Hemoptysis

Pulmonary Blood Supply


Etiology (from 1997 tertiary hospital series [MEDLINE])

  • Bronchiectasis (see Bronchiectasis, [[Bronchiectasis]]): 20% of cases
  • Lung Cancer (see Lung Cancer, [[Lung Cancer]]): 19% of cases
  • Acute Bronchitis (see Acute Bronchitis, [[Acute Bronchitis]]): 18% of cases
  • Pneumonia (see Pneumonia, [[Pneumonia]]): 16% of cases
  • Other: 11% of cases
  • Unknown: 8% of cases
  • Coagulopathy (see Coagulopathy, [[Coagulopathy]]): 4% of cases
  • Congestive Heart Failure (CHF) (see Congestive Heart Failure, [[Congestive Heart Failure]]): 4% of cases

Etiology

Bronchiectasis (see Bronchiectasis, [[Bronchiectasis]])

Coagulopathy of Any Etiology

  • Mechanism: impaired coagulation in setting of structural lung disease (notably, in the absence of diffuse alveolar hemorrhage)
    • Typical structural abnormalities include endobronchial lesions, bronchiectasis, etc
    • May be massive

Congestive Heart Failure (CHF) (see Congestive Heart Failure, [[Congestive Heart Failure]])

  • Mechanism: pulmonary venous hypertension

Diffuse Alveolar Hemorrhage (DAH) (see Diffuse Alveolar Hemorrhage, [[Diffuse Alveolar Hemorrhage]])

Infection

  • Acute Bronchitis (see Acute Bronchitis, [[Acute Bronchitis]]): may be massive
  • Aspergilloma (see Aspergillus, [[Aspergillus]]): may be massive
  • Lung Abscess (see Lung Abscess, [[Lung Abscess]]): may be massive
  • Pneumonia (see Pneumonia, [[Pneumonia]])
    • Aspergillosis (see Aspergillus, [[Aspergillus]])
    • Mucormycosis (see Mucormycosis, [[Mucormycosis]]): may be massive
    • Tuberculosis (see Tuberculosis, [[Tuberculosis]]): may be massive

Neoplasm

Trauma

Lung Transplant Rejection/Dysfunction (see Lung Transplant Rejection/Dysfunction, [[Lung Transplant Rejection]])

Drug/Toxin

Miscellaneous

Idiopathic Hemoptysis

  • xxx

Diagnosis

Bronchoscopy

  • xxx

Chest CT

  • xxx

Diagnostic Yield of Procedures for the Evaluation of Hemoptysis

  • Chest CT: 67% diagnostic yield
  • CXR: 50% yield
  • Bronchoscopy: 42% diagnostic yield
  • Angiogram: 25% yield
  • V/Q Scan: 21% yield
  • Chest CT + Bronchoscopy: 93% diagnostic yield

Clinical

Quantification of Hemoptysis

  • Massive Hemoptysis: defined as >200-600 mL/24-hr period (variable definitions exist among experts)

Prognosis of Hemoptysis

  • Trivial Hemoptysis
    • Duration of Hospitalization: 8.1 +/- 8 days
    • Surgery: 5% of cases
    • Death: 2.5% of cases
  • Moderate Hemoptysis
    • Duration of Hospitalization: 9.5 +/- 7.7 days
    • Surgery: 9% of cases
    • Death: 6% of cases
  • Massive Hemoptysis
    • Duration of Hospitalization: 19.3 +/- 21.1 days
    • Surgery: 17% of cases
    • Death: 38% of cases

Treatment

Anti-Tussives

  • xxx

Airway Protection

  • xxxx

Bronchial Artery Embolization

  • Rationale: the large majority of hemoptysis arises from the bronchial circulation and therefore bronchial arterial embolization is the procedure of choice
  • Rate of Success: success rates from selective bronchial embolization are reported to be up to 85% on the initial attempts but are associated with re-bleeding in up to 20% of patients over the 1 year

References

  • Massive hemoptysis. Assessment and management. Clin Chest Med 1994; 15:147-167
  • Hemoptysis: etiology, evaluation, and outcome in a tertiary referral hospital. Chest 1997; 112:440-444 [MEDLINE]
  • Immediate and long-term results of bronchial artery embolization for life-threatening hemoptysis. Chest 1999; 115:996-1001
  • Bronchial artery embolotherapy for control of acute hemoptysis: Analysis of outcome. Chest 1999; 115:912-915
  • Prognosis of bronchial artery embolization in the management of hemoptysis. Respiration 2000; 67:412-416
  • Bronchial artery embolization: experience with 54 patients. Chest 2002; 121:789-795