Major and massive hemoptysis: reassessment of conservative management.
The etiologic factors of major (greater than or equal to 200 ml/24 hr) and massive (greater than or equal to 1,000 ml/24 hr) hemoptysis may well affect the outcome and, therefore, the treatment of this often life-threatening problem. the decline in the incidence of tuberculosis (TB) and bronchiectasis, along with the increase in bronchitis and neoplasia, have led to a strong institutional bias against operating on patients with major and massive hemoptysis. A retrospective case study and an extensive literature review were undertaken to critically evaluate this policy. Fifty-nine consecutive patients with major hemoptysis, 26 of whom had massive hemoptysis, were identified from 887 patients seen in our institution over a 10-year period. Only four of these 59 patients underwent surgery, while 55 were managed conservatively. Etiologic factors, operability, and bleeding rate all appeared to play a major role in outcome. No patients with bronchitis, bronchiectasis, tuberculosis, or who were on anticoagulation therapy died compared to a mortality rate of 59% in patients with carcinoma (CA) of the lung and 71% in patients with leukemia. Eleven percent of operable patients treated conservatively died compared to a 46% mortality rate for nonoperable patients. And, 9% of patients with bleeding rates less than 1,000 ml/24 hr died compared to 58% of those with greater than or equal to 1,000 ml/24 hr. Conservative management appears to have a low mortality in patients with non-tuberculosis-related major hemoptysis as well as in many patients with massive hemoptysis, especially those patients who are operable and those without neoplastic disease.
Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710.
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D000293:Adolescent; D000328:Adult; D000368:Aged; D001987:Bronchiectasis / Q000150:complications; D001991:Bronchitis / Q000150:complications; D003550:Cystic Fibrosis / Q000150:complications; D005260:Female; D006469:Hemoptysis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D014397:Tuberculosis, Pulmonary / Q000150:complications