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

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Chest & Heart Journal Vol. 35, No.-2, July 2011cessation of bleeding, bronchocope is withdrawn.Balloon Tamponade: - Massive hemoptysis can becontrolled by placement of Fogarty- typeembolectomy catheters and subsequent ballooninflation in the bleeding bronchus usingbronchoscope.Selective coagulative treatment: - Topical thrombinand fibrinogen- thrombin solutions have been usedwith reported success in the treatment of patientswith massive hemoptysis. The fibrin precursorssprayed into the bronchus selectively to the site ofbleeding forms a fibrin clot which plugged thebronchus and hemoptysis ceased promptly. 2Arterial Embolization: - Bronchial arteryembolization is a definitive treatment in patientwith massive hemoptysis when a bleeding site isidentified by arteriograply. It is an attractivealternative to surgery in patient with bilateraldiseases, multiple bleeding sites or in patients withborderline pulmonary reserve. 2Pulmonary resection has been shown to be the mosteffective method for the control and prevention ofrecurrent bleeding in most patients. 8,9 The criteriafor selecting surgical cases include to localize thesite of bleeding, adequate pulmonary function, nomedical contraindication, resectable carcinomaswithout distant metastasis, no mitral diseases 7 .In elective cases we select patients for pulmonaryresection based on the forced expiratory volumein 1 second (FEV 1) Patient who has a minimumFEV 1of 2 or 1.7 L considered fit for pneumonectoryor lobectomy respectively. Bilateral parenchymaldiseases, unresectable carcinomas or the inabilityto localize the bleeding site also prohibit surgicalresection. 12With the introduction of ice-cold saline lavage andarterial embolization it is possible to controlmajority of cases of massive hemoptysis. Urgentsurgery (i.e., within 24 to 48 hours after initialcontrol) is required only in cases of fungal ball,lung abscess, failure of any control method,presence of cavity, obstruction of the main or lobarbronchus with a clot that can not be suctionedduring a rigid bronchoscope. 13Surgical procedures required are classified into 4groups-pulmonary resections (pneumonectomy,lobectomy, wedge resections, segmentectomy),collapse therapy (thoracoplasty), cavernostomies,& intrathoracic vascular ligatures. Bronchoscopyeither flexible or rigid should be performed at theend of the surgical procedure. 14Message:1. Most hemoptysis is not massive, but truemassive hemoptysis is a medicalemergency. Patients die from asphyxiation orexsanguination.2. The top 3 causes of massive hemoptysis areTB, bronchiectasis, and carcinoma.3. Remember the 3 principles of management:1) maintain airway patency and oxygenation,2) localize the source of bleeding, 3) controlhemorrhageConclusion:Endobronchial control measures and arterialembolization after medical therapy have radicallychanged the management of patients with massivehemoptysis. 15 With the control of hemorrhage, theclinician is able to identify non-surgical patientsand assess surgical candidates accurately, thusallowing an elective, less morbid operation.References:1. Stedman TL. Stedman’s Medical dictionary.27th ed. Philadelphia: Lippincott Williams& Wilkins, 20002. Thompson AB, Teacher H, Rennard SI:Pathogenesis, Evaluation and Therapy forMassive Hemoptysis. Cline Chest Med1992;13:69.3. medicine.ucsf.edu/education/resed/Chiefs_cover_sheets/hemoptysis1.pdf deGracia J, de la Rosa D, Catalán E, et al. Useof endoscopic fibrinogen-thrombin in thetreatment of severe hemoptysis. Respir Med2003; 97:7904. Chun HJ, Byun JY, Yoo SS, Choi BG. Addedbenefit of thoracic aortography after Tranarterial embolization in patients withhemoptysis. AJR Am J Roentgenol 2003;180:1577.5. Remy-Jardin M, Bouaziz N, Dumont P, et al.Bronchial and nonbronchial systemic arteriesat multi-detector row CT angiography:130
Massive Hemoptysis - An Overviewcomparison with conventional angiography.Radiology 2004; 233:741.6. Menchini L, Remy-Jardin M, Faivre JB, etal. Cryptogenic haemoptysis in smokers:angiography and results of embolisation in 35patients. Eur Respir J 2009; 34:1031.7. Jougon J., Ballester M., Delcambre F., MacBride T., Valat P., Gomez F., and LaurentF., Velly J.F. Massive hemoptysis: what placefor medical and surgical treatment. Eur JCardiothoracic Surg 2002; 22:345-3518. WU M, Zhang L-W, Zhu H, Qian Z-X. Surgicaltreatment for thoracic hydatidosis: review of1230 cases. Chinese Medical J 2005;118:1665-1667.9. JACOB L. BIDWELL, M.D. and ROBERT W.PACHNER, M.D., University of WisconsinMedical School, Milwaukee, Wisconsin AmFam Physician. 2005 Oct 1; 72(7):1253-1260Md. Shamsul Alam et al.10. Toker A, Tanju S, Bayrak Y, et al. Lifethreatening hemoptysis in a child; the onlysymptom. Ann Thorac Surg 2004;77:336-812. Humphrey LL, Teutsch S, Johnson M, U.S.Preventive Services Task Force. Lung cancerscreening with sputum cytologic examination,chest radiography, and computed tomography.Ann Intern Med. 2004; 140:740–53.13. JACOB L. BIDWELL, M.D. and ROBERT W.PACHNER, M.D., University of WisconsinMedical School, Milwaukee, Wisconsin. AmFam Physician. 2005 Oct 1; 72(7):1253-126014. Bharti S, Bharti B: Hydatid disease of the lung– unusual cause of hemoptysis. IndianPediatr 2002, 39:1062-1063.15. Ibrahim WH. Massive haemoptysis: thedefinition should be revised. Eur Respir J2008; 32:1131.131
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