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Abstract Pulmonary artery aneurysmal rupture is a rare cause of massive hemoptysis. When the suspected origin of bleeding is the pulmonary artery, comprehensive evaluation is necessary to determine aetiology and guide appropriate management. Behçet's disease and Hughes–Stovin Syndrome (HSS) are important differentials to consider after infections and malignancy have been ruled out. Pulmonary artery aneurysms with aneurysmal wall enhancement and ‘in‐situ’ thrombus should prompt the suspicion of HSS. Early diagnosis and treatment with immunosuppressants and endovascular interventions in selected patients may improve the prognosis and prevent episodes of fatal hemoptysis.

Abstract Background Surgery is the main treatment option for destroyed-lung (DL) patients with life-threatening massive hemoptysis. However, short-term and long-term surgical safety and efficacy are unclear, prompting this study. Methods Data from 124 DL patients undergoing surgery between November 2001 and January 2022 at Beijing Chest Hospital were retrospectively analyzed. Data of the DL group (82 cases) and DL + massive hemoptysis group (42 cases) were compared with regard to clinical characteristics, long-term postoperative residual lung reinfection. Results As compared with DL group rates, The DL + massive hemoptysis group had greater incidence rates of postoperative complications, invasive postoperative respiratory support, long-term postoperative residual lung reinfection, and postoperative tuberculosis recurrence. Revealed risk factors for postoperative complications (Extent of lung lesion resection), postoperative invasive respiratory therapy (preoperative Hb

Abstract Background Massive hemoptysis is characterized by its life-threatening nature, potentially leading to airway obstruction and asphyxia. The objective of this study was to evaluate the clinical effectiveness of combining endobronchial tamponade with bronchial artery embolization (BAE) in the treatment of massive hemoptysis. Methods Between March 2018 and March 2022, a total of 67 patients with massive hemoptysis who underwent BAE were divided into two groups: the combination group (n = 26) and the BAE group (n = 41). Technical and clinical success rates were assessed, and adverse events were monitored following the treatment. Blood gas analysis and coagulation function indicators were collected before and after the treatment, and recurrence and survival rates were recorded during the follow-up period. Results All patients achieved technical success. There were no significant differences in the clinical success rate, recurrence rates at 3 and 6 months, and mortality rates at 3 months, 6 months, and 1 year between the combination group and the BAE group. However, the hemoptysis recurrence rate at 1 year was significantly lower in the combination group compared to the BAE group (15.4% vs. 39.0%, P = 0.039). No serious adverse events were reported in either group. After treatment, the combination group showed higher levels of arterial partial pressure of oxygen (PaO2), oxygenation index (PaO2/FiO2), fibrinogen (FIB), and D-dimer (D-D) compared to the BAE group (P

Massive hemoptysis is a life-threatening complication in patients with advanced primary lung cancer, and effective, safe treatments are crucial. This study aimed to investigate the efficacy and safety of CalliSpheres drug-eluting bead bronchial arterial infusion chemoembolization (DEB-BACE) for managing this condition. A retrospective analysis included 144 patients with advanced primary lung cancer and massive hemoptysis treated at multiple hospitals from January 2019 to January 2023. Patients undergoing bronchial artery embolization were divided into two groups: the observation group (n=76) received CalliSpheres DEB-BACE with epirubicin, and the control group (n=68) received 8spheres blank embolization. Both groups achieved successful hemostasis, with no statistically significant difference in success rates (observation group: 88.16%, control group: 86.76%). However, the observation group had a significantly longer median duration without hemoptysis (96 days vs. 50 days). Two months post-therapy, the observation group showed higher objective response rates (82.89% vs. 38.24%) and disease control rates (92.11% vs. 66.18%) compared to the control group. Adverse reactions were manageable and similar between groups, with no serious complications observed. By January 31, 2024, the observation group had significantly longer median overall survival (11 months vs. 7 months). The DEB-BACE treatment demonstrates safety and efficacy in managing massive hemoptysis in patients with advanced lung cancer. However, the superiority of this approach over bland embolization remains to be established through well-designed prospective studies. Future research is anticipated to provide a definitive comparison and further validate the role of DEB-BACE in clinical practice

Fibrosing mediastinitis (FM) is a rare and benign fibroproliferative disease that presents with the proliferation of extensive, dense fibrous tissue in the mediastinum. Hemoptysis is a common clinical manifestation of FM. Clinically, most patients exhibit mild to moderate hemoptysis. We report a case of FM complicated with life-threatening massive hemoptysis. The patient was successfully rescued through a combination of bronchoscopic balloon closure, bronchial artery embolization (BAE), and surgical interventions. Although FM is frequently benign, vascular involvement can progress to life-threatening massive hemoptysis and must be treated appropriately.

