Massive Hemoptysis In Patients Research Articles

Risk factors for the recurrence in pulmonary tuberculosis patients with massive hemoptysis.

To evaluate the outcomes of bronchial artery embolization (BAE) for the treatment of massive hemoptysis in patients with pulmonary tuberculosis and identify risk factors that influence recurrence. A total of 81 patients with massive hemoptysis who underwent BAE between January 2014 and December 2017 were retrospectively reviewed. All of the patients had either a history of pulmonary tuberculosis or a current diagnosis of pulmonary tuberculosis. Follow-up ranged from 18 to 66 months. Hemoptysis was stopped or markedly decreased, with subsequent clinical improvement in 73 patients, while 11 patients experienced recurrence during the follow-up period. Systemic-pulmonary shunts and clinical failure showed a statistically significant correlation with the recurrence rate. The cumulative non-recurrence rate was 95.3% for 3 months and 81.9% for more than 24 months. Complications were common (12.5%), but self-limiting. BAE is a safe and effective treatment option for the control of massive hemoptysis in pulmonary tuberculosis patients. Systemic-pulmonary shunts and clinical failure are the risk factors for recurrence.

Bronchial artery diameter in massive hemoptysis in cystic fibrosis

BackgroundMassive hemoptysis is a rare but potentially life-threatening condition of patients with cystic fibrosis (CF) and advanced pulmonary disease. Hypertrophied bronchial arteries are understood to cause massive hemoptysis when rupturing. Risk factors to predict massive hemoptysis are scarce and bronchial artery diameters are not part of any scoring system in follow-up of patients with CF. Aim of this study was to correlate bronchial artery diameter with massive hemoptysis in CF.MethodsBronchial artery and non-bronchial systemic artery diameters were measured in contrast enhanced computed tomography (CT) scans in patients with massive hemoptysis and compared to patients with end-stage CF and no history of hemoptysis. Demographic and clinical data and side of bronchial artery/non-bronchial systemic artery hypertrophy and coil embolization were documented.ResultsIn this retrospective multicenter study 33 patients with massive hemoptysis were included for bronchial artery/non-bronchial systemic artery diameter measurements, (13 female, 20 male, median age 30 years (18–55)). Bronchial artery diameters were significantly larger in the case group than in the control group with median 4 mm (2.2–8.2 mm), and median 3 mm (1–7 mm), respectively (p = 0.002). Sensitivity of bronchial arteries ≥ 3.5 mm to be associated with hemoptysis was 0.76 and specificity 0.71 with ROC creating an area under the curve of 0.719. If non-bronchial systemic arteries were present, they were considered culprit and embolized in 92% of cases.ConclusionBronchial arteries ≥ 3.5 mm and presence of hypertrophied non-bronchial systemic arteries correlate with massive hemoptysis in patients with CF and might serve as risk predictor for massive hemoptysis. Therefore, in patients with advanced CF we propose CT scans to be carried out as CT angiography to search for bronchial arteries ≥ 3.5 mm and for hypertrophied non-bronchial systemic arteries as possible risk factors for massive hemoptysis.

A retrospective analysis of risk factors for massive hemoptysis in patients with bronchiectasis

BackgroundMassive hemoptysis is a common and fatal complication of bronchiectasis. However, the risk factors for massive hemoptysis in patients with bronchiectasis have not yet been reported. This study investigated the potential risk factors for massive hemoptysis in patients with bronchiectasis.MethodsThis retrospective study included patients with bronchiectasis and their data were obtained from medical records. The risk factors for massive hemoptysis were evaluated by multivariate analysis of patient characteristics, medical history, and computed tomography imaging data, including the number of lesions, lesion location, and laboratory findings.ResultsAmong 379 patients, 61 (16.09%) experienced severe hemoptysis. Multivariate analysis revealed that diabetes (odds ratio (OR) 2.885; 95% confidence interval (CI) 1.009–8.247), lesions involving two lobes (OR 4.347; 95% CI 1.960–9.638) and three lobes (OR 2.787; 95% CI 1.055–7.363) were significant predictors of severe hemoptysis. However, a disease course between 1 and 5 years (OR 0.300; 95% CI 0.112–0.801) and involvement of the left lower lobe (OR 0.394; 95% CI 0.196–0.793) were protective factors for the prevention of massive hemoptysis. Lesions in the right upper lobe were more likely to cause massive hemoptysis (OR 1.458) than involvement of other lobes.ConclusionsDiabetes and lesions involving two and three lobes, were risk factors for massive hemoptysis in patients with bronchiectasis. Disease duration between 1 and 5 years and involvement of the left lower lobe were protective factors, while lesions in the right upper lobe had a stronger relationship with massive hemoptysis in patients with bronchiectasis.

