INTERVENTIONAL PULMONOLOGY IN OTHER JOURNALS: Commentary on Selected Publications
Utility of fiberoptic bronchoscopy before bronchial artery embolization for massive hemoptysis.
AJR Am J Roentgenol 2001;177:861–7. Hsiao EI, Kirsch CM, Kagawa FT, Wehner JH, Jensen WA, Baxter RB. Division of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, Stanford, California, U.S.A.
This retrospective study investigated the utility of performing flexible bronchoscopy (FFB) before bronchial artery embolization in patients with massive hemoptysis. The study design included a retrospective review of all patients with hemoptysis who had presented at either of two local hospitals—one county hospital and one community hospital—between 1988 and 2000, and who had undergone FFB before bronchial arteriography. All data were abstracted using a standardized coding form, and radiographs were reviewed independently by two of the authors. The results showed that 28 patients meeting the inclusion criteria were identified, and the group consisted of 19 men and 9 women with an average age of 54.6 years. The clinically determined causes of hemoptysis were tuberculous bronchiectasis (n = 14, 50%); bronchogenic carcinoma (n = 4, 14.3%); active tuberculosis (n = 2, 7.1%); nontuberculous bronchiectasis (n = 2, 7.1%); active coccidioidomycosis, pancreaticobronchial fistula, arteriovenous malformation, and tetralogy of Fallot (n =1 each, 3.6% each); and unknown cause (n = 2, 7.1%). The bleeding site determined through FFB was consistent with that determined through radiographs in 23 patients (82.1%). All had either unilateral disease (n = 15), bilateral disease with unilateral cavities (n = 5), or a preponderance of disease on one side (n = 3). Bronchoscopy was an essential tool in determining the bleeding site in only three patients (10.7%), all of whom had bronchiectasis without localizing features visible on chest radiographs. In the remaining two patients (7.1%), bronchoscopic findings were indeterminate, but radiographs were helpful. The authors conclude that FFB before bronchial artery embolization is unnecessary in patients with hemoptysis of known cause if the site of bleeding can be determined from radiographs and no bronchoscopic airway management is needed. The results and conclusions of this study notwithstanding, one must recognize the fact that hemoptysis can have more than one etiology and site of origin, and that bronchoscopy may help determine these. Furthermore, in patients with bilateral lesions, either side or both sides can contribute to the hemoptysis. Again, bronchoscopy will help localize the side of bleeding. As the authors conclude, bronchoscopy may the first step in the management process when hemoptysis is massive and bronchial artery embolization is being arranged.