Abstract Background Tracheobronchial injuries generally occur due to iatrogenic or traumatic causes. Although bronchial rupture due to teratoma and germ cell tumors has been reported in the literature, no cases related to lung cancer have been determined. Our case is presented because of the refusal to be examined for the mass in the lung and the detection of bronchial rupture afterward when he presented with massive hemoptysis. Case presentation A 65-year-old male patient was admitted to the emergency department with the complaint of massive hemoptysis. Six months ago, bronchoscopy was recommended due to the 8 × 7 cm cavitary lesion obliterating the bronchus in the anterior upper lobe of the right lung on chest computed tomography, but the patient refused. The sputum sample, requested 3 times, was negative for acid-resistant bacteria, and no growth was detected in the mycobacterial culture. In the new pulmonary CT angiography, a progressive cavitary lesion invading the right main bronchus, carina, and vena cava superior was observed. Following tranexamic acid treatment and bronchial artery embolization, hemoptysis significantly decreased in the follow-up. In the flexible bronchoscopy performed for diagnostic purposes, the carina was pushed to the left and invaded, and there was damage to the right main bronchus. A biopsy was not performed due to the risk of bleeding, and lavage was performed. Lavage was negative for ARB, there was no growth in the mycobacteria culture, and cytology did not reveal malignant cells. The patient, diagnosed with right main bronchial rupture, was considered inoperable and died 1 month later due to respiratory failure. Conclusions Examinations should be initiated as soon as malignancy is suspected. When diagnosis and treatment are delayed, complications that would be challenging to intervene may develop.

Key Clinical Message Microscopic polyangiitis is a rare autoimmune vasculitis, that could present with renal‐pulmonary symptoms, posing diagnostic challenges in patients with preexisting kidney disease. Timely diagnosis is crucial to improve patient outcomes.

Abstract Objectives To evaluate the outcomes of bronchial artery embolization (BAE) for the treatment of massive hemoptysis in patients with pulmonary tuberculosis and identify risk factors that influence recurrence. Methods A total of 81 patients with massive hemoptysis who underwent BAE between January 2014 and December 2017 were retrospectively reviewed. All of the patients had either a history of pulmonary tuberculosis or a current diagnosis of pulmonary tuberculosis. Follow‐up ranged from 18 to 66 months. Results Hemoptysis was stopped or markedly decreased, with subsequent clinical improvement in 73 patients, while 11 patients experienced recurrence during the follow‐up period. Systemic‐pulmonary shunts and clinical failure showed a statistically significant correlation with the recurrence rate. The cumulative non‐recurrence rate was 95.3% for 3 months and 81.9% for more than 24 months. Complications were common (12.5%), but self‐limiting. Conclusions BAE is a safe and effective treatment option for the control of massive hemoptysis in pulmonary tuberculosis patients. Systemic‐pulmonary shunts and clinical failure are the risk factors for recurrence.

Objective To explore the efficacy and safety of CalliSpheres® drug-eluting beads trans-bronchial artery chemoembolization (DEB-BACE) . Methods A retrospective analysis was conducted on 45 patients with advanced primary lung cancer complicated with massive hemoptysis treated in Linyi Cancer Hospital from December 2019 to December 2021. All patients received bronchial artery embolization (BAE) and were divided into observation group (n=24) and control group (n=21) according to different embolization materials. DEB-BACE using CalliSpheres® drug-eluting beads loading 40-60 mg of epirubicin was performed in observation group, and BACE with 8Spheres® blank microspheres was given in control group. The control of hemoptysis, tumor response, the survival time and the related adverse reactions were observed and compared between two groups. Results There was no significant difference in hemostatic success rate between observation group and control group (87.5% vs 85.7%, P＞0.05) . The median duration of nonmassive hemoptysis in observation group was statistically longer than that in control group (96 days vs 50 days, P＜0.01) . At two months after embolization therapy, the objective response rate (83.3% vs 38.1%) in observation group were significantly higher than those in control group (P＜0.05) . The fever, chest tightness and chest pain related to the embolization treatment disappeared after symptomatic treatment in two groups, and there was no statistical difference in adverse reactions between two groups (P＞0.05) . No serious complications such as spinal cord injury and cerebral embolism occurred in two groups. By the end of September 30, 2022, the median overall survival in observation group (10 months) was statistically higher than that in control group (6 months) (P＜0.01) at a follow-up of 2-25 (9.97±5.41) month. Conclusion In the treatment of advanced lung cancer with massive hemoptysis, DEB-BACE can achieve higher tumor response rate, longer survival time without hemoptysis and total survival time compared with conventional BAE.

Abstract Background Massive hemoptysis is a life-threatening condition that requires immediate treatment. This study aimed to retrospectively analyze the outcome of bronchial artery embolization (BAE) for massive hemoptysis, as well as potential factors that may contribute to the recurrence of hemoptysis after BAE. Methods A total of 105 patients with massive hemoptysis treated with BAE were analyzed. Results The immediate control rate of bleeding was 84.8% (67/79); however, during the 36-month follow-up, 45.3% (29 out of 64) of the patients had recurrent hemoptysis after BAE. Comorbidities, pituitary hormone treatment, the angiographic appearance of artery dilation and hypertrophy, and the materials used for BAE were significantly correlated with the success rate of the BAE, while lack of pituitary hormone treatment and existence of arterio-arterial or arteriovenous fistula were risk factors for the recurrence of hemoptysis after BAE. Only a small proportion of patients (9/105, 8.6%) had mild complications after BAE treatment. Conclusion Findings suggest that BAE continues to be an effective treatment for massive hemoptysis in emergency settings. Moreover, the treatment of underlying pulmonary diseases and comorbidities is important to increase BAE’s success rate of BAE and decrease the risk of recurrent hemoptysis after BAE.

