency. Bronchial artery embolization (BAE) is one of the treatment options for hemoptysis. We reviewed the 10-yr experience at the University of North Carolina Hospitals in the treatment of hemoptysis by BAE. Eighteen patients with CF were hospitalized on 29 occasions and underwent 36 BAE procedures for the control of hemoptysis. Most patients (n = 11) had very severe lung disease (FEV1 < 35%) with a high incidence (n = 9, 50%) of multi-drug-resistant bacteria. Fifteen patients (n = 33 procedures) were followed for a mean of approximately 22 mo after BAE. The overall efficacy of BAE for initial control of hemoptysis was 75% (n = 22) after one session, 89% (n = 26) after two sessions, and 93% (n = 27) after three sessions. The overall recurrence rate per episode was 46% (12/26 presentations in four patients) with a mean time for recurrence of approximately 12 mo. There was a high incidence (75%) of bleeding from nonbronchial systemic collateral vessels among patients (n = 7) who had undergone a previous BAE. There were two deaths associated with massive hemoptysis despite BAE. Three patients had transient neurologic deficits during BAE. We concluded that BAE is a relatively safe and effective means of treating significant hemoptysis in patients with CF.

Bronchial artery embolization in the management of hemoptysis in cystic fibrosis

Massive hemoptysis and/or recurrent expectoration of measurable amounts of blood are common complications of chronic bronchopulmonary infections in cystic fibrosis (CF). When conservative treatment fails to control bleeding, surgery or bronchial artery embolization (BAE) is frequently considered. We present our experience and long-term follow up of BAE in 14 CF patients (age range 15-39 years) with massive (6 subjects) and/or recurrent (8 subjects) hemoptysis not responsive to medical treatment. Seven had chronic hypercapnic respiratory failure. After angiographic evaluation, polyvinyl alcohol particles (Ivalon) were injected to embolize obviously enlarged bronchial arteries. Seventeen procedures were performed in 14 patients and 36 bronchial arteries were embolized. All the patients stopped bleeding immediately upon BAE. Most of the patients had postembolization fever, dysphagia, and transient chest pain which were managed symptomatically. After a median follow-up period of 10.5 months (range 0.5-38 months), no recurrence of hemoptysis was observed in 8 patients who are still alive. In 3 patients hemoptysis recurred and they underwent reembolization after 3, 22, and 25 months, respectively. Three subjects died of respiratory failure within 5 months from BAE. Presently, 50% of patients studied had a > or = 1 year interval free of major hemoptysis after the first BAE. Our experience indicates that massive and/or recurrent hemoptysis in CF patients can be safety and effectively managed by BAE if the procedure is performed by a skilled practitioner. The procedure was well tolerated and resulted in prolonged and satisfactory bleeding control in most patients.

Audit of bronchial artery embolisation in a specialist respiratory centre.

To audit the use of bronchial arteriography and embolisation for controlling haemoptysis. Retrospective review of radiological and clinical data. Brompton and National Heart Hospitals. 35 patients with severe pulmonary disease in whom 58 bronchial arteriograms were obtained between 1 January 1984 and 31 December 1989 with the intention of bronchial artery embolisation for controlling haemoptysis. Rate of technical success and cessation of haemoptysis; detailed evaluation of patients, particularly those with major haemoptysis (> 100 ml expectorated blood); and retrospective assessment of the appropriateness of the procedure in each. 58 procedures were performed, nine of which were unsuitable for detailed analysis. Nine procedures were for minor haemoptysis, which subsequently recurred, and 40 for recent major haemoptysis in 26 patients with cystic fibrosis (16) aspergilloma (six), bronchiectasis (three), and an unknown diagnosis (one). The median total volume of haemoptysis in the episode before the procedure was 680 ml (range 270-2200 ml). Embolisation was technically successful in 33/40 procedures, in 17 of which, however, major haemoptysis recurred within 10 days of the procedure, leaving 16 clinically and technically successful procedures in 15 patients. Five patients (three with aspergilloma, two with cystic fibrosis) died of haemoptysis despite attempted embolisation. Success rate of bronchial artery embolisation was 40%(16/40). Bronchial artery embolisation is probably not justified for minor haemoptysis or when performed more than one week after a major haemoptysis. Repeat arteriograms during a single period of haemoptysis are seldom useful. With these criteria 43% fewer procedures would have been performed with no loss of clinical benefit.

