Original Articles
Major and Massive Hemoptysis: Reassessment of Conservative Management

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ABSTRACT

The etiologic factors of major (≥ 200 ml/24 hr) and massive (≥ 1,000 ml/24 hr) hemoptysis may well affect the outcome and, therefore, the treatment of this often life-threatening problem. The decline in the incidence of tuberculosis (TB) and bronchiectasis, along with the increase in bronchitis and neoplasia, have led to a strong institutional bias against operating on patients with major and massive hemoptysis. A retrospective case study and an extensive literature review were undertaken to critically evaluate this policy. Fiftynine consecutive patients with major hemoptysis, 26 of whom had massive hemoptysis, were identified from 887 patients seen in our institution over a 10-year period. Only four of these 59 patients underwent surgery, while 55 were managed conservatively. Etiologic factors, operability, and bleeding rate all appeared to play a major role in outcome. No patients with bronchitis, bronchiectasis, tuberculosis, or who were on anticoagulation therapy died compared to a mortality rate of 59% in patients with carcinoma (CA) of the lung and 71% in patients with leukemia. Eleven percent of operable patients treated conservatively died compared to a 46% mortality rate for nonoperable patients. And, 9% of patients with bleeding rates < 1,000 ml/24 hr died compared to 58% of those with ≥ 1,000 ml/24 hr.

Conservative management appears to have a low mortality in patients with non-tuberculosis-related major hemoptysis as well as in many patients with massive hemoptysis, especially those patients who are operable and those without neoplastic disease.

References (32)

  • J.A. Crocco et al.

    Massive hemoptysis

    Arch Intern Med

    (1968)
  • A.A. Garzon et al.

    Surgical management of massive hemoptysis

    Ann Surg

    (1977)
  • C.T. Yang et al.

    Conservative management of life- threatening hemoptysis

    Mount Sinai J Med

    (1978)
  • I.D. Bobrowitz et al.

    Comparison of medical vs. surgical treatment of major hemoptysis

    Arch Intern Med

    (1983)
  • D.K. Porter et al.

    Massive hemoptysis in cystic fibrosis

    Arch Intern Med

    (1983)
  • R.C. Stern et al.

    Treatment and prognosis of massive hemoptysis in cystic fibrosis

    Am Rev Respir Dis

    (1978)
  • Cited by (0)

    The authors would like to acknowledge Dr. Patrick McKee for his help on this manuscript.

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