Chronic Thromboembolic Pulmonary Hypertension (CTEPH) and massive hemoptysis: The rationale for bronchial artery embolization

IntroductionIn many patients with Chronic Thromboembolic Pulmonary Hypertension (CTEPH), bronchial artery hypertrophy is observed. Patients with bronchial dilatation have been shown to be at increased risk of hemoptysis introducing the risk of airway obstruction. In this study from an academic tertiary referral center, we aimed to assess the incidence of massive hemoptysis in our CTEPH patients, the success of bronchial artery embolization (BAE), recurrence, and hemoptysis-related mortality. MethodsRetrospective cohort study of all adults with CTEPH who underwent BAE for massive hemoptysis between 1 January 2015 and 30 July 2021. Primary endpoints were hemoptysis relapse and hemoptysis-related mortality. ResultsThere were 367 patients who were being treated and managed with a diagnosis of CTEPH at our institution. There were 24 bronchial artery embolization procedures performed for all causes. A total of 3 patients during this time met inclusion criteria with acute massive hemoptysis and CTEPH. All patients were taking therapeutic-dose anticoagulation. Technical success after BAE was 100%. No hemoptysis recurrence was demonstrated at 17, 24, and 40-months follow-up respectively. No patient died from hemoptysis. However, 1 patient died 24 months after the embolization procedure due to a non-hemoptysis cause. ConclusionThis study highlights the low but important incidence of massive hemoptysis in patients with CTEPH. Unlike other causes of hemoptysis, this unique cohort requires balancing anticoagulation and hemorrhage control. Given the high degree of success, BAE is a viable option, allowing continuation or early re-establishment of anticoagulation.

Surgery for Life-Threatening Massive Hemoptysis; Does the Time of Performed Surgery and the Timing of Surgery Affect the Rates of Complication and Mortality?

The changing of clinical and surgical presentation over the course of years and the effect of the timing of surgery for the massive hemoptysis were investigated. Between 2000 and 2015, 67 patients with life-threatening massive hemoptysis who underwent surgical treatment were analyzed. The timing of surgery was defined as urgent (n=6) and planned-delayed (n=61). The time of performed surgery was divided into two parts: the previous period (2003 to 2010) (n=48) and the recent period (2010 to 2017) (n=19). There were 25 patients (37.3%) with no preoperative diagnoses. The most common postoperative diagnosis was tuberculosis (n=20, 29.8%). The rate of operation for massive hemoptysis in patients who were admitted to the hospital for hemoptysis was lower in the recent period than the previous period (2.7% versus 7.9%, p<0.001). The urgent surgery group had a higher overall complication rate than the planned-delayed surgery group (66.7% versus 38.3%). Complication in patients with tuberculosis was not different than the remaining patients (p=0.254). Major complication rate was a trend downward in the recent period (22.7 to 10.5%). Mortality increased in the presence of urgent surgery (p=0.003) and in patients who were transferred to the intensive care unit (ICU) with intubation after surgery (p<0.001). There was a tendency to significant difference between two periods in regards of mortality rate (16.7% in the previous period, 0% in the recent period, p=0.09). Our results support a trend toward improved surgical outcomes in massive hemoptysis. High mortality indicators are the presence of urgent surgery and returning to the ICU with postoperative intubation.

