2. DEFINITION
• Hemoptysis is the expectoration of blood and it can
range from blood-streaking of sputum to the
presence of gross blood in the absence of any
accompanying sputum.
• The term massive hemoptysis is reserved for
bleeding that is potentially life-threatening.
• It has been defined by a number of different criteria,
often ranging from more than 100 to more than 600
ml of blood over a 24 hour period.
9. DIFFERENTIATING FEATURE OF HAEMOPTYSIS
AND HAEMATEMESIS
• HAEMOPTYSIS HAEMATEMESIS
• HISTORY
• Absence of nausea and Presence of nausea and vomiting
vomiting.
Lung disease. Gastric or hepatic disease
Asphyxia possible. Asphyxia unusual.
SPUTUM EXAMINATION
Frothy, Liquid or clotted Rarely frothy, coffy
appearance, Bright red or pink ground in appearance
In colour brown to black in
colour
17. INVESTIGATIONS
1) Complete Blood Count- Hb, TC, DLC,ESR, platelet
count, bld gp
2) Coagulation profile
3) Urine analysis – red cells and red cell casts
4) Blood urea nitrogen and creatinine levels
5) Sputum :
• Z-N staining – acid fast bacilli ( PTB)
• Gram staining
• Cytological examination- malignant cells
• Culture – isolation of organisms
18. 6) Chest X-Ray : ( PA and lateral)
• Cystic lesions, tram tracks, ring shadows -
bronchiectasis
• Distinct air- fluid level: lung abscess
Mass lesion
Focal or diffuse parenchymal disease- pneumonia
Tubercular fluffy opacity.
7) CT scan:
• Carcinoma
• Bronchiectasis- diagnostic procedure of choice
• Lung abscess
19. 8) ECHO:
• MS, pulmonary HTN and pulmonary
thromboembolism
9) Fibreoptic bronchoscopy (FOB):
• Localise the site of bleeding
• Visualise endobronchial lesions
if massive bleeding – rigid bronchoscopy
(permits better visualisation of central airways
and better suctioning )
20.
21. TREATMENT
Minor hemoptysis:
Scanty ( blood streaked sputum) - <100 ml/ 24 hrs
Resolve spontaneously without specific therapy
Treatment of underlying cause
Complete bed rest, cough
suppressants,tranexamic
acid,ethamsylate,sedative.
Massive hemoptysis:
• Huge amt of blood loss : >100-600 ml over 24 hrs
22. Stabilization:
Ensure adequate ventilation and perfusion
Avoid asphyxiation
Lateral decubitus position
oxygen
Patients with poor gas exchange, rapid ongoing
hemoptysis, hemodynamic instability, or severe
shortness of breath should be orally intubated
with a large bore endotracheal tube
Monitoring of BP, pulse rate, respiratory rate and
urine output
MASSIVE HEMOPTYSIS
23. Large IV access + Fluid resuscitation
Blood transfusions
Cough-suppressing drugs can be added.
Coagulation disorders should be rapidly
reversed
24. Protection of non-bleeding lung:
• Placement of bleeding lung in dependant
position- lateral decubitus ( if origin of bleed is
known and limited to 1 lung)
• Selective intubation of the nonbleeding lung
with bronchoscopic guidance ( isolate rt. and
lt. mainstem bronchi)
• Placement of a double lumen ETT specially
designed for selective intubation of the right
or left mainstem bronchi
• Emergency bronchoscopy – cold saline lavage
25. Endobronchial tamponade:
• Balloon catheter is introduced via
bronchoscopy and inflated to occlude the
bronchus(prevents aspiration of blood into
unaffected areas and also stops the bleeding)
• The balloon is left inflated for 24 to 48 hours,
and the patient is then observed for
rebleeding with the balloon deflated for
several hours
26. Bronchial arterial embolization:
• Angiography should be performed initially
• Vessel proximal to bleeding site is cannulated and
material like gelfoam – injected to occlude the
vessel
• Used as a semi-definitive treatment option or a
bridge to elective surgery.
• 85% of the time the bleeding stops after
embolization
• 10-20% of patients rebleed in the following 6-12
months
• Complication: embolization of the spinal artery
27. Other methods to control bleeding:
• Phototherapy
• Electrocautery
• Argon plasma coagulation
• Nd-YAG laser
28. SURGICAL MANAGEMENT
• Done in pts. with uncontrolled life-threatening
hemoptysis or localized disease subject to
recurrent bleeding
• Resection of bleeding lobe or lung maybe done
• Relative contraindications to surgery are: severe
underlying pulmonary disease, active TB, cystic
fibrosis, multiple AVMs, multifocal bronchiectasis,
and diffuse alveolar hemorrhage.
