Cardiothoracic Surgery: Massive Hemoptysis

Definition

• Definition: Life-Threatening Expectoration of Blood from the Lower Respiratory Tract
• Exact Threshold Debated
  • ≥ 100-1,000 cc/Day
  • ≥ 100 cc/Hour
• Most Common Source: Bronchial Arteries (90%)
  • Due to Higher Pressure
  • Rarely from Pulmonary Vessels

Causes

• Infection – Most Common Cause
  • Tuberculosis (TB)
  • Pneumonia
  • Aspergilloma
• Rasmussen Aneurysm – Pulmonary Artery Aneurysm Arising from a Tuberculosis Cavity
• Bronchitis
• Bronchiectasis
• Bronchiogenic Carcinoma
• Bleeding Diathesis
• Trauma
• Tracheoinnominate Fistula
• Diffuse Alveolar Hemorrhage

Complications

• Airway Obstruction
• Impairment of Gas Exchange
• Hemodynamic Instability
• Death

Diagnosis

• Diagnosis is Clinical
• Localize Bleeding with Bronchoscopy & CT

Treatment

• Immediate Management:
  • Position Lateral Decubitus with the Bleeding Side Down – Protect the Non-Bleeding Lung
  • Hemodynamic Support as Indicated
  • Consider Opposite-Side Mainstem Intubation
• Initial Treatment: Therapeutic Bronchoscopy
  • Therapeutic Options:
    • Cold-Saline Lavage
    • Topical Epinephrine
    • Packing
    • Balloon Tamponade
    • Thermal Ablation
• If Fails: Angioembolization or Surgery (Lobectomy)
  • Paraparesis
    • Possible Complication of Bronchial Artery Embolization
    • Cause: Anterior Spinal Artery with Common Origin Embolized
    • Presentation: Partial Paralysis of Both Legs