Lobectomía pulmonar de hemoptisis masiva en pacientes con tuberculosis pulmonar: Reporte de Caso

Lobectomía pulmonar de hemoptisis masiva en pacientes con tuberculosis pulmonar: Reporte de Caso

50 Years Ago in TheJournalofPediatrics: Massive Hemoptysis in Patients with Cystic Fibrosis: When the Problem Is Solved with Prevention

50 Years Ago in TheJournalofPediatrics: Massive Hemoptysis in Patients with Cystic Fibrosis: When the Problem Is Solved with Prevention

Endovascular embolization for pulmonary artery pseudoaneurysms with massive hemoptysis

Objective: To investigate the efficacy and safety of transcatheter embolization for the treatment of pulmonary artery pseudoaneurysms (PAPs) with massive hemoptysis via both arterial and venous access. Methods: The clinical data of 15 patients of pulmonary tuberculosis presenting with massive hemoptysis, who were confirmed by CTA/DSA with PAPs at the Second Affiliated Hospital of Hainan Medical University from January 2016 to February 2018, were retrospectively analyzed. The imaging presentation, technical and clinical success of endovascular treatment, and recurrence of hemoptysis within 1 year was recorded. Results: A total of 15 PAPs were involved. Fourteen PAPs were confirmed by pulmonary CTA and one by angiography. Six PAPs were visualized during bronchial artery angiography, 4 PAPs during pulmonary artery angiography, and 4 PAPs both. One PAP was not shown during catheter-directed angiography. Except for one patient who died of asphyxia due to severe hemoptysis undergoing embolization, hemoptysis relapse was achieved in 14 patients after endovascular treatment. During 12 months follow-up, one patient underwent surgical resection because of recurrent hemoptysis 2 weeks after embolization, and another patient with recurrence hemoptysis 3 months after embolization received repeated intervention and hemoptysis relapsed. Conclusion: Transcatheter embolization via dual access is effective and feasible for the treatment of PAPs with massive hemoptysis in patients with pulmonary tuberculosis, but still some risks.

Renin-associated hypertension after bronchial artery embolization in cystic fibrosis

Bronchial artery embolization is the recommended therapy for massive hemoptysis in patients with cystic fibrosis (CF). We report on two cases of multiple renal infarcts and renin-associated hypertension and hypokalemia occurring in CF adults after bronchial artery embolizations. These complications were presumably related to crossing of small calibrated microspheres through arteriovenous anastomoses. Although hypokalemia resolved rapidly, hypertension persisted at least 6 months and its control required multiple antihypertensive agents. Physicians should be aware of this potentially severe, but previously unreported, complication of bronchial artery embolization.

Endovascular Management of Massive Hemoptysis in Patients With Pulmonary Pseudosequestration

Idiopathic chronic lung consolidation is a rare cause of massive hemoptysis. We describe 2 patients with chronic pulmonary consolidation of unknown etiology who presented with massive hemoptysis resulting in airway compromise. Selective angiography demonstrated multiple hypertrophied systemic arteries supplying the area of consolidation, consistent with pulmonary pseudosequestration. Initial endovascular management with embolization resulted in immediate control of hemoptysis. Short interval repeat angiography and embolization was necessary in both patients to treat recurrent hemoptysis secondary to hemorrhage from multiple feeding arteries. Selective bronchial and nonbronchial systemic arterial embolization is an effective treatment for massive hemoptysis secondary to pulmonary pseudosequestration.

Massive hemoptysis from pulmonary ligament artery supplying abnormal basal segments of the lower lobe

Non-bronchial systemic arteries can be a significant source of massive hemoptysis in patients with marked pleural involvement. However, in some cases without pleural involvement, the pulmonary ligament artery (PLA) can also enter the abnormal lung parenchyma and be responsible for hemoptysis. To discuss the factors influencing the development of a blood supply from the PLA in patients with hemoptysis. Seventy-five consecutive patients who underwent bronchial artery embolization (BAE) for massive hemoptysis were evaluated between January 2006 and December 2011 retrospectively. Selective arteriography showed an enlarged and tortuous PLA in five patients. CT was done to determine the site and extent of the underlying diseases before BAE in all patients. Angiographic and CT images were analyzed to determine if there was a relationship between PLA supply and location of the underlying disease or mediastinal pleural involvement. The underlying lesions of six patients involved the basal segments of the lower lobe without marked mediastinal pleural thickening or adhesion, but diaphragmatic and lateral pleural thickening was observed in one case. Of these six patients, the PLA supplied blood to the lesions related to the hemoptysis in five patients. No patient with massive hemoptysis whose underlying lesions involved other segments of lung had a PLA supplying the lesions. Even though pleural involvement is absent, underlying lesions involving the basal segments of the lower lobe could be a good indicator that the PLA is the cause of bleeding in patients with massive hemoptysis.

