Management of massive hemoptysis in a thoracic surgical unit.
OBJECTIVE
Massive hemoptysis is a life-threatening condition. Surgery is effective but we are sometimes reluctant to operate on patients with this condition. We reviewed our experience with patients who underwent emergency surgery for massive hemoptysis to verify the indications for non-emergency surgical intervention.


METHODS
We reviewed chest computed tomography (CT) and angiographic and pathological findings and the postoperative course of 25 patients who underwent emergency pulmonary resection in our department between 1979 and 2001 due to life-threatening hemoptysis.


RESULTS
CT revealed a persistent cavity within the radiological opacity before massive hemoptysis in 12 patients (48%). Of the 21 patients who underwent angiography, nine showed focal bleeding in one bronchial branch and the others showed bleeding in multiple branches. Of these nine patients, seven did not undergo embolotherapy mainly due to minor vascularity. In the remaining patients, embolotherapy was not indicated in six due to multiple bleeding feeders and recurrence after embolotherapy was seen in six. Pathological findings showed that eight of the 12 patients with multiple systemic shunts had a fungal infection. Operative morbidity and hospital mortality were 32 and 4%, respectively. There was no recurrence in patients who underwent surgical treatment.


CONCLUSIONS
Early pulmonary resection is indicated in patients with hemoptysis of multiple branches from the cavity and chest wall, such as in fungal infections. When a bronchial branch is the only bleeding focus, superselective embolotherapy should be considered prior to surgery even if the localized focus of the bronchial branch shows minor vascularity on the angiography.
Endo
Shunsuke
S
Division of General Thoracic Surgery, Department of Surgery, Jichi Medical School, Minamikawachi-machi, Kawachi-gun, Tochigi 329-0498, Japan. tcvshun@jichi.ac.jp
Otani
Shin-ichi
S
Saito
Noriko
N
Hasegawa
Tsuyoshi
T
Kanai
Yoshihiko
Y
Sato
Yukio
Y
Sohara
Yasunori
Y
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D004621:Embolization, Therapeutic; D004630:Emergencies; D005260:Female; D006469:Hemoptysis / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000601:surgery*; D008172:Lung Diseases, Fungal / Q000150:complications / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D014057:Tomography, X-Ray Computed