Massive Hemoptysis: Diagnostic Approach, Risk Factors and Outcome in Six Years Experience

Massive hemoptysis is defined as hemoptysis exceeding 100 ml over a 24 hour period. It is often a sign of an important underlying disease that may be life-threatening due to asphyxiation.
The present retrospective study consisted of 126 consecutive patients who had been referred to Dr. Masih Daneshvari Hospital because of massive hemoptysis from lower airways during 6 years.
Mean volume of hemoptysis was 228.7±132 ml. Etiology of hemoptysis were tuberculosis (n=31, 25%), bronchiectasis and chronic bronchitis (n=40, 31.7%), hydatid cyst (n=8, 6.3%), lung cancer (n=8, 63%), pulmonary hypertension (n=8, 63%), anthracosis (n=7, 5.5%), pneumonia (n=5, 3.9%), unknown (n=19, 15%). Bleeding is ceased in 86 (68%) patients with cold saline and adrenaline (1/10000) during rigid and fiberoptic bronchoscopy. Embolization had been done in 2 cases in addition to other procedures. Operation was also conducted in 27 patients and mortality was occurred in 13 (10%) patients (7 cases during surgery, 1 case in emergency unit, and 5 cases in ward).
Based on the evidences from this study, bronchiectasis, chronic bronchitis and tuberculosis were the most prevalent cause of massive bleeding in this center. This volume of bleeding (228 ml) can be often controlled by cold saline washing during bronchoscopy. However, this volume of hemoptysis can lead to high mortality rates (10%) and complication during surgery.