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KEY POINTS

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  • Ensure proper oxygenation and secure the patient’s airway if necessary.

  • Correct coagulation abnormalities.

  • Localize bleeding with bronchoscopy (unstable patient) or CT scan (stable patient) and position the bleeding site in a dependent position.

  • In unstable, hypoxemic patients consider urgent bronchoscopy for suctioning, endobronchial hemostatic therapy and balloon tamponade.

  • Interventional radiology-guided bronchial artery embolization is effective and should be performed after initial stabilization.

  • Surgery is required in rare circumstances.

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INTRODUCTION

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Hemoptysis, or the expectoration of blood, can result from a wide variety of illnesses (Table 57-1). The prevalence of these different etiologies depends on the characteristics of the specific patient population studied. For example, tuberculosis is the most common cause of hemoptysis in underdeveloped countries while bronchiectasis is the most common cause in the industrialized world.1-2

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TABLE 57-1

Causes of Massive Hemoptysis and Pulmonary Hemorrhage

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Massive hemoptysis has been variably defined as production of more than 300 to 600 mL of blood in 12 to 24 hours, depending on the study. However, estimating the amount of hemoptysis is unreliable and has very little clinical utility. Accordingly, a “magnitude-of-effect” is the preferred clinical approach3 as it uses the clinical consequences of hemoptysis such as airway obstruction, hypoxemia, hemodynamic instability and underlying cardiopulmonary abnormalities to guide treatment and triage decisions. As an example of this principle, patients with diffuse ...

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