The value of bronchial artery embolization in acute major haemoptysis

The value of bronchial artery embolization in acute major haemoptysis

Long-term management of respiratory symptoms in advanced cancer

Respiratory symptoms are a common cause of distress in patients with advanced cancer. Optimal palliative therapy requires careful assessment and the appropriate use of symptomatic measures in conjunction with specific antitumor treatments. The etiology and management of the three major respiratory symptoms, dyspnea, cough and hemoptysis, are described. The indications for antitumor treatments and surgical procedures are briefly outlined, and symptomatic treatments, including drug and nondrug measures, are discussed in detail.

Bronchial Artery Embolization for Severe Hemoptysis in Cystic Fibrosis

We studied the long-term outcome after BAE for life-threatening hemoptysis in patients with CF. Data from pulmonary function tests were available for 18 of the 25 patients followed. A case-control comparison revealed that these 18 patients died sooner than hemoptysis-free patients with CF matched for age, sex, and pulmonary function (p less than 0.02), with the excess mortality occurring within the first three months after BAE. Of all 25 patients followed, six died of cardiorespiratory failure within three months of BAE; in two of them, hemoptysis was a contributing cause of death. The 19 patients who lived more than three months after BAE had a mean survival after embolization of 3.5 years (five were still alive at the end of the study). Most patients experienced long intervals (greater than 1 year) free of major hemoptysis. Extended follow-up (mean, 35 months) revealed a higher incidence of recurrent severe bleeding than previously reported for 13 of these patients followed a mean of 11 months. Repeat BAE for severe recurrence was performed successfully in eight of nine patients, without complication.

Major and Massive Hemoptysis: Reassessment of Conservative Management

The etiologic factors of major (greater than or equal to 200 ml/24 hr) and massive (greater than or equal to 1,000 ml/24 hr) hemoptysis may well affect the outcome and, therefore, the treatment of this often life-threatening problem. the decline in the incidence of tuberculosis (TB) and bronchiectasis, along with the increase in bronchitis and neoplasia, have led to a strong institutional bias against operating on patients with major and massive hemoptysis. A retrospective case study and an extensive literature review were undertaken to critically evaluate this policy. Fifty-nine consecutive patients with major hemoptysis, 26 of whom had massive hemoptysis, were identified from 887 patients seen in our institution over a 10-year period. Only four of these 59 patients underwent surgery, while 55 were managed conservatively. Etiologic factors, operability, and bleeding rate all appeared to play a major role in outcome. No patients with bronchitis, bronchiectasis, tuberculosis, or who were on anticoagulation therapy died compared to a mortality rate of 59% in patients with carcinoma (CA) of the lung and 71% in patients with leukemia. Eleven percent of operable patients treated conservatively died compared to a 46% mortality rate for nonoperable patients. And, 9% of patients with bleeding rates less than 1,000 ml/24 hr died compared to 58% of those with greater than or equal to 1,000 ml/24 hr. Conservative management appears to have a low mortality in patients with non-tuberculosis-related major hemoptysis as well as in many patients with massive hemoptysis, especially those patients who are operable and those without neoplastic disease.

Management of Major or Massive Hemoptysis in Active Pulmonary Tuberculosis by Bronchial Arterial Embolization

Management of massive hemoptysis in patients with active pulmonary tuberculosis is complicated. Transcatheter hemostatic embolization of bleeding vessels with absorbable material has been reported to be useful in controlling this problem. Twelve patients with active pulmonary tuberculosis who had major or massive hemoptysis were managed at Cook County Hospital, Chicago, from 1982 to 1986. Various methods of treatment have been evaluated. The technique of angiographic embolization and the criteria for selection of patients for its use constitute the basis of this report.

Aspergillomas and lung fibrosis--a review of cases in a general hospital.

