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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 FROM AUTHOR]

Massive hemoptysis (MH) is a serious condition that carries with it a high rate of morbidity and mortality. This review highlights the pearls and pitfalls of massive hemoptysis, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. MH is a rare but deadly condition. It is defined clinically as any bleeding from the tracheobronchial tree that compromises respiratory or circulatory function. The bronchial artery system is the primary source in the majority of cases of MH. The most common cause is tuberculosis worldwide, but bronchiectasis, bronchogenic carcinoma, and mycetoma are more common causes in the U.S. Patients with MH require rapid assessment and management, as decompensation can be rapid. Patients with altered mental status, inability to clear their sections, respiratory distress, or hemodynamic compromise require emergent airway intervention. The imaging modality of choice is computed tomography angiography with pulmonary arterial phase contrast. A reasonable order or sequence of management includes initial stabilization; assessment for the need for airway intervention; reversal of any coagulopathy; advanced imaging; and emergent consultation of pulmonary, cardiothoracic surgery, and interventional radiology. Ongoing resuscitation including blood products may be required in some patients with MH until definitive hemostasis is achieved. An understanding of MH can assist emergency clinicians in diagnosing and managing this dangerous disease. Providing a prompt evaluation, obtaining intravenous access, pursuing advanced imaging, providing reversal of coagulopathy, supporting hemodynamics, and appropriate consultation are key interventions in MH. [ABSTRACT FROM AUTHOR]

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

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 < 9 g/L, severe intraoperative hemoptysis), and postoperative long-term residual lung reinfection (DL with massive hemoptysis). Conclusions: DL patients with massive hemoptysis had greater rate of invasive respiratory support therapy and postoperative complications. Extensive lesion removal, preoperative anaemia, severe intraoperative bleeding associated with recent postoperative complications for the patient. [ABSTRACT FROM AUTHOR]

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 < 0.05). Multivariate regression analysis demonstrated a significant correlation between combined therapy and hemoptysis-free survival. Conclusion: Combination therapy, compared to embolization alone, exhibits superior efficacy in improving respiratory function, correcting hypoxia, stopping bleeding, and preventing recurrence. It is considered an effective and safe treatment for massive hemoptysis. [ABSTRACT FROM AUTHOR]

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.

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. [ABSTRACT FROM AUTHOR]

Double-origin right bronchial artery is a rare anatomical variation with varying presentation. Patients can be asymptomatic, but in case they present with hemoptysis, such anatomical variations may lead to clinical dilemmas. In this case report, we describe a young patient who presented with massive hemoptysis and was treated with superselective embolization. To the best of our knowledge, double-origin right bronchial artery has been rarely described in the literature. Herein, we aim to highlight the importance of understanding the anatomy and the variants of bronchial arteries. [ABSTRACT FROM AUTHOR]

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 FROM AUTHOR]

Life-threatening hemoptysis (formerly called massive hemoptysis), though relatively uncommon, imposes significant mortality risks. This article discusses the etiology, clinical presentation, assessment, treatment, and nursing interventions to promote effective clinical management of patients with this condition. [ABSTRACT FROM AUTHOR]

