पल्मोनरी एवं श्वसन चिकित्सा

Clinical-Radiological, Pathological Profile and Treatment Outcome of Patients with Haemoptysis

Abstract

Joseph T, Nair S, James PT

Background: Haemoptysis is a frequently occurring life threatening situation which can occur in various pulmonary conditions. Managing a case of haemoptysis is often difficult due to a large spectrum of causative factors. The effective control of haemoptysis depends upon identification of the etiology and localization of the site of bleeding.
Method: This was a two year cross sectional study of 102 patients who presented with active haemoptysis. Data from these patients was collected for the analyzing the underlying cause, diagnostic modality, treatment approach used and outcome of it in patients suffering from life-threatening haemoptysis.
Results: Old Pulmonary tuberculosis, (34.31%), bronchiectasis (25.49%), lung cancer (11.76%), aspergilloma (10.78%) accounted for the most common etiologies of haemoptysis. 12 patients (11.76%), out of 102 had mild haemoptysis, 26 patients (25.49%) had moderate haemoptysis and 64 patients (62.74%) had massive/severe haemoptysis. CT chest was the most sensitive diagnostic test when employed alone, with positive yield of 93.14%. Among study population 61 patients (59.80%) were treated conservatively, 39 patients (38.23%) were treated by bronchial artery embolisation (BAE) and 2 patients underwent surgery for management of recurrent haemoptysis. Most of the patients were treated conservatively, but in case of significant haemoptysis, Bronchial artery embolization was performed than the conservative treatment. Success rate of conservative treatment group on a long term basis was 72.13%, BAE group 89.47%, surgical treatment group was 100%, without any significant statistical significance (p value=0.090). The duration of hospitalization among conservative treatment group was 4.37 days and BAE group was 10.51 days (P-value<0.001).
Conclusion: The most common causes of haemoptysis were old pulmonary tuberculosis and bronchiectasis. Emergency bronchial artery embolisation is a better option than medical treatment for immediate cessation of haemoptysis. The successful treatment of haemoptysis requires thorough diagnostic evaluation and close interdisciplinary collaboration among pulmonologists, radiologists, and thoracic surgeons.