Abstract Background Massive hemoptysis is a rare but potentially life-threatening condition of patients with cystic fibrosis (CF) and advanced pulmonary disease. Hypertrophied bronchial arteries are understood to cause massive hemoptysis when rupturing. Risk factors to predict massive hemoptysis are scarce and bronchial artery diameters are not part of any scoring system in follow-up of patients with CF. Aim of this study was to correlate bronchial artery diameter with massive hemoptysis in CF. Methods Bronchial artery and non-bronchial systemic artery diameters were measured in contrast enhanced computed tomography (CT) scans in patients with massive hemoptysis and compared to patients with end-stage CF and no history of hemoptysis. Demographic and clinical data and side of bronchial artery/non-bronchial systemic artery hypertrophy and coil embolization were documented. Results In this retrospective multicenter study 33 patients with massive hemoptysis were included for bronchial artery/non-bronchial systemic artery diameter measurements, (13 female, 20 male, median age 30 years (18–55)). Bronchial artery diameters were significantly larger in the case group than in the control group with median 4 mm (2.2–8.2 mm), and median 3 mm (1–7 mm), respectively (p = 0.002). Sensitivity of bronchial arteries ≥ 3.5 mm to be associated with hemoptysis was 0.76 and specificity 0.71 with ROC creating an area under the curve of 0.719. If non-bronchial systemic arteries were present, they were considered culprit and embolized in 92% of cases. Conclusion Bronchial arteries ≥ 3.5 mm and presence of hypertrophied non-bronchial systemic arteries correlate with massive hemoptysis in patients with CF and might serve as risk predictor for massive hemoptysis. Therefore, in patients with advanced CF we propose CT scans to be carried out as CT angiography to search for bronchial arteries ≥ 3.5 mm and for hypertrophied non-bronchial systemic arteries as possible risk factors for massive hemoptysis.

Abstract Background Massive hemoptysis is a common and fatal complication of bronchiectasis. However, the risk factors for massive hemoptysis in patients with bronchiectasis have not yet been reported. This study investigated the potential risk factors for massive hemoptysis in patients with bronchiectasis. Methods This retrospective study included patients with bronchiectasis and their data were obtained from medical records. The risk factors for massive hemoptysis were evaluated by multivariate analysis of patient characteristics, medical history, and computed tomography imaging data, including the number of lesions, lesion location, and laboratory findings. Results Among 379 patients, 61 (16.09%) experienced severe hemoptysis. Multivariate analysis revealed that diabetes (odds ratio (OR) 2.885; 95% confidence interval (CI) 1.009–8.247), lesions involving two lobes (OR 4.347; 95% CI 1.960–9.638) and three lobes (OR 2.787; 95% CI 1.055–7.363) were significant predictors of severe hemoptysis. However, a disease course between 1 and 5 years (OR 0.300; 95% CI 0.112–0.801) and involvement of the left lower lobe (OR 0.394; 95% CI 0.196–0.793) were protective factors for the prevention of massive hemoptysis. Lesions in the right upper lobe were more likely to cause massive hemoptysis (OR 1.458) than involvement of other lobes. Conclusions Diabetes and lesions involving two and three lobes, were risk factors for massive hemoptysis in patients with bronchiectasis. Disease duration between 1 and 5 years and involvement of the left lower lobe were protective factors, while lesions in the right upper lobe had a stronger relationship with massive hemoptysis in patients with bronchiectasis.

Abstract Background Massive hemoptysis causing inadequate ventilation results in life-threatening consequences. We present a patient who developed respiratory insufficiency produced by bronchiectatic massive hemoptysis and underwent prolonged anticoagulation-free veno-venous extracorporeal membrane oxygenation (VV-ECMO) during which thoracic surgeries were performed. Case presentation A 79-year-old woman suffered massive hemoptysis resulting in respiratory failure during fiberoptic bronchoscopy. Bronchial intubation followed by one lung ventilation failed to ensure adequate oxygenation. Anticoagulation-free VV-ECMO, therefore, was installed immediately. Since conservative hemostatic measures including bronchial arterial embolization were not effective, resection of the culprit lung was performed while on VV-ECMO. Next day an exploratory thoracotomy and intercostal artery embolization were needed for recurrent bleeding. The VV-ECMO was withdrawn after five days of operation. Conclusions Massive hemoptysis can be fatal and needs instantaneous and intensive treatments. In our case, long-term anticoagulation-free VV-ECMO during which thoracic surgeries and endovascular interventions were performed provided a favorable outcome.

