What is hemoptysis?

The term hemoptysis means coughing blood. This means that the blood has originated from the airway or lung. It is a clinical presentation rather than a diagnosis. Hemoptysis may indicate  serious underlying medical conditions. Massive hemoptysis is defined as coughing blood of more than 300 ml in 24 hours. Another simple definition of massive hemoptysis is when the clinical condition of the patient is unstable.

How can hemoptysis be detected?

Hemoptysis is a clinical presentation (symptom). It is detected clinically. Other parameters such as blood pressure, pulse, O2 saturation should be monitored to exclude clinical compromise. Thorough medical background check up is required to detect any possible underlying cause of this presentation, such as prior infection, recent trauma, coagulopathy or connective tissue disease. Laboratory work up is needed to monitor the hemoglobin level.

What are the risks associated with this procedure?

Interventional radiology procedures are minimally invasive procedures with essentially no surgical wound complications. Embolizing the bronchial artery for acute haemoptysis is generally safe. One of the major precautions is to avoid blockingthe spinal arteries. These  arteries are bypassed during the procedure thus are not affected. Other complications associated with this procedure are similar to any other interventional procedure.

What to expect from embolizing procedures?

Embolization for acute hemoptysis is a temporary treatment. It helps to stop the acute episode of bleeding; hence, bypassing the acute phase. However, as the blood supply to the lung parenchyma is rich, multiple collaterals might develop in a later stage. These patient would  require frequent follow up by the pulmonologist and interventional radiologist to control the underlying cause of haemoptysis.

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.

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