Management Of Hemoptysis In Patients Research Articles

Management of hemoptysis in patients with lung cancer.

Hemoptysis related to malignancy is common and accounts for nearly a quarter of all cases of hemoptysis in the US, and approximately 20% of patients with lung cancer will experience some degree of hemoptysis during their disease course. Both minor and massive hemoptysis come with diagnostic and treatment challenges and are associated with increased mortality. We will discuss the definition and epidemiology of hemoptysis related to malignancy, outline our approach to the initial evaluation and diagnostic workup, and extensively review the management of minor and massive hemoptysis. Specific emphasis will be on relevant signs and symptoms, imaging, and the role of bronchoscopy, and the differences in approach for minor hemoptysis compared to massive hemoptysis. While the role of surgical management is very limited in this patient population, the role of endobronchial and endovascular management will be discussed in detail.

Bronchial Artery Embolization in the Management of Hemoptysis in Patients with Hematologic Diseases: Feasibility and Short-Term Efficacy

Background: Patients with hematologic diseases are frequently accompanied by coagulopathy; even a small amount of hemoptysis may worsen clinical outcomes compared to those with the similar severity of injury without coagulopathy. However, a few studies have included various hematologic conditions, and none of them were large series. Objectives: To evaluate the feasibility and short-term efficacy of bronchial artery embolization (BAE) in the management of hemoptysis in patients with hematologic diseases. Patients and Methods: This was a retrospective study of 25 patients with hematologic diseases who visited our interventional unit for the management of hemoptysis between 2009 and 2012. The clinical, laboratory, and radiographic data were retrospectively analyzed and we correlated clinical response with the amount of hemoptysis, coagulation condition, radiographic pattern, and bronchial artery hypertrophy. Results: The amount of hemoptysis was trivial in 13 patients (52 %), moderate in ten patients (40%), and massive in two patients (8%). Thirteen patients (52%) had coagulopathy (platelet count 1.5). Seventeen patients (68%) showed focal pulmonary hemorrhagic patterns and eight patients (32%) showed diffuse pulmonary hemorrhagic patterns. BAE provided complete clinical response in 21 out of 25 patients (84%). Complete clinical response was not correlated with the amount of hemoptysis, coagulation condition, radiographic pattern, or bronchial artery hypertrophy (P > 0.05). There was no significant difference in short-term survival between patients with coagulopathy and those without coagulopathy (P = 0.425), and between patients with focal hemorrhagic pattern and those with diffuse hemorrhagic pattern (P = 0.728). Conclusion: BAE in hematology patients was relatively efficient in controlling hemoptysis. The amount of hemoptysis, coagulation condition, radiographic pattern, or bronchial artery hypertrophy was not a significant factor affecting the outcome.

Pulmonary Artery Access Embolization in Patients with Massive Hemoptysis in Whom Bronchial and/or Nonbronchial Systemic Artery Embolization Is Contraindicated

The objective of this paper is to present an alternative therapeutic approach for the treatment of patients with massive hemoptysis in whom bronchial and/or nonbronchial systemic arterial embolization is not possible. We describe a percutaneous procedure for pulmonary segmental artery embolization. Between May 2000 and July 2006, 27 adult patients with hemoptysis underwent percutaneous treatment at our department; 20 of 27 patients were embolized via bronchial and or nonbronchial systemic arteries and 7 patients were embolized via pulmonary artery. Femoral arterial access for systemic artery catheterization and femoral vein access for pulmonary arterial catheterization were used. Gelfoam particles and coils were used for embolization. In this study, we report on three cases of massive hemoptysis from a systemic arterial source in whom bronchial and/or nonbronchial arteries embolization was not possible. Percutaneous embolization via the pulmonary artery access was successful in all three patients. In conclusion, embolization via pulmonary artery is presented as an alternative approach for the management of hemoptysis in patients in whom bronchial arterial embolization is not possible.