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Therapeutic approach in haemoptysis 

Therapeutic approach in haemoptysis
Chapter:
Therapeutic approach in haemoptysis
Author(s):

Francesco Blasi

and Paolo Tarsia

DOI:
10.1093/med/9780199600830.003.0127
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date: 29 February 2020

The aim of diagnostic studies in patients with haemoptysis is two-fold—locate the source of bleeding and identify the underlying cause. A chest X-ray may be informative regarding conditions involving the lung parenchyma, pulmonary vasculature, or the heart, but may be normal in 20–40% of cases. A chest CT scan may allow correct localization of the bleeding site in 65–100% of cases. Contrast-enhanced CT scans allow high resolution angiographic studies that may be useful prior to planning bronchial arterial embolization. Bronchoscopy may allow identification of the site of bleeding, identify the underlying cause, help clear the airways from blood clots favouring gas exchange, and be a means to stop the bleeding. Treatment of haemoptysis varies from outpatient management to intensive care unit admittance. Choice of optimal management depends on the intensity of bleeding, degree of respiratory compromise, and severity of underlying cardiorespiratory status. Important steps in the management of patients with massive haemoptysis include resuscitation, airway protection and patient stabilization as the priority, subsequent localization of the site of bleeding, and specific interventions to stop the bleeding and prevent recurrence. Bronchoscopy may be useful in stopping bleeding through use of cold saline lavage, use of topical vasoconstrictive agents, or temporary endobronchial tamponade with a balloon catheter. The procedure of choice in many cases is selective bronchial artery embolization. With this procedure immediate control of bleeding may be obtained in 70–95% of patients, although recurrence has been reported in 10–30% of cases.

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