American Review of Respiratory Medicine - Volumen 23, Número 3 - September 2023

Editorials

Diagnostic Approach and Treatment of Hemoptysis: Advances and Clinical Considerations

Abordaje diagnóstico y tratamiento de la hemoptisis: avances y consideraciones clínicas

Hemoptysis, defined as the expectoration of blood originating from the tracheobronchial tree, represents a significant clinical and diagnostic challenge. A recent scientific article examined the demographic, clinical, diagnostic, and therapeutic characteristics of patients with hemoptysis at a tertiary care level hospital in Mexico City.^1-4

The retrospective study included 34 patients diagnosed with hemoptysis between January 2014 and December 2016. Data were obtained from clinical records, revealing a mean age of 52 years, predominantly men. Tuberculosis was the leading cause of hemoptysis, followed by neoplasms and arteriovenous malformations.

It is important to note that approximately 95% of cases of hemoptysis resolve spontaneously.^2,3,5,7 However, comprehensive management is essential to ensure a permeable airway and determine the optimal treatment according to the etiology and type of hemoptysis.

The chest X-ray is the first study to be per­formed during the initial approach, even though its low sensitivity suggests the need to use more sensitive techniques, such as computed angioto­mography.^1,5,6 The latter provides a more precise image of the anatomy and location of the bleeding.

In cases of massive and recurrent hemoptysis, bronchial artery embolization has become the treatment of choice. This minimally invasive endovascular technique has shown a success rate of more than 80% in the first episode. However, there is a recurrence rate ranging from 10% to 55%, which may require surgical intervention as a last resort.

The scientific article highlights the impor­tance of a multidisciplinary approach in the management of hemoptysis. Each patient shall be evaluated individually to determine the underlying cause and apply the most appropriate treatment. In addition, the article highlights the need for close surveillance, especially in patients with recurrent hemoptysis, in order to provide additional interventions when nec­essary.

In conclusion, this retrospective study provides valuable information on the demographics, clinical symptoms, diagnosis and treatment of hemoptysis in a tertiary care hospital in Mexico City. These findings reinforce the need for a comprehensive and multidisciplinary approach to ensure optimal medical care and improve clinical outcomes in patients with this condition.

REFERENCES

1. Cordovilla R, Bollo de Miguel E, Nunez Ares A, Cosano Povedrano Fj, Herraez Ortega I, Jimenez Merchan R. Diagnosis and treatment of Hemoptysis. Arch Bronco­neumol.2016;52:368-77. https://doi.org/10.1016/j.ar­bres.2015.12.002

2. Ittrich H, Bockhorn M, Klose H, Simon M. The Diagnosis and Treatment of Hemoptysis. Dtsch Arztebl Int. 2017;114:371- 81. https://doi.org/10.3238/arztebl.2017.0371

3. Larici AR, Franchi P, Occhipinti M, et al. Diagnosis and management of hemoptysis. Diagnostic and Interventional Radiology (Ankara, Turkey). 2014;20:299-309. https://doi.org/10.5152/dir.2014.13426

4. Kang MJ, Kim JH, Kim YK, et al. 2018 Korean Clinical Imaging Guideline for Hemoptysis. Korean J Radiol. 2018;19:866-71. https://doi.org/10.3348/kjr.2018.19.5.866

5. Radchenko C, Alraiyes AH, Shojaee S. A systematic ap­proach to the management of massive hemoptysis. J Thorac Dis. 2017;9(Suppl 10):S1069-s86. https://doi.org/10.21037/jtd.2017.06.41

6. Lu MS, Liu HP, Yeh CH, et al. The role of surgery in he­moptysis caused by thoracic actinomycosis; a forgotten disease. Eur J Cardiothorac Surg. 2003;24:694-8. https://doi.org/10.1016/S1010-7940(03)00515-3

7. Cody O’Dell M, Gill AE, Hawkins CM. Bronchial Artery Embolization for the Treatment of Acute Hemoptysis. Tech Vasc Interv Radiol. 2017;20:263-5. https://doi.org/10.1053/j.tvir.2017.10.006

8. Yun JS, Song SY, Na KJ, Kim S, Jang K-H, Jeong IS, et al. Surgery for hemoptysis in patients with lung disease. J Thorac Dis. 2018;10:3532. https://doi.org/10.21037/jtd.2018.05.122