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Liddell SS, Hwang SR, Szostek JH. 81-Year-Old Woman With Hemoptysis. Mayo Clin Proc 2024; 99:1646-1651. [PMID: 38958622 DOI: 10.1016/j.mayocp.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/22/2023] [Accepted: 10/31/2023] [Indexed: 07/04/2024]
Affiliation(s)
- Savannah S Liddell
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Steven R Hwang
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Jason H Szostek
- Advisor to residents and Consultant in General Internal Medicine, Mayo Clinic, Rochester, MN.
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Karlafti E, Tsavdaris D, Kotzakioulafi E, Kougias L, Tagarakis G, Kaiafa G, Netta S, Savopoulos C, Michalopoulos A, Paramythiotis D. Which Is the Best Way to Treat Massive Hemoptysis? A Systematic Review and Meta-Analysis of Observational Studies. J Pers Med 2023; 13:1649. [PMID: 38138876 PMCID: PMC10744930 DOI: 10.3390/jpm13121649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/21/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
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.
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Affiliation(s)
- Eleni Karlafti
- Emergency Department, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
- 1st Propaedeutic Department of Internal Medicine, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.K.); (G.K.); (C.S.)
| | - Dimitrios Tsavdaris
- 1st Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (D.T.); (S.N.); (A.M.); (D.P.)
| | - Evangelia Kotzakioulafi
- 1st Propaedeutic Department of Internal Medicine, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.K.); (G.K.); (C.S.)
| | - Leonidas Kougias
- Department of Radiology, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - Georgios Tagarakis
- Department of Cardiothoracic Surgery, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - Georgia Kaiafa
- 1st Propaedeutic Department of Internal Medicine, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.K.); (G.K.); (C.S.)
| | - Smaro Netta
- 1st Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (D.T.); (S.N.); (A.M.); (D.P.)
| | - Christos Savopoulos
- 1st Propaedeutic Department of Internal Medicine, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.K.); (G.K.); (C.S.)
| | - Antonios Michalopoulos
- 1st Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (D.T.); (S.N.); (A.M.); (D.P.)
| | - Daniel Paramythiotis
- 1st Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (D.T.); (S.N.); (A.M.); (D.P.)
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Coviello E, Puma F, Pourmolkara D, Mandarano M, Napolitano AG. Massive, life-threatening hemoptysis due to localized granulomatosis with polyangiitis. J Cardiothorac Surg 2023; 18:239. [PMID: 37496070 PMCID: PMC10373328 DOI: 10.1186/s13019-023-02302-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 06/10/2023] [Indexed: 07/28/2023] Open
Abstract
Massive hemoptysis may be related to a wide spectrum of diseases whose differential diagnosis can be challenging, also due to the medical emergency condition.We present a case of a 33-year-old woman presented to our department with sudden, life-threatening hemoptysis from unknown etiology, which required a rescue pulmonary lobectomy after resuscitation maneuvers. Histology proved to be a localized Wegener granulomatosis. Our case shows that granulomatosis should always be considered among the possible, although rarer, causes of massive hemoptysis.
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Affiliation(s)
- Eleonora Coviello
- Department of Thoracic Surgery, University of Perugia Medical School, Piazzale Giorgio Menghini 3, Perugia, 06129, Italy.
- Thoracic Surgery Unit, Department of Surgical Sciences, Santa Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, 06134, Italy.
