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Massive Hemoptysis in Cystic Fibrosis

Massive Hemoptysis in Cystic Fibrosis Abstract • Massive hemoptysis occurs in 5% to 7% of patients with cystic fibrosis. Approximately 11% of these patients will die within 48 hours of manifestation because of uncontrolled hemoptysis and asphyxiation. If conservative medical treatment fails to control hemoptysis, fiberoptic or rigid bronchoscopy is the least risky and most accurate method of localizing the source of hemoptysis. Acute control of hemoptysis can be obtained in up to 100% of patients with endobronchial Fogarty balloon tamponade and in up to 88% of patients with bronchial artery embolization. Emergency thoracotomy can be performed if the above fail, but only in patients with mild cystic fibrosis and adequate pulmonary reserve. (Arch Intern Med 1983;143:287-290) References 1. Wood RE, Boat TF, Doershuk CF: Cystic fibrosis. Am Rev Respir Dis 1976;113:833-878. 2. Shwachman H, Redmond A, Khaw KT: Report of 130 patients diagnosed under 3 months of age over a 20-year period. Pediatrics 1970;46:335-343. 3. DiSant' Agnese PA, Davis PB: Cystic fibrosis in adults. Am J Med 1979;66:121-132.Crossref 4. Garzon AA, Cerruti M, Gourin A, et al: Pulmonary resection for massive hemoptysis. Surgery 1970;67:633-638. 5. Gourin A, Garzon AA: Operative treatment of massive hemoptysis. Ann Thorac Surg 1974;18:52-60.Crossref 6. Garzon AA, Gourin A: Surgical management of massive hemoptysis. Ann Surg 1978;187:267-271.Crossref 7. Holsclaw DS, Grand RJ, Shwachman H: Massive hemoptysis in cystic fibrosis. J Pediatr 1970;76:829-838.Crossref 8. Stern RC, Wood RE, Boat TF, et al: Treatment and prognosis of massive hemoptysis in cystic fibrosis. Am Rev Respir Dis 1978;117:825-828. 9. Vawter GF, Shwachman H: Cystic fibrosis in adults: An autopsy study , in Sommers SC, Rosen PR (eds): Pathology Annual Part 2 . New York, Appleton-Century-Crofts, 1979, vol 14, p 359. 10. Liebow AA, Hales MR, Lindskog GE: Enlargement of the bronchial arteries, and their anastamoses with the pulmonary arteries in bronchiectasis. Am J Pathol 1949;25:211-220. 11. Mack JF, Moss AJ, Harper WW, et al: The bronchial arteries in cystic fibrosis. Br J Radiol 1965;38:422-429.Crossref 12. Moss AJ, Desilets DT, Higashimo SM, et al: Intrapulmonary shunts in cystic fibrosis. Pediatrics 1968;41:438-445. 13. Shwachman H, Kulczycki LL: Long-term study of 105 patients with cystic fibrosis. Am J Dis Child 1958;96:6-15.Crossref 14. Pursel SE, Lindskog GE: Hemoptysis: A clinical evaluation of 105 patients examined consecutively on a thoracic surgical service. Am Rev Respir Dis 1961;84:329-336. 15. Smiddy JF, Elliot RC: The evaluation of hemoptysis with fiberoptic bronchoscopy. Chest 1973;64:158-162.Crossref 16. Saw EC, Gottlieb LS, Yokoyama T, et al: Flexible fiberoptic bronchoscopy and endobronchial tamponade in the management of massive hemoptysis. Chest 1976;70:589-591.Crossref 17. Swersky RB, Chang JB, Wisoff BG, et al: Endobronchial balloon tamponade of hemoptysis in patients with cystic fibrosis. Ann Thorac Surg 1979;27:262-264.Crossref 18. Fellows KE, Stigol L, Shuster S, et al: Selective bronchial angiography in patients with cystic fibrosis and massive hemoptysis. Radiology 1975;114:551-556.Crossref 19. Fellows KE, Khaw KT, Schuster S, et al: Bronchial artery embolization in cystic fibrosis: Technique and long-term results. J Pediatr 1979; 95:959-963.Crossref 20. Shuster SR, Fellows KE: Management of major hemoptysis in patients with cystic fibrosis. J Pediatr Surg 1977;12:889-896.Crossref 21. Gottlieb LS, Hillberg R: Endobronchial tamponade therapy for intractable hemoptysis. Chest 1975;67:482-483.Crossref 22. Wholey MH, Charnorro HA, Rao G, et al: Bronchial artery embolization for massive hemoptysis. JAMA 1976;236:2501-2504.Crossref 23. Rémy J, Arnaud A, Fardon H, et al: Treatment of hemoptysis by embolization of bronchial arteries. Radiology 1977;122:33-37.Crossref 24. Bookstein JJ, Moser KM, Kalafer ME, et al: The role of bronchial arteriography and therapeutic embolization. Chest 1977;72:658-661.Crossref 25. MacErlean DP, Gray BJ, Fitzgerald MX: Bronchial artery embolization in the control of massive hemoptysis. Br J Radiol 1979;52:558-561.Crossref 26. Levitsky S, Lapey A, diSant' Agnese PA: Pulmonary resection of life-threatening hemoptysis in cystic fibrosis. JAMA 1970;213:125-127.Crossref 27. Mearns M: Simple tests of ventilatory capacity in children with cystic fibrosis. Arch Dis Child 1968;43:528-539.Crossref 28. Godfrey S, Mearns M: Pulmonary function and response to exercise in cystic fibrosis. Arch Dis Child 1971;46:144-151.Crossref 29. Beier F, Renzetti A, Mitchell M, et al: Pulmonary pathophysiology in cystic fibrosis. Am Rev Respir Dis 1966;94:430-440. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1983 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1983.00350020113021
Publisher site
See Article on Publisher Site

