title: Diagnosis and Treatment of Hemoptysis.
abstract: Hemoptysis is the expectoration of blood from the tracheobronchial tree. It is commonly caused by bronchiectasis, chronic bronchitis, and lung cancer. The expectorated blood usually originates from the bronchial arteries. When hemoptysis is suspected, it must be confirmed and classified according to severity, and the origin and cause of the bleeding determined. Lateral and AP chest X-ray is the first study, although a normal chest X-ray does not rule out the possibility of malignancy or other underlying pathology. Multidetector computed tomography (MDCT) must be performed in all patients with frank hemoptysis, hemoptoic sputum, suspicion of bronchiectasis or risk factors for lung cancer, and in those with signs of pathology on chest X-ray. MDCT angiography has replaced arteriography in identifying the arteries that are the source of bleeding. MDCT angiography is a non-invasive imaging technique that can pinpoint the presence, origin, number and course of the systemic thoracic (bronchial and non-bronchial) and pulmonary arterial sources of bleeding. Endovascular embolization is the safest and most effective method of managing bleeding in massive or recurrent hemoptysis. Embolization is indicated in all patients with life-threatening or recurrent hemoptysis in whom MDCT angiography shows artery disease. Flexible bronchoscopy plays a pivotal role in the diagnosis of hemoptysis in patients with hemoptoic sputum or frank hemoptysis. The procedure can be performed rapidly at the bedside (intensive care unit); it can be used for immediate control of bleeding, and is also effective in locating the source of the hemorrhage. Flexible bronchoscopy is the first-line procedure of choice in hemodynamically unstable patients with life-threatening hemoptysis, in whom control of bleeding is of vital importance. In these cases, surgery is associated with an extremely high mortality rate, and is currently only indicated when bleeding is secondary to surgery and its source can be accurately and reliably located.
authors.affiliation: Servicio de Neumología, Complejo Asistencial Universitario de Salamanca, Salamanca, España. Electronic address: rcordovilla@usal.es.
authors.forename: Rosa
authors.initials: R
authors.lastname: Cordovilla
authors.affiliation: Servicio de Neumología, Complejo Asistencial Universitario de León, León, España.
authors.forename: Elena
authors.initials: E
authors.lastname: Bollo de Miguel
authors.affiliation: Servicio de Neumología, Complejo Hospitalario Universitario de Albacete, Albacete, España.
authors.forename: Ana
authors.initials: A
authors.lastname: Nuñez Ares
authors.affiliation: Servicio de Neumología, Hospital Universitario Reina Sofía, Córdoba, España.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Cosano Povedano
authors.affiliation: Servicio de Radiología, Complejo Asistencial Universitario de León, León, España.
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Herráez Ortega
authors.affiliation: Servicio de Cirugía Torácica, Hospital Universitario Virgen Macarena, Sevilla, España.
authors.forename: Rafael
authors.initials: R
authors.lastname: Jiménez Merchán
mesh_terms: D000792:Angiography / Q000379:methods; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D001999:Bronchoscopy; D003937:Diagnosis, Differential; D003948:Diagnostic Techniques, Respiratory System; D004621:Embolization, Therapeutic; D006396:Hematemesis / Q000175:diagnosis; D006469:Hemoptysis / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D006489:Hemostatic Techniques; D006801:Humans; D008171:Lung Diseases / Q000150:complications; D008175:Lung Neoplasms / Q000150:complications; D061330:Multidetector Computed Tomography; D017410:Practice Guidelines as Topic; D015272:Pulmonary Medicine / Q000458:organization & administration; D012771:Shock, Hemorrhagic / Q000517:prevention & control; D012955:Societies, Medical; D013030:Spain
chemical_list: D000933:Antifibrinolytic Agents
keywords: Bronchoscopy; Broncoscopia; Hemoptisis; Hemoptisis amenazante; Hemoptysis; Interventional radiology; Life-threatening hemoptysis; Radiología intervencionista