| | - Francesco Puma
- Department of Thoracic Surgery, University of Perugia Medical School, Piazzale Giorgio Menghini 3, Perugia, 06129, Italy
| | - Domenico Pourmolkara
- Department of Thoracic Surgery, University of Perugia Medical School, Piazzale Giorgio Menghini 3, Perugia, 06129, Italy
| | - Martina Mandarano
- Department of Anatomic Pathology and Histology, University of Perugia Medical School, Piazzale Giorgio Menghini 3, Perugia, 06129, Italy
| | - Antonio Giulio Napolitano
- Department of Thoracic Surgery, University of Perugia Medical School, Piazzale Giorgio Menghini 3, Perugia, 06129, Italy
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Robson PC, O’Connor D, Pardini P, Akard TF, Dietrich MS, Kotin A, Solomon A, Chawla M, Kennedy M, Solomon SB. Hemoptysis associated with percutaneous transthoracic needle biopsy: Development of critical events checklist and procedure outcomes. JOURNAL OF RADIOLOGY NURSING 2021; 40:221-226. [PMID: 34483778 PMCID: PMC8409504 DOI: 10.1016/j.jradnu.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND A percutaneous transthoracic needle biopsy (PTNB) is performed to obtain tissue for a pathologic diagnosis. A PTNB is necessary prior to the initiation of many cancer treatments. There is a risk of hemoptysis, the expectoration of blood, with the possibility for adverse, life-threatening outcomes. A critical event checklist is a cognitive aid used in an emergency to ensure critical steps are followed. To date, there are no known checklists published for management of PTNB-related, life-threatening hemoptysis. The purpose of this report is to describe the development and implementation of a critical event checklist and the adoption of the checklist into hemoptysis management. METHODS In March 2017, a process improvement team convened to evaluate the hemoptysis response using the Plan-Do-Study-Act (PDSA) methodology. The checklist was evaluated and updated through September 2019. The team educated Interventional Radiology (IR) clinicians on the new checklist and conducted simulations on its use. A retrospective chart review was performed on hemoptysis events between the ten-year period of October 1, 2008 and September 30, 2018 to evaluate the adoption of the checklist into practice. RESULTS There were 231 hemoptysis events occurring in 229 patients (2 with repeat biopsies). Prior to implementing the protocol and checklist, there were 166 (71.9%) hemoptysis events. After implementation there were 65 (28.1%) events. The median amount of documented blood expectorated with hemoptysis was 100 mL (IQR 20.0-300.0). Twenty-six patients were admitted after PTNB for reasons related to the hemoptysis event (11.3%). During the procedure, four (1.7%) patients with hemoptysis suffered a cardiac arrest. Prior to implementation of the protocol and critical events checklist, nurses positioned patients in the lateral decubitus (LD) position in 40 out of 162 (24.7%) cases. After implementation of the critical events checklist, nurses positioned patients in the LD position 42 out of 65 cases (64.6%) (OR=5.57(95% CI 2.99-10.367), p<0.001). DISCUSSION Interventional Radiology nurses successfully adopted the checklist into management of hemoptysis events. The reported incidence of hemoptysis suggests a need for IR teams to prepare for and simulate hemoptysis events. Future research is needed to evaluate the change in patient outcomes before and after critical events checklist implementation.
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Affiliation(s)
- Piera C. Robson
- Memorial Sloan Kettering Cancer Center Department of Nursing and, Vanderbilt University School of Nursing, 1275 York Avenue, S121, New York, NY 10065
| | - David O’Connor
- Memorial Sloan Kettering Cancer Center Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C-613D, New York, NY 10065
| | - Perri Pardini
- Memorial Sloan Kettering Cancer Center Department of Nursing, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, M2 D-desk, New York, NY 10065
| | - Terrah F. Akard
- Vanderbilt University School of Nursing, 461 21 Ave South, 514 Godchaux Hall, Nashville, TN 37240
| | - Mary S. Dietrich
- Vanderbilt University School of Nursing and School of Medicine (Biostatistics, VICC, Psychiatry), 461 21 Ave South, 410 Godchaux Hall, Nashville, TN 37240
| | - Alan Kotin
- Memorial Sloan Kettering Cancer Center, Department of Anesthesiology and Critical Care Medicine, 1275 York Avenue, C330A, New York, NY
| | - Alexandra Solomon
- Memorial Sloan Kettering Cancer Center, Department of Nursing, 1275 York Avenue, New York, NY
| | - Mohit Chawla
- Memorial Sloan Kettering Cancer Center, Department of Medicine, 1275 York Avenue, New York, NY
| | - Matthew Kennedy
- Memorial Sloan Kettering Cancer Center, Department of Nursing, 1275 York Avenue, New York, NY
| | - Stephen B. Solomon
- Memorial Sloan Kettering Cancer Center, Department of Radiology, Memorial Sloan Kettering Cancer Center, H118, 1275 York Avenue, New York, NY 10065
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Argun Barış S, Coşkun İS, Selvi G, Boyacı H, Başyiğit İ. Case Series of COVID-19 Presenting with Massive Hemoptysis. Turk Thorac J 2020; 21:454-456. [PMID: 33352103 PMCID: PMC7752106 DOI: 10.5152/turkthoracj.2020.20150] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 07/22/2020] [Indexed: 01/28/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is a novel viral infection that has led to a global pandemic. The clinical spectrum of COVID-19 has a wide range from asymptomatic disease to severe disease, including acute respiratory distress syndrome and death. The most common symptoms are fever, cough, myalgia, and fatigue. Diarrhea, headache, sore throat, and hemoptysis are rare symptoms. There is no patient with COVID-19 presenting with massive hemoptysis in the literature. Here we present a case series of 3 patients with COVID-19 who were admitted to the emergency department with massive hemoptysis without any other symptoms.