Introduction: Hemoptysis is one of the most common symptoms of respiratory system diseases. Common causes include bronchiectasis, tumors, tuberculosis, aspergilloma, and cystic fibrosis. The severity of hemoptysis varies from mild to moderate to massive hemoptysis and can easily lead to hemodynamic instability and death from suffocation or shock. Nevertheless, the most threatening hemoptysis that is presented to the emergency department and requires hospitalization is the massive one. In these cases, today, the most common way to manage hemoptysis is bronchial artery embolization (BAE). Methods: A systematic literature search was conducted in PubMed and Scopus from January 2017 (with the aim of selecting the newest possible reports in the literature) until May 2023 for studies reporting massive hemoptysis. All studies that included technical and clinical success rates of hemoptysis management, as well as rebleeding and mortality rates, were included. A proportional meta-analysis was conducted using a random-effects model. Results: Of the 30 studies included in this systematic review, 26 used bronchial artery embolization as a means of treating hemoptysis, with very high levels of both technical and clinical success (greater than 73.7% and 84.2%, respectively). However, in cases where it was not possible to use bronchial artery embolization, alternative methods were used, such as dual-vessel intervention (80% technical success rate and 66.7% clinical success rate), customized endobronchial silicone blockers (92.3% technical success rate and 92.3% clinical success rate), antifibrinolytic agents (50% clinical success rate), and percutaneous transthoracic embolization (93.1% technical success rate and 88.9% clinical success rate), which all had high success rates apart from antifibrinolytic agents. Of the 2467 patients included in these studies, 341 experienced rebleeding during the follow-up period, while 354 other complications occurred, including chest discomfort, fever, dysphagia, and paresis. A total of 89 patients died after an episode of massive hemoptysis or during the follow-up period. The results of the meta-analysis showed a pooled technical success of bronchial artery embolization equal to 97.22% and a pooled clinical success equal to 92.46%. The pooled recurrence was calculated to be 21.46%, while the mortality was 3.5%. These results confirm the ability of bronchial artery embolization in the treatment of massive hemoptysis but also emphasize the high rate of recurrence following the intervention, as well as the risk of death. Conclusion: In conclusion, massive hemoptysis can be treated with great clinical and technical success using bronchial artery embolization, reducing mortality. Mortality has now been reduced to a small percentage of cases. [ABSTRACT FROM AUTHOR]

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.

We present a patient with life-threatening airway bleeding from an infectious pulmonary cavity with limited treatment options. Bronchial artery embolization was unsuccessful. Surgery was not feasible due to compromised lung function. Lung transplant was considered but not endorsed. Palliative hemostatic radiotherapy with 20 Gy in 5 fractions was delivered to the site of bleeding as a last resort. Hemoptysis gradually disappeared within a month and did not recur during the 4‑month follow-up. There were no side effects. We highlight the potential of radiotherapy for massive hemoptysis of infectious etiology, especially in cases with exhausted standard treatment options. [ABSTRACT FROM AUTHOR]

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.

To investigate whether pre-procedure Computed Tomography Angiography (CTA) improves radiation exposure, procedure complexity, and symptom recurrence after bronchial embolization for massive hemoptysis. A single-center retrospective review of bronchial artery embolization (BAE) for massive hemoptysis was performed for procedures between 2008 and 2019. Multi-variate analysis was performed to determine the significance of pre-procedure CTA and etiology of hemoptysis on patient radiation exposure (reference point air kerma, RPAK) and rate of recurrent hemoptysis. There were 61 patients (mean age 52.5 years; SD = 19.2 years, and 57.3% male) and CTA was obtained for 42.6% (26/61). Number of vessels selected was a mean of 7.2 (SD = 3.4) in those without CTA and 7.4 (SD = 3.4) in those with CTA (p = 0.923). Mean procedure duration was 1.8 h (SD = 1.6 h) in those without CTA and 1.3 h (SD = 1.0 h) in those with CTA (p = 0.466). Mean fluoroscopy time and RPAK per procedure were 34.9 min (SD = 21.5 min) and 1091.7 mGy (SD = 1316.6 mGy) for those without a CTA and 30.7 min (SD = 30.7 min) and 771.5 mGy (SD = 590.0 mGy) for those with a CTA (p = 0.523, and p = 0.879, respectively). Mean total iodine given was 49.2 g (SD = 31.9 g) for those without a CTA and 70.6 g (SD = 24.9 g) for those with a CTA (p = 0.001). Ongoing hemoptysis at last clinical follow up was 13/35 (37.1%) in those without CTA and 9/26 (34.6%) in those with CTA (p = 0.794). Pre-procedure CTA did not improve radiation effective dose and symptom recurrence after BAE and is associated with significant increases in total iodine dose. • Bronchial artery embolization can be performed without pre-procedure cross-sectional imaging. • Computed tomography angiography does not add significant radiation effective dose. • Cases with an otherwise suspected bleeding site should proceed directly to interventional treatment. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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.

