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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, utilizing local Interventional Pulmonology experts and resources if available.

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

  • Surgery is required in rare circumstances.


Hemoptysis, or the expectoration of blood, can result from a wide variety of illnesses (Table 59-1). 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

TABLE 59-1Causes of Massive Hemoptysis and Pulmonary Hemorrhage

Massive hemoptysis has been variably defined as production of more than 100 to 1000 mL of blood in 24 hours, depending on the study.3,4 However, estimating the amount ...

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