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The Journal of Thoracic and Cardiovascular Surgery, Vol 105, 394-397, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
CJ Knott-Craig, JG Oostuizen, G Rossouw, JR Joubert and PM Barnard
A retrospective analysis was done of 120 consecutive patients with life-
threatening hemoptysis (greater than 200 ml of discharge per 24 hours)
cared for between 1983 and 1990 at our institution. Seventy-nine percent of
the patients (95/120) had hemoptysis exceeding 500 ml/24 hr. Inflammatory
lung disease was the underlying cause in at least 85% of cases (n = 103);
and of these, pulmonary tuberculosis was the primary diagnosis in 85%
(88/103). Fifty-two patients (43%) had had a prior episode of massive
hemoptysis, usually within 3 months of their admission. Urgent examination
with rigid endoscope in 97 patients (81%) localized the bleeding in only 42
(43%). The overall hospital mortality rate was 10% (12/120) and was similar
for those having pulmonary resection (7.1%, 3/42), and those assisted
medically (11.5%, 9/78) (p = not significant). However, of these hospital
survivors on whom 6-month follow-up was available, 36.4% (20/55) of those
with medical management and none (0/39) (p < 0.001) of those with
surgical management had recurrent massive hemoptysis. Forty-five percent of
these cases were fatal. Current management of massive hemoptysis has
resulted in improved hospital outcome. However, the high risk of recurrent
and often fatal hemoptysis mandates the definitive management of the
bronchial arteries before discharge from the hospital. Recent reports
suggest that percutaneous embolization may be effective in nonsurgical
candidates.
ARTICLES
Management and prognosis of massive hemoptysis. Recent experience with 120 patients
Department of Cardiothoracic Surgery, University of Stellenbosch, South Africa.
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