Abstract Background Massive hemoptysis due to aspergilloma is a rare but life-threatening complication. Bronchial artery embolization is recommended as a definitive treatment for massive hemoptysis. Polyvinyl alcohol is widely used in bronchial artery embolization. A very small number of studies have reported disrupted polyvinyl alcohol, which may cause ectopic embolism. Case presentation This case highlights an unusual phenomenon in which polyvinyl alcohol fragments appeared on pathological examination in a 61-year-old man, ethnic Han, with massive hemoptysis caused by aspergilloma for whom bronchial artery embolization failed. Lobectomy was carried out successfully. Hematoxylin and eosin stain provides clear images of polyvinyl alcohol fragments, while alpha-smooth muscle cell actin and cluster of differentiation-34 immunohistochemistry revealed their localization in bronchioles. Conclusion Thus far, only two cases of polyvinyl alcohol fragments in the lung have been reported, and the mechanism has not been elucidated. These two cases revealed no counter-indication for the use of polyvinyl alcohol. However, in some cases of off-target embolization causing fatal complications, such as stroke, paraplegia, and myocardial, polyvinyl alcohol fragmentation needs to be taken into consideration.

Abstract Two patients with history of cardiac ablation presented with massive hemoptysis secondary to pulmonary vein stenosis. They underwent successful pulmonary vein angioplasty and stenting. Although the second patient ended up having a lobectomy, the successful opening of the Left Superior Pulmonary Vein helped sparing the superior lobe and lingula.

Abstract Background Salvage surgery is an effective therapeutic option for patients experiencing relapses after chemoradiotherapy for advanced-stage lung cancer or after high-dose radiotherapy for early-stage lung cancer. We report a case involving an emergent salvage surgery for a patient with massive hemoptysis who developed lung cancer recurrence after undergoing proton beam therapy 7 years prior to presentation. Case presentation A 70-year-old male patient was emergently admitted due to massive hemoptysis. He had undergone proton beam therapy for a stage I adenocarcinoma of the left upper lobe 7 years ago, and was receiving chemotherapy for local recurrence. We performed an emergent salvage pulmonary resection to achieve hemostasis. During the operation, we confirmed the presence of a left broncho-pulmonary arterial fistula, which was considered as the origin of the massive hemoptysis. We repaired the fistula between the pulmonary artery and left upper bronchus without incident; an orifice of the fistula at the left pulmonary artery was sutured using a non-absorbable monofilament, and the central portion of the orifice of the fistula at the left upper bronchus was closed with a mechanical stapling device. The postoperative diagnosis was of an adenocarcinoma—ypT3(pm1) N0M1a (dissemination)-IVA, ef1b. The patient has survived for over a year with the cancer in almost complete remission following the administration of an epidermal growth factor receptor tyrosine kinase inhibitor. Conclusions Emergent salvage surgery demands high skill levels with optimal timing and correct patient selection. Our case suggested that the procedure played an important role in controlling serious bleeding and/or infectious conditions. Consequently, he could receive chemotherapy again and survive for over a year.

Hemoptysis, the coughing out of blood, is a fear-provoking symptom with possible life-threatening implications such as hypotensive shock, asphyxia and, myocardial stunning. The severity of hemoptysis can range from streaky episodes to massive episodes (> 500 ml/day or > 150 ml/hour). The etiology of hemoptysis varies from lower respiratory causes such as tuberculosis, lung cancer, bronchiectasis, lung abscess, and pulmonary thromboembolism. The usual line of management is detailed history, imaging studies such as chest X-ray and CT thorax and excluding drugs affecting bleeding and clotting. Treating the underlying cause and including procoagulants usually helps to control moderate bleeding. Swift and effective management is important, especially in life-threatening cases as patients deteriorate fast. Bronchial artery embolization is indicated when conventional medical management fails and the patient is hemodynamically unstable to undergo emergency lobe/lung resection surgeries. We report our experience with four patients who presented to us with massive hemoptysis in whom superselective bronchial artery embolization (SBAE) was carried out successfully with gel-foam and coil. These patients were meticulously followed up for possible complications for one year.

Ting Chen,1 Li Yao,1 Chunyan Zhu2 1Department of Critical Care Medicine, The Second People’s Hospital of Hefei, Hefei, Anhui 230009, People’s Republic of China; 2Department of Critical Care Medicine, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui 230032, People’s Republic of ChinaCorrespondence: Chunyan ZhuDepartment of Critical Care Medicine, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui 230032, People’s Republic of ChinaTel +86-551-62282731Fax +86-551-62283409Email chunyanzhu0509@126.comBackground: Massive hemoptysis in pregnancy is very rare but can be life-threatening for both the pregnant woman and fetus. Extracorporeal membrane oxygenation (ECMO) is extremely rare in the treatment of severe hemoptysis in pregnancy. Here we describe the case of massive hemoptysis in the second trimester of pregnancy successfully treated with a combination of venovenous (VV)-ECMO, and bronchial artery embolization combined with fiberoptic bronchoscopy–assisted CO2 cryotherapy.Case Presentation: A 34-year-old patient at 28 2/7 weeks gestation with a history of hemoptysis for 3 days was transferred to our care. Massive hemoptysis completely blocked the trachea and main bronchus, and a ventilator could not carry out ventilation. ECMO was performed immediately when oxygenation was not maintained. A right lower bronchial artery hemorrhage was found by bronchial arteriography under ECMO, and embolization with microcoils and gelatin sponge particles was then performed. An emergency bedside carbon dioxide cryo-thrombectomy was performed under fiberoptic bronchoscopy because of obstruction of the trachea and main bronchus. Endotracheal cryotherapy was repeated (for a total three times) until bronchoscopic evaluation confirmed no obstruction of the trachea and no active bleeding in the airway. On day 7, ECMO was successfully evacuated. On day 15, the patient was extubated. On day 17, the tracheotomy was closed and replaced by nasal oxygen inhalation. On day 20, the patient was discharged from hospital. The patient has had no recurrence of hemoptysis in 3-month follow-up.Conclusion: VV-ECMO combined with carbon dioxide cryotherapy in the treatment of pregnancy complicated with massive hemoptysis is an effective treatment, when massive hemoptysis completely blocked the trachea.Keywords: VV-ECMO, bronchial artery embolization, carbon dioxide freezing, pregnancy, massive hemoptysis