Background: We investigated the efficacy and safety of bronchial artery embolization (BAE) using a 5F JL4 catheter in patients with hemoptysis and a bronchial artery opening in the inferior wall of the aortic arch. Methods: This was a single-center retrospective study. Seventeen patients underwent BAE using 5F JL4. We then evaluated technical success (TS), clinical success (CS), incidence of complications, and hemoptysis recurrence rate (RR). Results: The TS rate of microcatheter superselective catheterization and CS rate after surgery were 100%, and the incidence of severe complications and postoperative RR were 17.6%. Conclusions: Bronchial artery embolization for hemoptysis with a BA opening in the inferior wall of the aortic arch using the 5F JL4 catheter could be a safe method. The short- and medium-term results were excellent. [ABSTRACT FROM AUTHOR]

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 FROM AUTHOR]

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.

Rationale: Hemoptysis is a common and important complication in persons with cystic fibrosis (PwCF). Despite this, there is limited literature on the impact of hemoptysis on contemporary cystic fibrosis (CF) outcomes. Objectives: Evaluate whether hemoptysis increases the risk of lung transplant or death without a transplant in PwCF. Methods: We reviewed a dataset of PwCF ages 12 years or older from the CFFPR (CF Foundation Patient Registry) that included 29,587 individuals. We identified hemoptysis as our predictor of interest and categorized PwCF as either no hemoptysis, any hemoptysis (submassive and/or massive), or massive hemoptysis. We subsequently evaluated whether hemoptysis, as defined above, was associated with death without transplant or receipt of lung transplant via logistic regression. We adjusted for age, sex, body mass index, forced expiratory volume in one second (FEV1), number of exacerbations, supplemental oxygen use, CF-related diabetes, and Pseudomonas aeruginosa colonization status. Subgroup analyses were performed in advanced lung disease, defined as PwCF with an FEV1 <40% predicted. Results: PwCF with any form of hemoptysis were more likely to progress to lung transplant or die without transplant than PwCF who did not have hemoptysis (odds ratio [OR], 1.3 [95% confidence interval (CI), 1.1-1.7]). The effect size of these associations was larger when hemoptysis events were classified as "massive" (massive hemoptysis OR, 2.2 [95% CI, 1.2-3.8]) or in PwCF with advanced lung disease (massive hemoptysis in advanced lung disease OR, 3.2 [95% CI 1.3-8.2]). Conclusions: Hemoptysis is associated with an increased risk of lung transplant and death without a transplant in PwCF, especially among those with massive hemoptysis or advanced lung disease. Our results suggest that hemoptysis functions as a useful predictor of serious outcomes in PwCF and may be important to incorporate into risk prediction models and/or transplant decisions in CF. [ABSTRACT FROM AUTHOR]

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.

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 FROM AUTHOR]

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 FROM AUTHOR]

Massive hemoptysis is a life-threatening medical condition which usually occurs in the course of parenchymal destructive diseases. We herein report the case of a 61-year-old male patient who presented with massive hemoptysis six months after commencement of dual antiplatelet therapy with acetylsalicylic acid and ticagrelor, for drug-eluting coronary stents. Control of bleeding with discontinuation of both antiplatelet agents, as well as negative imaging and laboratory studies for other pulmonary hemorrhage causes, indicate that either of the antiplatelet drugs or combination thereof was the cause of the pulmonary hemorrhage. In contrast to the previous limited case reports with pulmonary hemorrhage early during antiplatelet therapy with ticagrelor, this case highlights that it can even occur later in the course of antiplatelet therapy. [ABSTRACT FROM AUTHOR]

