Abstract
Hemoptysis is a common and alarming symptom. There are no accepted volume-based definitions of non-massive or massive hemoptysis. For practical purposes, massive hemoptysis is better defined on the basis of magnitude of effect rather than the amount of expectorated blood. Acute bronchitis is the most common cause of non-massive hemoptysis. The common causes of massive hemoptysis include bronchiectasis, tuberculosis, lung cancer, and mycetoma. Bronchoscopy plays a central role in the evaluation and management of hemoptysis. Direct inspection allows localization of the bleeding site and isolation of bleeding segment to prevent flooding of non-bleeding lung and asphyxiation. Rigid bronchoscope is preferred over flexible bronchoscope for management of massive hemoptysis but its utility is limited by lack of trained personnel in majority of medical centers. In the absence of facilities for rigid bronchoscopy, it is prudent to secure airway with a large endotracheal tube, perform early flexible bronchoscopy, and initiate aggressive resuscitative measures. Several bronchoscopic techniques such as balloon tamponade, topical application of cold saline, vasoconstrictors, and pro-coagulant substances may be applied for temporary control of bleeding. Interventional techniques such as laser photoresection and argon plasma coagulation may be helpful in selected cases. Temporary control of bleeding may facilitate institution of definitive therapies such as bronchial artery embolization and surgery in selected patients.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Stoller JK. Diagnosis and management of massive hemoptysis: a review. Respir Care. 1992;32:564–81.
Conlan AA, Hurwitz SS, Krige L, et al. Massive hemoptysis. Review of 123 cases. J Thorac Cardiovasc Surg. 1983;85:120–4.
Yeoh CB, Hubaytar RT, Ford JM, et al. Treatment of massive hemorrhage in pulmonary tuberculosis. J Thorac Cardiovasc Surg. 1967;54:503–10.
Holsclaw DS, Grand RJ, Shwachman H. Massive hemoptysis in cysticfibrosis. J Pediatr. 1970;76:829–38.
Marshall TJ, Jackson JE. Vascular intervention in the thorax: bronchial artery embolization for hemoptysis. Eur Radiol. 1997;7:1221–7.
Sakr L, Dutau H. Massive hemoptysis: an update on the role of bronchoscopy in diagnosis and management. Respiration. 2010;80:38–58.
Crocco JA, Rooney JJ, Fankushen DS, DiBenedetto JR, Lyons HA. Massive hemoptysis. Arch Intern Med. 1968;121:495–8.
Corder R. Hemoptysis. Emerg Med Clin North Am. 2003;21:421–35.
Levitzky MG. Pulmonary physiology. Blood flow to the lung. McGraw-Hill 1995;4:87–114.
Cauldwell EW, Sickert RG, Lininger RE, et al. The bronchial arteries: an anatomic study of 150 human cadavers. Surg Gynecol Obstet. 1948;86:395–412.
Hirshberg B, Biran I, Glazer M, et al. Hemoptysis: etiology, evaluation, and outcome in a tertiary referral hospital. Chest. 1997;112:440–4.
Rumbak M, Kohler G, Eastrige C, et al. Topical treatment of life threatening hemoptysis from aspergillomas. Thorax. 1996;51:253–5.
Ong TH, Eng P. Massive hemoptysis requiring intensive care. Intensive Care Med. 2003;29:317–20.
Savale L, Parrot A, Khalil A, et al. Cryptogenic hemoptysis: from a benign to a life threatening pathologic vascular condition. Am J Respir Crit Care Med. 2007;175:1181–5.
Marshall TJ, Flower CD, Jackson JE. The role of radiology in the investigation and management of patients with hemoptysis. Clin Radiol. 1996;51:391–400.
Haponik EF, Britt EJ, Smith PL, Bleecker ER. Computed chest tomography in the evaluation of hemoptysis: impact on diagnosis and treatment. Chest. 1987;91:80–5.