INTRODUCTION: Hemoptysis is a life-threatening condition and requires immediate diagnosis and treatment. Herein this study, our aim was demonstrate our single center experience of super selective arterial embolization in cases of massive hemoptysis, to describe the demographic and clinical data of those patients, to evaluate the success rate of the intervention and to document the complications. METHODS: In this study, total of 72 patients who admitted to our tertiary center's emergency service or chest diseases department and underwent endovascular treatment were enrolled. The demographic and clinical data were analyzed retrospectively. RESULTS: The median age was 55 years (min-max; 22-78). 25 patients (34.70%) were female whereas 47 (65.30%) were male. 16 patients was diagnosed with lung cancer (squamous cell / adeno cancer), 7 alveolar hemorrhage, 1 pulmonary metastasis of malign melanoma, 2 mediastinal and hilar mass of unknown origin, 4 tuberculosis, 4 pulmonary thromboembolism, 1 sarcoidosis, 2 pneumonia, 1 cirrhosis and hepatopulmonary syndrome and 34 patients with bronchiectasis. The embolized vessel was right bronchial in 32 cases, left bronchial in 9, bilateral in 15, costobronchial trunk in 10 and non-bronchial in 6 patients. The most common angiographic pattern was vascular hypertrophy followed by vascular irregularity and blush. The immediate clinical success was 100%. Rebleeding occurred in 12 patients due to recanalization of the vessel. The most common complication was chest pain. DISCUSSION AND CONCLUSION: In experienced hands, arterial embolization is the most effective and minimally invasive procedure for treat­ing massive and recurrent hemoptysis.This study confirms the efficacy and safety of the intervention

Abstract It is estimated that 5–14% of patients presenting with hemoptysis will have life-threatening hemoptysis, with a reported mortality rate between 9 and 38%. This manuscript provides a comprehensive literature review on life-threatening hemoptysis, including the etiology and mechanisms, initial stabilization, and management of patients. There is no consensus on the optimal diagnostic approach to life-threatening hemoptysis, so we present a practical approach to utilizing chest radiography, computed tomography, and bronchoscopy, alone or in combination, to localize the bleeding site depending on patient stability. The role of angiography and embolization as well as bronchoscopic and surgical techniques for the management of life-threatening hemoptysis is reviewed. Through case presentation and flow diagram, an overview is provided on how to systematically evaluate and treat the bronchial arteries, which are responsible for hemoptysis in 90% of cases. Treatment options for recurrent hemoptysis and definitive management are discussed, highlighting the role of bronchial artery embolization for recurrent hemoptysis.

BackgroundBronchial inflammatory polyps are usually treated by surgical operation or with steroids and/or antibiotics, and it is quite rare that such polys spontaneously disappear without any treatment. This report shows a rare case with a bronchial inflammatory polyp which caused massive hemoptysis but spontaneously disappeared without any treatment.Case PresentationA 66-year-old man with type 2 diabetes mellitus and a history of cough and asthma suddenly developed massive hemoptysis while smoking and was brought to an emergency room in our institution. In bronchoscopy on admission, a polypoidal elevated lesion was observed in the left upper lobe bifurcation. Pulsatile hemorrhage from a polypoidal elevated lesion was observed upon stimulation of passage of the bronchoscope. Bronchoscopy performed 25 days after discharge showed no evidence of active bleeding and a tendency toward reduction of the elevated lesion. In bronchoscopy performed 106 days after the initial hospitalization, the bronchial inflammatory polyp completely disappeared.ConclusionsWe should bear in mind the possibility of spontaneous disappearance of bronchial inflammatory polyps causing some serious symptoms such as massive hemoptysis and repeated bloody sputum. Finally, we should select the best therapy for bronchial inflammatory polys based on each patient's background and conditions in clinical practice.

