| Print Date: | May 18, 2013, 9:28 am |
| Title | Acute Hemoptysis |
| Text | Bronchial artery anatomy is extremely variable, and it was not until 1948 that the minute and detailed variations were
described. Sixteen years later, Viamonte et al first reported selective bronchial artery catheterization. In the same year, additional articles describing selective bronchial artery catheterization were reported. The application of bronchial artery embolization (BAE) to control hemoptysis was first reported by Remy et al in 1973. The technique was soon adopted for management of massive hemoptysis in France and the United States. Since then, BAE has become a well-accepted and established method used widely in the treatment of massive and recurrent hemoptysis. Acute Massive Hemoptysis Massive hemoptysis (defined variably as the production of 200 to 600 mL of blood in a 24-hour period) has a poor prognosis with a high mortality rate in those treated medically and a mortality rate up to 35% in those treated surgically during an acute bleed. The postoperative death rates have been particularly high when surgical resections are performed as an emergency. In recent years, many favor using BAE for massive hemoptysis as a palliative, temporizing measure that allows for a planned, elective surgery as the definitive treatment. Clinically, patients with major hemoptysis most often have underlying inflammatory lung disease. The predominant cause of hemoptysis worldwide is tuberculosis but other common conditions include lung abscess; sarcoidosis with aspergilloma; bronchogenic carcinoma; chronic infection, in particular cystic fibrosis; and pneumoconiosis. Less common causes include pulmonary emboli, bronchovascular fistula, pulmonary artery aneurysms, and arteriovenous malformations. In those with chronic lung infection and pleural disease, systemic vascular collaterals develop from internal mammary,intercostal, phrenic, thyrocervical, and other adjacent branches of the subclavian artery. Bronchopulmonary collaterals also become extremely prominent and hypertrophied, particularly in diseased lung or cor pulmonale and can lead to hemoptysis. Patients with congenital heart disease leading to decreased lung perfusion and oxygenation or severe chronic pulmonary emboli undergo bronchial artery enlargement with subsequent propensity to bleed. The initial management of a patient with acute, massive hemoptysis is focused on airway protection because the most frequent cause of death in this clinical setting is aspiration. A clinical assessment of the respiratory status, strict bed rest in a semiupright position, humidified oxygen, fluid or blood replacement through stable intravenous access, and correction of any coagulation abnormalities comprise the initial management. Chest radiographs should be obtained as early as possible and bronchoscopy performed to lateralize the bleed and, if possible, localize it. In cases of massive hemoptysis requiring urgent, life-saving embolization, some authors recommend avoiding bronchoscopy and moving directly to angiography. If bronchoscopy is performed, the opposite airway can be protected by selective intubation of the normal side or balloon occlusion on the side of the hemorrhage. - Sanjay Saluja MD, et al. EMBOLOTHERAPY IN THE BRONCHIAL AND PULMONARY CIRCULATIONS Radiologic Clinics of North America Volume 38 W. B. Saunders Company Number 2 March 2000 |
| References: | Sanjay Saluja MD, et al. EMBOLOTHERAPY IN THE BRONCHIAL AND PULMONARY CIRCULATIONS Radiologic Clinics of North America Volume 38 W. B. Saunders Company Number 2 March 2000 |
| Contributor | Courtney T Tripp (Uniformed Services University) |
| Peer Reviewer | Alex Freitas (Tripler Army Medical Center) |
| Record Number | : 4507 |
| Created | 2003-01-10 12:14:30-05 |
| Modified | 2003-01-23 03:58:11-05 |
| Category: | Inflammatory, NOS |
| Location: | Chest, Pulmonary (ex. Heart) |
| Sublocation: | None Selected |
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