Approach to Hemoptysis in the Modern Era

Abstract

Hemoptysis is a frequent manifestation of a wide variety of diseases, with mild to life-threatening presentations. The diagnostic workup and the management of severe hemoptysis are often challenging. Advances in endoscopic techniques have led to different new therapeutic approaches. Cold saline, vasoconstrictive and antifibrinolytic agents, oxidized regenerated cellulose, biocompatible glue, laser photocoagulation, argon plasma coagulation, and endobronchial stents and valves are amongst the tools available to the bronchoscopist. In this article, we review the evidence regarding the definition, etiology, diagnostic modalities, and treatment of severe hemoptysis in the modern era with emphasis on bronchoscopic techniques.

Figure 1

(a) Double-lumen tube. (b) Endobronchial blocker in the left mainstem bronchus.

Figure 2

Endobronchial blockers. (a) Head of endotracheal tubes for Arndt tube on the left and Fuji blocker on the right. (A) BB port, (B) bronchoscope port, (C) ventilator port, D) Three-way connector adaptor for endotracheal tube, and (E) connector to the endotracheal tube. (b) Arndt BB (Cook Medical, Bloomington, IN, USA) with a loop at the distal end. (c) Cohen BB (Cook Medical, Bloomington, IN, USA) with a wheel to deflect the distal tip. (d) Fuji BB (Fuji, Tokyo, Japan) with a distal curve to allow positioning guidance with rotation of the proximal end.