Background. Hemoptysis is the most common complication of lung tuberculosis (TB). Its can occur repeated and massive. Reccurent massive hemoptysis resolved with conservative therapy but if conservative therapy fails, definitive therapies such as lobectomy surgery are used as alternative treatments especially life-threatening. Case. A 38-year-old man with chief complaint hemoptysis since 4 months pior to admission hospital. Hemoptysis 4-5 times daily with volume 200-600 cc per day and make him shortness of breath and anemia. Initial AFB (Acid Fast Bacilli) was positive and GeneXpert MTB (+) sensitive rifampisin. He got Anti Tuberculosis Drug (ATD) therapy 1st category since 3 months ago. He has been given conservative therapy for hemoptysis but failed. Discussion. Surgery is one of alternative therapy for reccurent massive hemoptysis. Surgery only if source of bleeding already known certainty. In this case patient were suggest for lobectomy superior right lung lobe, not a segmentectomy because there was adhesions on intrathoracic. After lobectomy he getting better and hemoptysis stops. He has continued ATD until 6 months without hemoptysis. Conclusion. Reccurent massive hemoptysis and life-threatening with failure of conservative therapy may given definitive therapy such as lobectomy.

Abstract Background Hyperimmunoglobulin E syndrome (HIES) is a rare primary immunodeficiency disorder defined by high serum immunoglobulin E titers that is associated with recurrent respiratory infections, formation of pneumoatoceles, recurrent skin abscesses, and characteristic dental and skeletal abnormalities. Case presentation We report a case of a 56-year-old male with a history of HIES, cavitary mycetomas, and allergic bronchopulmonary aspergillosis who presented with recurrent massive hemoptysis. Bronchial artery angiography and bronchoscopy failed to identify active hemorrhage, and two embolizations of the bronchial artery did not resolve the bleeding. Subsequently, selective pulmonary artery angiography was conducted that demonstrated a subsegmental pulmonary artery branch pseudoaneurysm with extravasation into an adjacent lung cavity. This was treated successfully with transcatheter embolization. Conclusions To our knowledge, this is the first case reported of pulmonary artery pseudoaneurysm in HIES in the medical literature. Pulmonary artery pseudoaneurysm should be considered in the differential diagnosis in patients with HIES and massive hemoptysis.

Massive hemoptysis is one of the rare manifestations of mitral valve stenosis. Massive hemoptysis is considered as a potentially life threatening that frequently needs emergency procedures. A 43- year-old pregnant woman presented with coughing and massive hemoptysis. She was diagnosed severe rheumatic mitral stenosis. The patient underwent percutaneous transluminal mitral valvuloplasty (PTMC). Before ICU admission and hospitalization, she was healthy, without any past medical history and complaints.

Abstract Background Massive hemoptysis is a serious complication in Cystic Fibrosis (CF), occurring commonly in older patients. Bronchial artery embolization (BAE) can be performed to stop the bleeding. BAE is generally safe and effective, but can sometimes lead to serious complications. We report the first case of temporary unilateral diaphragmatic paralysis associated to lung consolidation following BAE in a pediatric CF female patient. This complication worsened the lung function of the patient who underwent lung transplantation after 9 months. Case presentation A 14 years old female CF patient followed by the CF center of Florence presented low-grade fever, cough increase and recurrent episodes of major hemorrhages such as to carry out a BAE. Within 24 h the patient started to complain of severe thoracic pain in the right hemithorax, increased dyspnea and fever. A computed tomographic angiography and a dynamic fluoroscopic evaluation revealed the right diaphragmatic paralysis, not present before the procedure. After 4 days the clinical condition and radiological imaging had improved with restored mobility of the right hemidiaphragm. Nine months later, she required mechanical ventilation, and subsequently the initiation of extracorporeal membrane oxygenation (ECMO) for a pulmonary exacerbation with septic shock. Lung transplantation in ECMO was performed with success. Conclusion Clinicians should be aware of the possibility of phrenic nerve injury with BAE in pediatric CF patients.

Bronchial artery embolization is an established intervention for management of recurrent massive hemoptysis in a majority of patients. The source of bleeding in a majority of cases is systemic arteries – orthotopic bronchial arteries, anomalous bronchial arteries, or nonbronchial systemic collaterals. We report a case of an aberrant left inferior bronchial artery arising from the left gastric artery (LGA) in a patient with massive hemoptysis. Such origin from infradiaphragmatic vessels and specially left gastric arteries is very rare and needs to be considered by interventional radiologists and pulmonologists in case with hemoptysis disproportionate to supply by orthotopic arteries. Technical challenges were present in the present case in the form of an aneurysm in the aberrant artery and nontarget hepatic and gastric branches arising from LGA. Appropriate selection of hardware and embolic agents was done to deal with the clinical situation.

Hughes–Stovin syndrome is an extremely rare autoimmune clinical disorder that is characterized by deep vein thrombosis with multiple pulmonary and/or bronchial arterial aneurysms. This syndrome is an important cardiovascular status that may manifest Behçet's disease with systemic aneurysms. Here, we present the case of a 16-year-old female patient who suffered from recurrent life-threatening hemoptysis episodes due to right lower lobe pulmonary artery aneurysms and was finally treated with pulmonary resection.