Revel MP, Fournier LS, Hennebicque AS, Cuenod CA, Meyer G, Reynaud P, et al. Can CT replace bronchoscopy in the detection of the site and cause of bleeding in patients with large or massive hemoptysis? Am J Roentgenol. 2002;179:1217–24.
Khalil A, Soussan M, Mangiapan G, Fartoukh M, Parrot A, Carette MF. Utility of high-resolution chest CT scan in the emergency management of hemoptysis in the intensive care unit: severity, localization and etiology. Br J Radiol. 2007;80:21–5.
RemyJardin M, Bouaziz N, Dumont P, Brillet PY, Bruzzi J, Remy J. Bronchial and non-bronchial systemic arteries at multi-detector row CT angiography: comparison with conventional angiography. Radiology. 2004;233:741–9.
Khalil A, Parrot A, Nedelcu C, Fartoukh M, Marsault C, Carette MF. Severe hemoptysis of pulmonary arterial origin: signs and role of multidetector row CT. Chest. 2008;133:212–9.
Hsiao EI, Kirsch CM, Kagawa FT, Wehner JH, Jensen WA, Baxter RB. Utility of fiberoptic bronchoscopy before bronchial artery embolization for massive hemoptysis. Am J Roentgenol. 2001;177:861–7.
Naidich DP, Funt S, Ettenger NA, Arranda C. Hemoptysis: CT-bronchoscopic correlations in 58 cases. Radiology. 1990;177:357–62.
Gong Jr H, Salvatierra C. Clinical efficacy of early and delayed fiberoptic bronchoscopy in patients with hemoptysis. Am Rev Respir Dis. 1981;124:221–5.
Dweik R, Stoller JK. Role of bronchoscopy in massive hemoptysis. Clin Chest Med. 1999;20:89–105.
Conlan AA, Hurwitz SS. Management of massive hemoptysis with the rigid bronchoscope and cold saline lavage. Thorax. 1980;35:901–4.
Zavala DC. Pulmonary hemorrhage in fibreoptic transbronchial biopsy. Chest. 1976;70:584–8.
Mazkereth R, Paret G, Ezra D, et al. Epinephrine blood concentrations after peripheral bronchial versus endotracheal administration of epinephrine in dogs. Crit Care Med. 1992;20:1582–7.
Kalyanaraman M, Carpenter RL, McGlew MJ, Guertin SR. Cardiopulmonary compromise after use of topical and submucosal α agonists: possible added complication by the use of β-blocker therapy. Otolaryngol Head Neck Surg. 1997;117:56–61.
Breuer HW, Charchut S, Worth H, Trampisch HJ, Glänzer K. Endobronchial versus intravenous application of the vasopressin derivative glypressin during diagnostic bronchoscopy. Eur Respir J. 1989;2:225–8.
Sharkey AJ, Brennen MD, O’Neill MP, et al. A comparative study of the haemostatic properties and cardiovascular effects of adrenaline and ornipressin in children using enflurane anaesthesia. Acta Anaesthesiol Scand. 1982;26:368–70.
Tuller C, Tuller D, Tamm M, Brutsche MH. Hemodynamic effects of endobronchial application of ornipressin versus terlipressin. Respiration. 2004;71:397–401.
Wong LT, Lillquist YP, Culham G, DeJong BP, Davidson AG. Treatment of recurrent hemoptysis in a child with cystic fibrosis by repeated bronchial artery embolizations and long-term tranexamic acid. Pediatr Pulmonol. 1996;22:275–9.
Chang AB, Ditchfield M, Robinson PJ, Robertson CF. Major hemoptysis in a child with cystic fibrosis from multiple aberrant bronchial arteries treated with tranexamic acid. Pediatr Pulmonol. 1996;22:416–20.
Graff GR. Treatment of recurrent severe hemoptysis in cystic fibrosis with tranexamic acid. Respiration. 2001;68:91–4.
Solomonov A, Fruchter O, Zuckerman T, Brenner B, Yigla M. Pulmonary hemorrhage: a novel mode of therapy. Respir Med. 2009;103:1196–200.