Abstract

Abstract • Massive hemoptysis occurs in 5% to 7% of patients with cystic fibrosis. Approximately 11% of these patients will die within 48 hours of manifestation because of uncontrolled hemoptysis and asphyxiation. If conservative medical treatment fails to control hemoptysis, fiberoptic or rigid bronchoscopy is the least risky and most accurate method of localizing the source of hemoptysis. Acute control of hemoptysis can be obtained in up to 100% of patients with endobronchial Fogarty balloon tamponade and in up to 88% of patients with bronchial artery embolization. Emergency thoracotomy can be performed if the above fail, but only in patients with mild cystic fibrosis and adequate pulmonary reserve. (Arch Intern Med 1983;143:287-290) References 1. Wood RE, Boat TF, Doershuk CF: Cystic fibrosis. Am Rev Respir Dis 1976;113:833-878. 2. Shwachman H, Redmond A, Khaw KT: Report of 130 patients diagnosed under 3 months of age over a 20-year period. Pediatrics 1970;46:335-343. 3. DiSant' Agnese PA, Davis PB: Cystic fibrosis in adults. Am J Med 1979;66:121-132.Crossref 4. Garzon AA, Cerruti M, Gourin A, et al: Pulmonary resection for massive hemoptysis. Surgery 1970;67:633-638. 5. Gourin A, Garzon AA: Operative treatment of massive hemoptysis. Ann Thorac Surg 1974;18:52-60.Crossref 6. Garzon AA, Gourin A: Surgical management of massive hemoptysis. Ann Surg 1978;187:267-271.Crossref 7. Holsclaw DS, Grand RJ, Shwachman H: Massive hemoptysis in cystic fibrosis. J Pediatr 1970;76:829-838.Crossref 8. Stern RC, Wood RE, Boat TF, et al: Treatment and prognosis of massive hemoptysis in cystic fibrosis. Am Rev Respir Dis 1978;117:825-828. 9. Vawter GF, Shwachman H: Cystic fibrosis in adults: An autopsy study , in Sommers SC, Rosen PR (eds): Pathology Annual Part 2 . New York, Appleton-Century-Crofts, 1979, vol 14, p 359. 10. Liebow AA, Hales MR, Lindskog GE: Enlargement of the bronchial arteries, and their anastamoses with the pulmonary arteries in bronchiectasis. Am J Pathol 1949;25:211-220. 11. Mack JF, Moss AJ, Harper WW, et al: The bronchial arteries in cystic fibrosis. Br J Radiol 1965;38:422-429.Crossref 12. Moss AJ, Desilets DT, Higashimo SM, et al: Intrapulmonary shunts in cystic fibrosis. Pediatrics 1968;41:438-445. 13. Shwachman H, Kulczycki LL: Long-term study of 105 patients with cystic fibrosis. Am J Dis Child 1958;96:6-15.Crossref 14. Pursel SE, Lindskog GE: Hemoptysis: A clinical evaluation of 105 patients examined consecutively on a thoracic surgical service. Am Rev Respir Dis 1961;84:329-336. 15. Smiddy JF, Elliot RC: The evaluation of hemoptysis with fiberoptic bronchoscopy. Chest 1973;64:158-162.Crossref 16. Saw EC, Gottlieb LS, Yokoyama T, et al: Flexible fiberoptic bronchoscopy and endobronchial tamponade in the management of massive hemoptysis. Chest 1976;70:589-591.Crossref 17. Swersky RB, Chang JB, Wisoff BG, et al: Endobronchial balloon tamponade of hemoptysis in patients with cystic fibrosis. Ann Thorac Surg 1979;27:262-264.Crossref 18. Fellows KE, Stigol L, Shuster S, et al: Selective bronchial angiography in patients with cystic fibrosis and massive hemoptysis. Radiology 1975;114:551-556.Crossref 19. Fellows KE, Khaw KT, Schuster S, et al: Bronchial artery embolization in cystic fibrosis: Technique and long-term results. J Pediatr 1979; 95:959-963.Crossref 20. Shuster SR, Fellows KE: Management of major hemoptysis in patients with cystic fibrosis. J Pediatr Surg 1977;12:889-896.Crossref 21. Gottlieb LS, Hillberg R: Endobronchial tamponade therapy for intractable hemoptysis. Chest 1975;67:482-483.Crossref 22. Wholey MH, Charnorro HA, Rao G, et al: Bronchial artery embolization for massive hemoptysis. JAMA 1976;236:2501-2504.Crossref 23. Rémy J, Arnaud A, Fardon H, et al: Treatment of hemoptysis by embolization of bronchial arteries. Radiology 1977;122:33-37.Crossref 24. Bookstein JJ, Moser KM, Kalafer ME, et al: The role of bronchial arteriography and therapeutic embolization. Chest 1977;72:658-661.Crossref 25. MacErlean DP, Gray BJ, Fitzgerald MX: Bronchial artery embolization in the control of massive hemoptysis. Br J Radiol 1979;52:558-561.Crossref 26. Levitsky S, Lapey A, diSant' Agnese PA: Pulmonary resection of life-threatening hemoptysis in cystic fibrosis. JAMA 1970;213:125-127.Crossref 27. Mearns M: Simple tests of ventilatory capacity in children with cystic fibrosis. Arch Dis Child 1968;43:528-539.Crossref 28. Godfrey S, Mearns M: Pulmonary function and response to exercise in cystic fibrosis. Arch Dis Child 1971;46:144-151.Crossref 29. Beier F, Renzetti A, Mitchell M, et al: Pulmonary pathophysiology in cystic fibrosis. Am Rev Respir Dis 1966;94:430-440.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Feb 1, 1983

References