IN a review of eleven patients with aspergilloma attending St. Vincent’s Hospital between 1973 and 1984 sarcoid osis was the commonest predisposing disease (six patients) whereas cavitary tuberculosis, previously the most frequently associated condition, was present in only two patients. All patients had a combined restrictive-obstructive pulmonary deficit with mean values for FVC, FEV, and DLCO being 49%, 35% and 46% of predicted respectively. Life threatening haemoptysis was the most significant complication, occurring in six of eleven patients. In only two of these patients was lung function sufficiently adequate to permit surgical resection and both are alive 5 and 9 years respectively following the procedure. Four patients precluded from surgery because of prohibitive lung function had emergency bronchial arteriography performed with a vitw to arterial embolisation. This was successfully achieved in three patients with prompt cessation of active major haemoptysis, but could not be performed in a fourth because of an arterial anomaly. However there were no long term survivors in this latter non-surgical group. Finally, in five untreated patients observed over a mean period of three years, no major complications developed, despite enlargement of the fungus ball in three individuals. This study demonstrates a changing pattern of underlying disease in patients with aspergilloma and illutrates the usefulness of emergency arterial embolisation in the short term management of life threatening haemoptysis.

Comparison of Medical v Surgical Treatment of Major Hemoptysis

One hundred thirteen patients hospitalized with substantial hemoptysis were studied. Thirty-one patients underwent surgery and 82 were treated medically, and the two groups had similar diagnoses and bleeding patterns. There were four deaths in the surgical group and 18 deaths in the medical group. Of these, eight patients had a sudden first hemoptysis with instantaneous death. Ten patients had a terminal hemoptysis after prior bleeding, but nine of these patients had absolute contraindications for surgery. In 64 patients hemoptysis was controlled with medical treatment. Most patients showed a steady decrease of bleeding, with cessation of hemoptysis after four days. Our experience indicates that the majority of patients with serious hemoptysis can be successfully treated conservatively. Massive hemoptysis, aspiration, or recurrence of bleeding in and of themselves are not indications for surgery. Where the hemoptysis remains uncontrolled in spite of a trial of adequate medical care or where the aspiration is severe and progressive, surgery may be indicated and can be lifesaving.

Comparison of medical v surgical treatment of major hemoptysis

Comparison of medical v surgical treatment of major hemoptysis

Direct percutaneous needle aspiration of localized pulmonary lesions: result in 422 patients.

Over a period of 38 months, diagnostic needle aspiration of 400 (293 malignant and 107 benign) pulmonary lesions was performed with 20-gauge needles. Deep as well as peripheral nodules and masses were routinely biopsied. Positive diagnostic accuracy was 96.5%. There were 9 (2%) incorrect diagnoses with 5 false negatives and 4 false positives. In almost all patients with malignant pulmonary neoplasms, the specific cell type was identifiable. Pneumothorax was a frequent complication, but there were no fatalities, and no episodes of major bleeding or hemoptysis. A new slotted 20-gauge thin wall needle was used in 258 patients which enabled aspiration of larger amounts of material than had been possible with the standard 20-gauge thin wall needle, and in approximately 50% of patients, enough material was obtained to perform tissue sections as well as smears for cytology. In 77 patients with benign lesions and in 114 with unresectable neoplasms, needle aspiration established the diagnosis and made it unnecessary to perform surgery and/or mediastinoscopy.

Fatal Pulmonary Hemorrhage

To the Editor: In the October 1979 issue of Physical Therapy, a Clinical Report entitled “Fatal Pulmonary Hemorrhage Associated with Chest Physical Therapy” by Hammon and Martin appeared. I applaud the use of such case reporting to alert and enable other therapists in the field to recognize both positive and potentially harmful treatments. I, however, believe that this particular case study drew stronger conclusions than the situation warranted. The authors have failed to consider a major potential precipitation of hemoptysis in the patient with lung cancer and that is vigorous coughing. The potential for hemoptysis in any patient with such diffuse disease is real, and a reasonable course of maximizing clearance of secretions without precipitating major hemoptysis must be followed. However, even the most careful judicious treatment plan does not reverse the destructive process of the disease with its concomitant potential for hemorrhage. Related Article: [PubMed][1] [1]: http://www.ncbi.nlm.nih.gov/pubmed/493347