Bronchoscopy is useful in both the diagnostic work-up as well as a therapeutic modality.
The timing of performing bronchoscopy is controversial. One suggestion is to perform urgent bronchoscopy when there is rapid deterioration and elective bronchoscopy within 24–48 h in stable patients.
In patients with massive hemoptysis, rigid bronchoscopy is the method of choice due to its better suction ability. The major limitation of rigid bronchoscopy is that it is difficult or even impossible to visualize the upper lobes or peripheral lesions
Selective intubation of one lung can be performed by a rotational technique. After intubating the trachea, the tube is rotated through 90 in the direction of the desired placement until resistance is felt. The tube placement should be confirmed both clinically and radiologically.
Alternatively, a double-lumen endotracheal tube can be passed to protect the unaffected lung.
Currently, surgery represents one of a few treatment options, but still represents the only definitive one.
Surgical mortality ranges 1–50%.
Surgery remains the procedure of choice in patients with localised bronchiectasis, trauma, hydatid cyst, arteriovenous malformations, thoracic aneurysm and aspergilloma, because it is curative for these underlying diseases.
A patient with an aspergilloma should undergo surgical resection. Unfortunately, such patients often have significant concomitant bronchiectasis that may preclude them from surgery due to insufficient pulmonary reserves. In these patients intracavitary Na of K iodide is curative. In some series external beam irradiation was used .
Some of the immunological diseases, such as Goodpasture’s
disease, can present with massive haemoptysis. These diseases do not need invasive procedures and are usually treated with high-dose corticosteroids, cytotoxic agents or plasmapheresis.
In practice tailored management for hemoptysis is needed