Educational Exhibit Abstract No. 253 - Arterial embolization for massive hemoptysis in patients with chronic lung consolidations

Learning Objectives 1). Review the pathophysiology of chronic lung consolidations that result in massive hemoptysis. 2). Discuss the clinical and imaging work-up of patients with massive hemoptysis emphasizing a thorough multidisciplinary evaluation and treatment plan. 3). Review of bronchial artery and non-bronchial systemic arterial anatomy. 4). Highlight embolization techniques and strategies that interventional radiology can offer patients for non-surgical management of massive hemoptysis. Background Chronic lung consolidation results in local hypoxia and vasoconstriction of pulmonary arterioles. This alteration of physiologic blood flow stimulates bronchial artery hypertrophy, vascular tortuosity, and the proliferation of regional systemic arteries most commonly intercostal, internal mammary, and inferior phrenic arteries. Over time these vascular changes may result in life threatening massive hemoptysis and compromise of the airway. Clinical Findings/Procedure Details This exhibit reviews the angiographic evaluation and techniques for embolizing bronchial and non-bronchial systemic arteries in patients with massive hemoptysis secondary to chronic lung consolidation. A variety of embolization materials maybe used and benefits and limitations of each will be discussed. Our exhibit includes quality images to: 1) Demonstrate changes in arterial supply to regions of chronic consolidation, 2) Show variant bronchial artery anatomy, and 3) Review embolization techniques for effective non-surgical treatment. Imaging modalities include radiography, CT, and digital subtraction angiography. Conclusion and/or Teaching Points Life-threatening hemoptysis in patients with chronic lung consolidation is rare, however this can be safely and effectively treated by interventional radiologists. Being aware of changes in arterial vasculature, embolization strategies, and the importance of multidisciplinary evaluation is essential for good patient outcomes.

Coronary to Bronchial Artery Fistula Causing Massive Hemoptysis in Patients with Longstanding Pulmonary Tuberculosis

We report on three cases of longstanding pulmonary tuberculosis patients with coronary to bronchial artery fistula (CBF) who presented with recurrent massive hemoptysis. The first and second patients died because of decreased functional pulmonary volume plus massive hemoptysis and cannulation failure of CBF due to hypovolemic vasospasm, respectively. When recurrent hemoptysis occurs despite successful embolization treatment, CBF should be considered as a potential bleeding source. Moreover, a coronary angiography should be performed, especially in patients with longstanding cardiopulmonary disease such as pulmonary tuberculosis.

Recombinant Activated Factor VII for Massive Hemoptysis in Patients With Cystic Fibrosis

Massive hemoptysis is a common complication in patients with cystic fibrosis (CF) and is associated with significant morbidity and mortality. Conventional treatment with antibiotic therapy and early bronchial artery embolization (BAE) is usually successful in achieving hemostasis in the majority of patients. Recombinant activated factor VII (rFVIIa), originally developed for use in patients with hemophilia, has emerged as a general hemostatic agent that is potentially useful in the management of many life-threatening bleeding conditions. In this article, we present four patients with CF lung disease and massive hemoptysis who were treated successfully with rFVIIa. We suggest that in patients with CF who present with massive hemoptysis, the use of rFVIIa can be considered in patients with refractory hemoptysis despite conventional therapy or as a temporizing therapy when BAE is not immediately available.

Transcatheter arterial embolization for massive hemoptysis in patients with coal workers' pneumoconiosis: an 11-year experience

