Severe Hemoptysis

Abstract

Severe hemoptysis is associated with poor prognosis in the absence of adequate treatment. The evaluation of initial severity is essential to guide the therapeutic decision and its time of realization, based on the combination of the existence of comorbid conditions, and the mechanism, etiology, and respiratory consequences of hemoptysis. The first- line therapeutic management includes medical measures and interventional vascular radiology, which has dramatically improved with the development of multi-detector computed tomodensitometry (CT) angiography and the use of microcatheters. In the absence of emergent indications, fiberoptic bronchoscopy should be reserved for situations during which CT-scan fails to locate hemoptysis (bilateral bronchiectasis, for example). Emergency surgical resection should be reserved for failure of interventional vascular radiology and situations at high-risk of bleeding recurrence. The optimization of operative conditions is mandatory to reduce morbidity and mortality related to surgery.