Aspergillus niger is usually considered to be a low virulence fungus, not commonly reported to cause invasive infections. Invasive pulmonary aspergillosis due to Aspergillus niger was diagnosed in a 43-year-old woman following bilateral lung transplantation. Intravenous voriconazole failed to control progression of the disease. Despite salvage therapy with a combination of voriconazole and caspofungin for 23 days, the patient developed massive hemoptysis leading to death. The authors report the clinical features and treatment of this case.

Abstract Background Massive hemoptysis is a common encounter in respiratory medicine. Bronchoscopy plays an important role in localizing the origin of bleeding, as well as endoscopic treatment of centrally located lesions. Endobronchial embolization is a novel technique enabling the management of hemoptysis arising even from peripheral lesions, via occlusion of the culprit bronchus, thereby securing the airway. Endobronchial Watanabe Spigot had been advocate in the treatment of bronchopleural fistula and the use of this novel technique had since then been expanded into the management of massive hemoptysis. To the best of our knowledge, this is the first reported case in Malaysia. Case presentation 78-year-old lady who presented with life-threatening hemoptysis leading rapidly to cardiac arrest upon arrival. Spontaneous circulation was restored after resuscitation with an urgent thoracic computed tomography angiogram revealed bleeding likely from the posterior basal segment of left lower lobe, with bronchiectatic changes. Urgent flexible bronchoscopy revealed airway flooding, with bleeding originating from the lingular and posterior-basal segment of the left lower lobe. Airway toileting was performed and two 7 mm Endobronchial Watanabe Spigots were plugged into the culprit bronchi. Urgent bronchial artery embolization was then attempted, but was unsuccessful. She was managed conservatively, as surgical resection was deemed high risk. The spigots were removed 4 days later uneventfully. There was no recurrence of hemoptysis, and patient remained well during 1-month follow up. Conclusions The utmost priority in managing life-threatening hemoptysis is to prevent airway flooding. Endobronchial embolization with Endobronchial Watanabe Spigot is useful as a temporary measure before definitive therapy, or can itself be the main therapeutic player in the hemoptysis armament for high-risk patients.

Abstract Aortobronchial fistula (ABF) is a rare and potentially lethal complication of thoracic aortic replacement surgery. Currently, thoracic endovascular aortic repair (TEVAR) has emerged as a less invasive alternative to open surgery for ABF to facilitate prompt hemostasis. However, there are no published reports of TEVAR for ABF, particularly for presentation with life-threatening respiratory failure from massive hemoptysis. A 48-year-old male patient, who had recently undergone aortic root and arch replacement due to aortic dissection, was transferred to the emergency department with massive hemoptysis and severe dyspnea. A single-lumen endotracheal tube was immediately placed in the right main bronchus to protect the nonbleeding lung from spillage of blood. Chest computed tomography (CT) showed leakage of contrast material from the distal anastomosis of the aortic graft and consolidated lung tissue adjacent to the leakage. He was diagnosed with an ABF following aortic arch replacement, and an emergency TEVAR was performed. After adequate hemostasis, severe hypercapnia remained uncorrected despite the maximum ventilatory support. Thus, venovenous extracorporeal membrane oxygenation (VV ECMO) was immediately initiated, and severe respiratory acidosis improved dramatically. Furthermore, VV ECMO facilitated prompt bronchoscopic washout of the remaining blood clot without any danger of respiratory collapse and was weaned off successfully after 5 days as ventilation improved. This case demonstrates that emergency TEVAR in combination with VV ECMO can be a rescue strategy for massive hemoptysis from an ABF.

Behçet's disease (BD) is a multisystem disorder with various clinical presentations. Herein, we present a lethal complication associated with pulmonary artery aneurysm due to BD, resulting in massive hemoptysis that was controlled using endobronchial balloon lung isolation.

Mucormycosis is a life-threatening infection caused by fungi in the Mucorales species. It most often affects immunocompromised hosts, including diabetics patients. It can affect a variety of organ systems with pulmonary manifestations being the second most common. In severe cases, significant bronchial necrosis and angioinvasion can be seen. Due to its rarity, such extensive cases are not often reported in literature. We present a case of a 32-year-old man who presented with severe bronchial necrosis, including bronchomediastinal fistula, due to Rhizopus. Despite prompt treatment, he developed massive hemoptysis from invasion of the pulmonary vasculature and died. We also provide a brief review of mucormycosis.

We report a male patient who underwent bronchoscopic instillation of glue to control moderate hemoptysis which later led to the development of postobstructive pneumonia and extensive foreign body reaction in the bronchial wall and the lung distal to the glue application. He continued to have intermittent hemoptysis and underwent bronchial artery embolization. However, recurrent moderate hemoptysis eventually led to pneumonectomy, which showed severe foreign body reaction in bronchi- and post-obstructive changes in the lung parenchyma and the draining lymph nodes. This case highlights a serious complication of intrabronchial cyanoacrylate gluing to control bleeding in hemoptysis, which might warrant its very cautious use in moderate hemoptysis although surgical modality is considered the definitive treatment in life-threatening hemoptysis.