Tsukamoto T, Sasaki H, Nakamura H. Treatment of hemoptysis patients by thrombin and fibrinogen-thrombin infusion therapy using a fiberoptic bronchoscope. Chest. 1989;96:473–6.
Bense L. Intrabronchial selective coagulative treatment of hemoptysis. Chest. 1990;97:990–6.
Freitag L, Tekolf E, Stamatis G, Montag M, Greschuchna D. Three years experience with a new balloon catheter for the management of hemoptysis. Eur Respir J. 1994;7:2033–7.
Dutau H, Palot A, Haas A, Decamps I, Durieux O. Endobronchial embolization with a silicone spigot as a temporary treatment for massive hemoptysis. Respiration. 2006;73:830–2.
Valipour A, Kreuzer A, Koller H, Koessler W, Burghuber OC. Bronchoscopy-guided topical hemostatic tamponade therapy for the management of life-threatening hemoptysis. Chest. 2005;127:2113–8.
Sarkar BP, Ghosh D, Nag S, Chowdhury S, et al. Evaluation of the technical details of bronchoscopic endobronchial sealing: review of 67 patients. Indian J Chest Dis Allied Sci. 2007;49:137–42.
Strong MS, Jako GJ. Laser surgery in the larynx. Early clinical experience with CO2 laser. Ann Otol Rhinol Laryngol. 1972;86:791–8.
Dumon JF, Meric B, Surpas P, Ragni J. Endoscopic resection in bronchology using the YAG laser. Evaluation of a five year experience. Schweiz Med Wochenschr. 1985;115:1336–44.
Han CC, Prasetyo D, Wright GM. Endobronchial Âpalliation using Nd-YAG laser is associated with improved survival when combined with multimodal adjuvant treatments. J Thorac Oncol. 2007;2:59–64.
Hetzel MR, Smith SGT. Endoscopic palliation of tracheobronchial malignancies. Thorax. 1991;46:325–33.
Keller CA, Hinerman R, Singh A, Alvarez F. The use of endoscopic argon plasma coagulation in airway complications after solid organ transplantation. Chest. 2001;119:1968–75.
Morice RC, Ece T, Ece F, Keus L. Endobronchial argon plasma coagulation for treatment of hemoptysis and neoplastic airway obstruction. Chest. 2001;119:781–7.
Homasson JP. Endobronchial electrocautery. Semin Respir Crit Care Med. 1997;18:535–43.
Mathur PN, Wolf KM, Busk MF, Briete WM, Datzman M. Fiberoptic bronchoscopic cryotherapy in the management of tracheobronchial obstruction. Chest. 1996;110:718–23.
Maiwand MO, Asimakopoulos G. Cryosurgery for lung cancer: clinical results and technical aspects. Technol Cancer Res Treat. 2004;3:143–50.
Cardona AF, Reveiz L, Ospina EG, Ospina V, Yepes A. Palliative endobronchial brachytherapy for non-small cell lung cancer. Cochrane Database Syst Rev. 2008; 16:CD004284.
Cremaschi P, Nascimbene C, Vitulo P, et al. Therapeutic embolization of bronchial artery: a successful treatment in 209 cases of relapse hemoptysis. Angiology. 1993;44:295–9.
Yu-Tang Goh P, Lin M, Teo N, En SWD. Embolization for hemoptysis: a six year review. Cardiovasc Intervent Radiol. 2002;25:17–25.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer Science+Business Media New York
About this chapter
Cite this chapter
Subramanian, S., Kate, A.H., Chhajed, P.N. (2013). Role of Bronchoscopy in Hemoptysis. In: Mehta, A., Jain, P. (eds) Interventional Bronchoscopy. Respiratory Medicine, vol 10. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-62703-395-4_14
Download citation
DOI: https://doi.org/10.1007/978-1-62703-395-4_14
Published:
Publisher Name: Humana Press, Totowa, NJ
Print ISBN: 978-1-62703-394-7
Online ISBN: 978-1-62703-395-4
eBook Packages: MedicineMedicine (R0)