Volume. 35, No. 2 july. 2011 - The Chest and Heart Association of ...

Chest & Heart JournalVol. 35, No. 2, July 2011REVIEW ARTICLEMassive Hemoptysis - An OverviewMd. Shamsul Alam 1 , AKM Razzaque 2 , Md. Zillur Rahman 2 , AA Kibria 1 ,Md. Mofizur Rahman Mia 1 , MA Hamid 1 . Md. Zakir H. Bhuiyan 3Abstract:Massive hemoptysis has been variably defined as 100 to more than 1000 ml ofblood expectorated from lungs over 24 to 48 hours. Most hemoptyses are notmassive but true hemoptysis is a medical or surgical emergency.The etiologies of massive hemoptysis are tuberculosis (85.5%), bronchiectasis,carcinoma (2.3%), infections, CHF, Pericarditis and many others. Patients diefrom asphyxiation or exsanguinations. In pulmonary tuberculosis hemorrhage isdue to aneurysmal dilatations of pulmonary arteries leading to a rupture of avessel in the wall of a tuberculous cavity. Friction of fungal ball against thehypervescularized walls of the cavity leads to hemorrhage in intracavitary fungallesion. In bronchiectasis, there is proliferation and enlargement of bronchialarteries and precapillary bronchopulmonary anastomosis which become erodedthat leads to bleeding.To localize the site of bleeding, some investigations are necessary like radiography,bronchoscopy, C.T scan of chest, Bronchial arteriography, Pulmonaryangiography.Aim of management of massive hemoptysis is to prevent asphyxiation, to localizethe site of bleeding, and to arrest the hemorrhage. It includes medical, someinvasive procedures as well as surgical approach. Medical treatment implies restin bed with Trendelenburg position with affected site down, wide i.v. line, arterialblood gas monitoring, sedatives, 0 2, antibiotic, blood transfusion, reversal ofanticoagulation, corticosteroids in immunologic cases, and anti-TB in tuberculosis.Endobronchial control measures with ice cold saline lavage, balloon tamponade,vasoconstrictive agents, selective coagulative treatment with laser, topicalthrombin, arterial embolisation, i.v. angiotensin, radiotherapy and intracavitarytreatment. If all the measures fail, then surgical intervention is to be considered.Endobronchial control measures and arterial embolization after medical therapyhave radically changed the management of patients with massive hemoptysis.Surgical candidates should be assessed accurately, thus allowing an elective, lessmorbid operation.[Chest & Heart Journal 2011; 35(2) : 127-131]Introduction:Hemoptysis is defined as the spitting of bloodderived from the lungs or bronchial tubes as aresult of pulmonary or bronchial hemorrhage. 1Hemoptysis is classified as nonmassive or massivebased on the volume of blood loss; however, thereare no uniform definitions for these categories.Massive hemoptysis has been variably defined as1. Assistant Professor of Thoracic Surgery, NIDCH, Mohakhali, Dhaka.2. Associate Professor of Thoracic Surgery, NIDCH, Mohakhali,3. MS, Thesis part, Thoracic Surgery, NIDCHCorrespondence to: Md. Shamsul Alam, Assistant Professor of Thoracic Surgery, NIDCH, Mohakhali, Dhaka.