Transcatheter Bronchial Artery Embolization in the Multimodality Management of Massive Hemoptysis: Discussion (1)
The clinical entity of massive hemoptysis has been reviewed in several monographs in the recent medical and surgical literature. Mortality in patients with this problem has ranged from 50 to 100 percent. The majority of cases of massive hemoptysis are due to nonmalignant conditions, including tuberculosis, bronchiectasis, lung abscess, fungal infection, arteriovenous malformations, and others. Malignant neoplasms account for less than 10 percent of cases in most series. In the case presented, the submucosal vessel that was the presumed source of bleeding may have arisen as a result of prior radiation therapy, as has been suggested in a similar recent case report.
These patients require a multimodality approach to save life and preserve function. Early bronchoscopy is essential for localization and control of hemorrhage. In the face of ongoing bleeding, the rigid bronchoscope offers the most effective means of suctioning and allows the use of temporizing measures such as saline solution irrigation and bron-chial-blocking balloons. birth control pills
Transcatheter bronchial artery embolization is a relatively recent addition to the modalities for treating massive hemoptysis. Since Wholey et al first reported the technique in 1976, other authors have accumulated experience with substantial series of patients. * Because there is segmental spinal cord blood supply near, a detailed knowledge of bronchial artery anatomy is essential to minimize neurologic complications.