Transcatheter arterial embolization (TAE) is a safe and well-established treatment option to control hemoptysis, but there are few studies focused on treating hemoptysis accompanying coal workers' pneumoconiosis (CWP). To evaluate the immediate and long-term efficacy of TAE for control of massive hemoptysis in patients with CWP, and to clarify the factors which influence the frequency of rebleeding. This study included 34 CWP patients with massive hemoptysis who were treated with 47 TAE sessions over the last 11 years. Immediate (within 1 month) and long-term outcomes (mean 37 months, range 1 month-11 years) were evaluated retrospectively. The relationships between the frequency of rebleeding and the type of CWP, angiographic findings, and presence of tuberculosis were evaluated. The immediate success rate was 91.2% (31/34). In 23 patients (68%), hemoptysis did not recur on long-term follow-up. In eight patients who received repeated procedures for recurrent hemoptysis, bleeding was discovered in the non-bronchial systemic artery (n = 13) or bronchial artery (n = 7). The frequency of recurrent hemoptysis was higher in cases with complicated pneumoconiosis (n = 7) than in cases of the simple type (n = 1; P = 0.029). There was no statistical difference between rebleeding and angiographic findings or the presence of tuberculosis. TAE is an effective treatment modality for controlling massive hemoptysis in patients with CWP. However, many non-bronchial systemic collaterals contribute to recurrent hemoptysis. Furthermore, there is a high probability of rebleeding in patients with the complicated type of CWP, and extra care must be taken in the embolization procedure.

Utilización de fibrinógeno-trombina por vía endoscópica en el tratamiento de la hemoptisis masiva

We assessed the efficacy of fibrinogen-thrombin instillation through the fiberoptic bronchoscope to treat massive hemoptysis in patients to whom embolization of bronchial arteries was not available, was contraindicated or had failed. The fibrinogen-thrombin solution used was Tissucol, which in addition to 2% fibrinogen and 4 U/ml of thrombin, also contained factor XIII an aprotinin. The fibrinogen-thrombin solution was instilled with the aid of the Duplojec system and a 70 cm x 2 mm 4-way catheter. In 53 of the 628 fiberoptic bronchoscopies performed during the study, the indication was hemoptysis > or = 150 ml/12 h. Of these, bronchoscopic instillation of fibrinogen-thrombin was indicated in 5 cases because bronchial artery embolization was impossible. The point of bleeding was located by bronchoscopy in all cases and fibrinogen-thrombin instillation controlled hemoptysis immediately and throughout the follow-up period, which ranged 4 to 10 months. Morning expectoration of blood (< 10 ml) was observed in only 1 patient in the 3 days after treatment. The mean time taken for bronchoscopic exploration was 3 minutes (range, 2-7). In all cases fiberoptic bronchoscopy was performed without complications that might have required the procedure to be suspended. We conclude that the local use of fibrinogen-thrombin or fibrin glue instilled through the fiberoptic bronchoscope to the point of bleeding is a simple, fast and cheap way to control massive hemoptysis on a short and long-term basis.(ABSTRACT TRUNCATED AT 250 WORDS)

Emergency Pulmonary Resection for Pneumonia: High Morbidity and Mortality

Emergency pulmonary resection was performed because of complicated pneumonia in eight patients (5 pneumonectomies, 2 lobectomies, 1 bilobectomy) over a 2-year period. The patients' age range was 5 months to 43 years. The indications were rapid aggravation of respiratory insufficiency in children with staphylococcal pneumonia and enlarging pneumatoceles, and massive hemoptysis in patients with chronic destructive pneumonia. Two patients died after pneumonectomy, one from contralateral aspiration and one from cardiogenic shock. Postoperative complications occurred in four cases--bronchopleural fistula and pyopneumothorax in three and thoracic empyema with massive chest-wall infection in one. Only two patients had an uneventful postoperative course. Complications of pulmonary necrosis in pneumonia may dictate urgent pulmonary resection, often pneumonectomy. Surgery will be life-saving in most cases, but high morbidity is to be expected.

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.

Massive hemoptysis in patients with cystic fibrosis: Three case reports and a protocol for clinical management: A. Trento, S.M. Estner, B.P. Griffith, et al. Ann Thorac Surg 39:254–256, (March), 1985

Massive hemoptysis in patients with cystic fibrosis: Three case reports and a protocol for clinical management: A. Trento, S.M. Estner, B.P. Griffith, et al. Ann Thorac Surg 39:254–256, (March), 1985

Massive Hemoptysis in Patients with Cystic Fibrosis: Three Case Reports and a Protocol for Clinical Management

The clinical management of massive hemoptysis in patients with cystic fibrosis proceeds according to the following paradigm. The site of bleeding is identified by bronchoscopy, ideally under general anesthesia. Then selective bronchial arteriography is performed. If collaterals to the spinal cord are visualized, arterial embolization is abandoned and pulmonary resection is undertaken within the limits of pulmonary function.