Aspergillomas are often misdiagnosed as tuberculosis (TB) in developing countries where the prevalence of TB is high, hemoptysis is often equated with TB, and most patients are diagnosed clinically. This report describes the case of a patient being treated for smear-negative TB who presented with hemoptysis and was found to have an aspergilloma.

A patient with pulmonary bullae died of massive hemoptysis. At autopsy a hole was observed in the aortic wall. A microscopic examination indicated small Aspergillus lesions in pulmonary bullae and extensive necrotic lesions with Aspergillus hyphae in the media of the thoracic aorta. These findings led to a diagnosis of invasive aspergillosis in the aortic arch. This is a rare case in which Aspergillus invaded the aorta in a patient without hematologic neoplasms or neutropenia.

Massive hemoptysis is a stressful and life-threatening event that can occur in lung cancer patients. The management of this event is usually challenging, and can involve surgery, embolization, and bronchoscopy. Unfortunately, while surgery can offer a definitive solution to hemoptysis, lung cancer patients are often excluded from this approach. On the other hand, bronchial arterial embolization rarely results in long-term control of bleeding. Endoscopy allows a skilled physician to perform mechanical tamponade or laser photocoagulation of bleeding lesions and preserve the main airways. While endoscopic stent placement is usually performed in order to treat stenosis, it has been occasionally employed to isolate and mechanically block the bleeding sites within the bronchial tree. We present the cases of two patients suffering from lung cancer-related life-threatening hemoptysis; both patients were successfully treated by positioning a silicone stent during emergency bronchoscopy. Subsequently, we present a concise review of the available literature.

Massive hemoptysis is one of the most important respiratory emergencies and pulmonary infiltrating diseases are among the rare causes of hemoptysis. Bronchial artery embolization (BAE) is a safe and effective treatment in these patients. Our case was a 45 years old woman with a 7 year history of Hodgkin's lymphoma who presented with massive hemoptysis of 20 days duration. CT scan revealed prebronchial infiltrating pattern. Diagnostic angiography showed hypervascularity in both hilar and perihilar areas and simultaneous opacification of both bronchial arteries from a right common trunk. BAE was successfully performed with 300 µ diameter polyvinyl alcohol. In follow up, hemoptysis did not recurred and patient was in good general health.

Introduction. Invasive pulmonary aspergillosis (IA) is the most frequent invasive fungal infection in patients with hematological malignancies. Massive hemoptysis (MH) with blood loss more than 300- 600 ml in 24 hours is a rare (5-10% of IA patients) but frequently fatal complication. Standard treatment of MH, such as oxygenation, a semi-sitting position with the bleeding site down, bronchoscopical suctioning, antifungal therapy, transfusion support and surgical resection might be either ineffective or not feasible in some cases. Outline of Cases. We report two patients with life threatening, non-controlled, massive hemoptysis who were successfully managed by non-standard measures. A 61-year-old male with acute myeloid leukemia developed pulmonary IA and massive hemoptysis after consolidation cure by chemotherapy. The bleeding site was localized in the VI lung segment by bronchoscopy. Local application of fibrinogen-thrombin concentrate (fibrin glue) stopped the bleeding. A 22-year-old female patient with the diagnosis of severe aplastic anemia developed IA and massive hemoptysis early after application of immunosuppressive therapy (antilymphocyte globulin, cyclosporine and corticosteroids). Conventional transfusion therapy, desmopresine and antifibrinolytics were ineffective. This urgent condition was successfully treated with human activated recombinant factor VII (rFVIIa, NovoSeven®). Conclusion. Our experience together with data from the available literature suggests a potential benefit of fibrinogen-thrombin concentrate and rFVIIa in the treatment of refractory critical bleeding in hematooncological patients.

Abstract This simulated case details a frequent and usually benign complaint, a cough, which becomes a very difficult situation, massive hemoptysis requiring intentional mainstem intubation. This resource includes the simulated case narrative along with case debriefing. The case is designed to instruct medical students and residents in the management and stabilization of patients with massive hemoptysis. This simulation is intended to improve understanding and competence in the management of a potentially life-threatening clinical scenario.

Massive hemoptysis is one of the most important respiratory emergencies and pulmonary infiltrating diseases are among the rare causes of hemoptysis. Bronchial artery embolization (BAE) is a safe and effective treatment in these patients. Our case was a 45 years old woman with a 7 year history of Hodgkin's lymphoma who presented with massive hemoptysis of 20 days duration. CT scan revealed prebronchial infiltrating pattern. Diagnostic angiography showed hypervascularity in both hilar and perihilar areas and simultaneous opacification of both bronchial arteries from a right common trunk. BAE was successfully performed with 300 µ diameter polyvinyl alcohol. In follow up, hemoptysis did not recurred and patient was in good general health.

Abstract We present a case of a 57 year old woman who suffered from massive hemoptysis; she was sent to our Department for a suspect neoformant lesion. We assumed it might be a Dielafoy’s disease and proceeded with an imaging study that confirmed the diagnosis. After embolization the patient no longer showed signs of bleeding. In brief, we concluded that whenever there is a suspect of Dielafoy’s disease, the biopsy has to be avoided.