BACKGROUND AND AIM: The aim of this study is to evaluate the etiology, length of stay, treatment modality and treatment success in patients who underwent bronchoscopy due to massive hemoptysis. METHODS: The study is a cross-sectional study and was carried out with 148 patients who were transferred to our center with the complaint of massive hemoptysis between January 1, 2018 and January 1, 2021. RESULTS: The average age of the study group is 55.64±17.54. 71.6% of the patients in the study group were male. Etiological causes of patients with massive hemoptysis who underwent bronchoscopy were determined as bronchiectasis, lung cancer, tuberculosis, arterio-venous malformation and aspergilloma, respectively. The patients underwent 64.9% bronchial artery embolization (BAE), 29.7% medical treatment and 5.4% surgical treatment. The average length of stay in the intensive care unit is 4.66 days, while the length of stay in the service is 3.51 days. Relapse was seen in 9.45% of patients after BAE. The mean time to recurrence was 137.28 days. It was determined that hemoptysis recurred under 90 days in 8 cases and over 90 days in 6 cases. The success rate of BAE treatment was 90.55% and no mortal complications were observed. CONCLUSIONS: Massive hemoptysis is a life-threatening and urgent condition. Maintaining airway patency and controlling bleeding is a priority. We think that the patient should be hospitalized and followed up in the intensive care unit, contrast-enhanced thorax computed tomography and bronchoscopy should be performed in the rapid diagnosis process, BAE should be preferred first in the treatment, and surgical and other treatments should be applied if necessary. [ABSTRACT FROM AUTHOR]

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.

A cognitive aid is a tool used to help people accurately and efficiently perform actions. Similarly themed cognitive aids may be collated into a manual to provide relevant information for a specific context (eg, operating room emergencies). Expert content and design are paramount to facilitate the utility of a cognitive aid, especially during a crisis when accessible memory may be limited and distractions may impair task completion. A cognitive aid does not represent a rigid approach to problem-solving or a replacement for decision-making. Successful cognitive aid implementation requires dedicated training, access, and culture integration. Here the authors present a set of evidence-based cognitive aids for thoracic anesthesia emergencies developed by a Canadian thoracic taskforce. [ABSTRACT FROM AUTHOR]

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.

Although COVID-19 coagulopathy typically manifests with thrombotic complications, hemorrhagic complications also occur and must be considered when making decisions about anticoagulation in these patients. Here, we report a case of massive hemoptysis occurring in a recently post-partum woman via Cesarean section with COVID-19 who was managed via bronchial artery embolization while on extracorporeal membrane oxygenation. • Although COVID-19 coagulopathy typically manifests with thrombotic complications, hemorrhagic complications can occur and must be considered when making decisions about anticoagulation • Pulmonary hemorrhage is an uncommon manifestation of COVID-19 infection, occurring in 0.9-3% of cases • Bronchial artery embolization for pulmonary hemorrhage seems safe and effective in the setting of COVID-19 infection [ABSTRACT FROM AUTHOR]

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: 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 FROM AUTHOR]

Bronchial artery (BA) pseudoaneurysm is an uncommon vascular complication of tuberculosis (TB), and early diagnosis is crucial due to risk of rupture and life-threatening hemorrhage. Immediate intervention is warranted in massive hemoptysis due to high mortality. Various causes of massive hemoptysis are TB, bronchiectasis, aspergilloma, lung abscess, lung cancer, necrotizing pneumonia, and cystic fibrosis. Active pulmonary TB as well as chronic pulmonary TB can manifest with massive hemoptysis. Hemoptysis in active TB occurs due to ulceration in bronchiolar wall, eroding the wall of the adjacent BA or pulmonary artery, and in chronic TB due to hypertrophied bronchial arteries, or bronchiectasis, or aspergilloma. Herein, we report a case of pulmonary TB causing intrapulmonary BA pseudoaneurysm in a young male patient who presented with acute massive hemoptysis. The BA pseudoaneurysm as well as other hypertrophied bronchial arteries were embolized using polyvinyl alcohol (PVA) particles. [ABSTRACT FROM AUTHOR]