Tuberc Respir Dis.  2012 Aug;73(2):107-114.

Analysis of Patients with Hemoptysis in a Tertiary Referral Hospital

• Lee BR
• Yu JY
• Ban HJ
• Oh IJ
• Kim KS
• Kwon YS
• Kim YI
• Kim YC
• Lim SC

Abstract

BACKGROUND
This study attempted to investigate the main causes of hemoptysis, the type of examinations used for diagnosis, the treatment modalities and outcomes.
METHODS
A retrospective study was conducted on the medical records of 221 patients admitted to the Chonnam National University Hospital, between January 2005 and February 2010, with hemoptysis.
RESULTS
Bronchiectasis (32.6%), active pulmonary tuberculosis (18.5%), fungus ball (10.8%), and lung cancer (5.9%) accounted for most causes of hemoptysis. Computed tomography scan was the most sensitive diagnostic test when employed alone, with positive yield of 93.2%. There were 161 cases of conservative treatment (72.9%), 42 cases of bronchial artery embolization (BAE) (19.0%), and 18 cases of surgery (8.1%). Regarding the amount of hemoptysis, 70 cases, out of 221 cases, were mild (31.5%), 36 cases moderate (16.2%), and 115 cases massive hemoptysis (52.0%). Most of the patients were treated conservatively, but if there was more bleeding present, BAE or surgery was more commonly performed than the conservative treatment (p< or =0.0001). In the multivariate model, severe hemoptysis and lung cancer were independently associated with short-term recurrence. BAE was independently associated with long-term recurrence, and lung cancer was associated with in-hospital mortality. The overall in-hospital mortality rate was 11.3%.
CONCLUSION
Hemoptysis is a common symptom with a good prognosis in most cases. However, patients exhibiting massive bleeding or those with malignancy had a poorer prognosis. In-hospital mortality was strongly related to the cause, especially in lung cancer.

Keyword

Hemoptysis; Etiology; Diagnosis; Therapeutics; Treatment Outcome

MeSH Terms

Bronchial Arteries
Bronchiectasis
Diagnostic Tests, Routine
Fungi
Hemoptysis
Hemorrhage
Hospital Mortality
Humans
Lung Neoplasms
Medical Records
Prognosis
Recurrence
Retrospective Studies
Tertiary Care Centers
Treatment Outcome
Tuberculosis, Pulmonary

Reference

1. Kim SK. Differential diagnosis of hemoptysis. Korean J Med. 1998. 55:634–641.

2. Yoon W, Kim JK, Kim YH, Chung TW, Kang HK. Bronchial and nonbronchial systemic artery embolization for life-threatening hemoptysis: a comprehensive review. Radiographics. 2002. 22:1395–1409.

3. Knott-Craig CJ, Oostuizen JG, Rossouw G, Joubert JR, Barnard PM. Management and prognosis of massive hemoptysis: recent experience with 120 patients. J Thorac Cardiovasc Surg. 1993. 105:394–397.

4. Santiago S, Tobias J, Williams AJ. A reappraisal of the causes of hemoptysis. Arch Intern Med. 1991. 151:2449–2451.

5. Fernando HC, Stein M, Benfield JR, Link DP. Role of bronchial artery embolization in the management of hemoptysis. Arch Surg. 1998. 133:862–866.

6. Fidan A, Ozdoğan S, Oruç O, Salepçi B, Ocal Z, Cağlayan B. Hemoptysis: a retrospective analysis of 108 cases. Respir Med. 2002. 96:677–680.

7. Ayed A. Pulmonary resection for massive hemoptysis of benign etiology. Eur J Cardiothorac Surg. 2003. 24:689–693.

8. Crocco JA, Rooney JJ, Fankushen DS, DiBenedetto RJ, Lyons HA. Massive hemoptysis. Arch Intern Med. 1968. 121:495–498.

9. Erdogan A, Yegin A, Gürses G, Demircan A. Surgical management of tuberculosis-related hemoptysis. Ann Thorac Surg. 2005. 79:299–302.

10. McCollun WB, Mattox KL, Guinn GA, Beall AC Jr. Immediate operative treatment for massive hemoptysis. Chest. 1975. 67:152–155.

11. Kim SO, Oh IJ, Kim KS, Yu YK, Lim SC, Kim YC, et al. Recurrent hemoptysis after bronchial artery embolization. Tuberc Respir Dis. 2001. 51:364–372.

12. Swanson KL, Johnson CM, Prakash UB, McKusick MA, Andrews JC, Stanson AW. Bronchial artery embolization: experience with 54 patients. Chest. 2002. 121:789–795.

13. Chung WY, Byun MK, Park MS, Hahn CH, Kang SM, Lee DY, et al. Risk factors of recurrent hemoptysis after bronchial artery embolization. Tuberc Respir Dis. 2006. 60:65–71.

14. Rémy J, Arnaud A, Fardou H, Giraud R, Voisin C. Treatment of hemoptysis by embolization of bronchial arteries. Radiology. 1977. 122:33–37.

15. Yeo DS, Lee SY, Hyun DS, Lee SH, Kim SC, Choi YM, et al. Effect of bronchial artery embolization(BAE) in management of massive hemoptysis. Tuberc Respir Dis. 1999. 46:53–64.

16. Abal AT, Nair PC, Cherian J. Haemoptysis: aetiology, evaluation and outcome: a prospective study in a third-world country. Respir Med. 2001. 95:548–552.

17. Mayr B, Ingrisch H, Häussinger K, Huber RM, Sunder-Plassmann L. Tumors of the bronchi: role of evaluation with CT. Radiology. 1989. 172:647–652.

18. Hirshberg B, Biran I, Glazer M, Kramer MR. Hemoptysis: etiology, evaluation, and outcome in a tertiary referral hospital. Chest. 1997. 112:440–444.

19. Strickland B. Investigating haemoptysis. Br J Hosp Med. 1986. 35:242246–251.

20. Brinson GM, Noone PG, Mauro MA, Knowles MR, Yankaskas JR, Sandhu JS, et al. Bronchial artery embolization for the treatment of hemoptysis in patients with cystic fibrosis. Am J Respir Crit Care Med. 1998. 157(6 Pt 1):1951–1958.

21. Mal H, Rullon I, Mellot F, Brugière O, Sleiman C, Menu Y, et al. Immediate and long-term results of bronchial artery embolization for life-threatening hemoptysis. Chest. 1999. 115:996–1001.