The Causes and Clinical Course of Massive Hemoptysis

Kim, Yu Il; Jang, Il Gweon; Hwang, Jun Hwa; Im, Seong Chul; Kim, Young Chul; Park, Kyung Ok

Abstract

METHOD: We reviewed the records of 185 patients with hemoptysis from Jan 1994 to May 1997. The amount of hemoptysis was classified into small (<20 mL / 24 hours), moderate (between 20 and 200 mL / 24 hours), or massive (>200 mL/ 24 hours) hemoptysis. RESULTS AND CONCLUSION: 1) Over a recent 3-year period, underlying causes of massive hemoptysis were active pulmonary tuberculosis(n=19, 33.9%), inactive tuberculosis (n=19, 33.9%), bronchiectasis(n=10, 17.9%), lung cancer(n=3, 5.4%), bronchitis(n=1, 1.8%) and miscellaneous. The most common cause of hemoptysis was tuberculosis. 2) 106 of 110 patients(96.4%) with small to moderate hemoptysis were undertaken conservative management which resulted in no recurrent hemoptysis. 3) Conservative management in massive hemoptysis was used in 33 patients, with recurrent hemoptysis(n=3, 9.1%), death(n=2, 6.1%) and no hemoptysis(n=22, 66.7%). Arterial embolization was used in 22 patients, with recurrent small amount hemoptysis(n=7, 31.8%), death(n=2, 9.1%) and no hemoptysis(n=9, 40.9%). Operation was performed in 5 patients including the patients(n=4, 18.2%) who had recurrent significant hemoptysis after arterial embolization, with recurrent hemoptysis(n=0), death(n=1, 20.0%) and no hemoptysis(n=4, 80.0%). 4) Arterial embolization or operation was performed in 19 of 89 patients (21.3%) with Tuberculosis-associated hemoptysis. On the other hand, 8 of 96 patients(8.4%) with non-tuberculosis hemoptysis underwent arterial embolization or operation. Ten of 89 patients(11.2%) with recurrent hemoptysis was caused by tuberculosis associated hemoptysis after initial treatment. Recurrences after initial treatment were more frequent in tuberculosis-associated hemoptysis, significantly(P>0.05). Therefore, the patients with tuberculosis-associated hemoptysis may be more frequently undertaken the operation or arterial embolization. 5) The overall mortality rate due to massive hemoptysis was 8.9% (5/56).