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Affiliation(s)
- Serap Argun Barış
- Department of Pulmonary Disease, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - İlkim Sema Coşkun
- Department of Pulmonary Disease, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Gözde Selvi
- Department of Pulmonary Disease, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Haşim Boyacı
- Department of Pulmonary Disease, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - İlknur Başyiğit
- Department of Pulmonary Disease, Kocaeli University School of Medicine, Kocaeli, Turkey
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Zeng J, Wu X, Zhang M, Lin L, Ke M. Modified silicone stent for difficult-to-treat massive hemoptysis: a pilot study of 14 cases. J Thorac Dis 2020; 12:956-965. [PMID: 32274164 PMCID: PMC7139086 DOI: 10.21037/jtd.2019.12.47] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Massive hemoptysis is a life-threatening event with limited therapeutic options. Bronchoscopic placement of stents may offer an alternative option for massive hemoptysis. However, traditional silicone stents have not been customized, making it difficult to tailor to individual patient’s needs for achieving optimal hemostasis. To investigate the efficacy and safety of the modified silicone stent in patients with difficult-to-treat massive hemoptysis. Method Between May 2016 and November 2018, we enrolled 14 patients who underwent bronchoscopic placement of the modified silicone stent, which was fabricated manually based on the Y-shaped silicone stent by tailoring and suturing on site. We recorded the technical success, clinical success, and complications. Patients were followed up for recording the recurrence of massive hemoptysis and complications. Results Placement of the modified silicone stent was successful in all 14 patients with a mean duration of 69.6 minutes (technical success rate: 100%). After stenting, no further massive hemorrhage episodes recurred in 12 patients (clinical success rate: 85.7%). Two cases suffered from recurrent hemoptysis in 4 and 6 days after stenting, respectively. The main complications were sputum plugging, granuloma proliferation and pulmonary infection such as pneumonia. There were no adverse events of stent migration and suture dehiscence. After a median follow-up of 5.8 (range, 0.3–21.3) months, three patients withdrew and seven patients succumbed. Only one patient died of uncontrolled pneumonia which was possibly related to stent placement. Conclusions The modified silicone stent is an effective and safe gate-keeping therapeutic option for difficult-to-treat massive hemoptysis.
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Affiliation(s)
- Junli Zeng
- Department of Respiratory Centre, The Second Affiliated Hospital of Xiamen Medical College, Xiamen 361000, China
| | - Xuemei Wu
- Department of Respiratory Centre, The Second Affiliated Hospital of Xiamen Medical College, Xiamen 361000, China
| | - Meihua Zhang
- Department of Respiratory Centre, The Second Affiliated Hospital of Xiamen Medical College, Xiamen 361000, China
| | - Liancheng Lin
- Department of Respiratory Centre, The Second Affiliated Hospital of Xiamen Medical College, Xiamen 361000, China
| | - Mingyao Ke
- Department of Respiratory Centre, The Second Affiliated Hospital of Xiamen Medical College, Xiamen 361000, China
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Azdaki N, Moezi S, Farzad M. Pulmonary tuberculosis: a differential diagnostic priority in unprovoked deep venous thrombosis patients with haemoptysis. Pan Afr Med J 2018; 29:57. [PMID: 29875938 PMCID: PMC5987074 DOI: 10.11604/pamj.2018.29.57.14225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/20/2017] [Indexed: 11/11/2022] Open
Abstract
Deep vein thrombosis (DVT) is a common cause of death worldwide. Several factors are associated with increased risk of DVT. In this report a case of deep venous thrombosis (DVT) of the lower limb and its link with underlying pulmonary tuberculosis is described in a young male patient with haemoptysis.
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Affiliation(s)
- Nahid Azdaki
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Seyedali Moezi
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Marjan Farzad
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
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