How can acute hemoptysis be managed?
Massive hemoptysis is a serious presentation.
If the patient is clinically stable, a team of emergency physicians and pulmonologists are required to diagnose and manage such cases. Laboratory work up and radiological studies, such as a Chest X-ray and Chest Computerized Tomography will be ordered. Direct visualization of the large airways by bronchoscopy is usually done by the pulmonologists. If the source of the bleeding cannot be identified or treated by bronchoscopy then an interventional radiologist would be consulted to perform Bronchial artery embolization. In which, from a small incision in the thigh, an interventional radiologist would advance catheters and guidewires to the bleeding bronchial artery branch and block that vessel.
If the patient is unstable, a team of emergency physicians, pulmonologists and intensivists are required to stabilize the patient, reach the diagnose and provide supportive measures. Once stabilized, the management would be similar to the above mentioned algorithm.
What is an embolization procedure?
Embolization procedures are one of the major techniques in the armamentarium of interventional radiology. They are common and are essential procedures. Using a minimally invasive approach, an artery or a vein can be blocked using different kinds of liquid or solid materials. Some of the applications of these procedures are to stop bleeding, treat congenital vascular malformations or aneurysms , stop tumor growth in the liver,treat uterine fibroids, etc.
How is an embolization procedure performed?
After deciding to perform an embolization by the managing medical team, an interventional radiologist will approach the patient to explain the procedure, benefits and risks*. A written consent is obtained*. The patient will be shifted to an interventional radiology suite. Under sterile conditions and local anesthesia*, a femoral or radial vascular access is performed. Using this access, catheters and wires are advanced till reaching the source of bleeding which wold be stopped by applying embolizing material. The embolization material to be used will be decided by the interventional radiologist performing the case and he/she might as well discuss it with the patient.
*in certain conditions, the patient might be intubated and unconscious, the procedure explanation, the written consent will be explained to his/her next of ken. It will be performed under general anaesthesia or conscious sedation.