• Tuberculosis and Respiratory Diseases
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• v.42 no.1
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• pp.50-57
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• 1995

Background: Transcather arterial embolization has been established as an effective means to control hemoptysis, especially in patients with decreased pulmonary function such as postpneumonectomy patients and those with advanced chronic obstructive pulmonary disease. We evaluated the effect of arterial embolization and analysed the correlation of the clinical and angiographic characteristics and investigated the clinical course and outcome after arterial embolization in the patients with significant hemoptysis. Method: 58 patients with massive or recurrent hemoptysis underwent transcatheter arterial embolization for the treatment of hemoptysis from April 1992 to Sept. 1993. Results: Most common cause of hemoptysis was pulmonary tuberculosis(34 cases, 58.3%). Embolized vessels responsible for hemoptysis were 56 bronchial arteries and 32 nonbronchial systemic arteries. Initial most common angiographic findings were hypervascularity and shunt. Initial success rate of hemoptysis control revealed 81.1%. However, 15 of 58 patients(25.9%) showed recurrence of hemoptysis after transcatheter arterial embolization. The complications(18 cases, 31%) such as chest pain, fever, voiding difficulty, atelectasis, paralytic ileus and unwanted embolization were occured. Conclusion: Transcatheter arterial embolization is useful and relatively safe treatment modality for immediate bleeding control of patients with massive hemoptysis or inoperable cases. The further evaluation of the long term results according to the embolized material and underlying pulmonary disease will be required.

• Journal of Chest Surgery
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• v.47 no.6
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• pp.566-568
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• 2014

A 51-year-old woman visited our hospital with massive hemoptysis. She had suffered from recurrent hemoptysis for five years and had undergone bronchial artery embolization many times. The patient had a history of pulmonary tuberculosis and bronchiectasis. Chest radiography showed consolidation around the nodule in the lateral basal segment of the right lower lobe. We successfully performed a right lower lobectomy. The histological study of the resected specimen showed a vegetable foreign body and clumps of Actinomyces, indicating actinomycosis, which was suggested to be the cause of the hemoptysis. This was a very rare case of hemoptysis caused by a vegetable foreign body and actinomycosis.

• Tuberculosis and Respiratory Diseases
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• v.60 no.1
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• pp.65-71
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• 2006

Background : Hemoptysis, when massive and untreated, has a mortality rate of over 50 percents, is considered as one of most dreaded of all respiratory emergencies and can have a variety of underlying causes. Bronchial artery embolization (BAE) has become an established procedure in the management of massive and recurrent hemoptysis, and its efficacy is widely documented thereafter by number of articles. However, the long-term success rate of BAE is known to be unfavorable. Risk factors influencing that control failure are inevitably needed. Materials and methods : Seventy-five patients underwent bronchial artery embolization due to massive hemoptysis in Severance Hospital from Jan. 2000 to Jan. 2005. Nine patients' data were not available and could not be contacted with. Finally 66 patients' (48 males, 18 females) medical records were analyzed retrospectively during a mean follow up period of 20.4 months (ranging from 1 month to 54 months). Results : Among 66 patients whose data were available, 23(34.9%) patients had recurrent major hemoptysis. Patients' age, sex, underlying disease, previous intervention history, and number of feeding vessels had no statistical validity as risk factors of recurred major hemoptysis. But bilaterality of lesion, amount of hemoptysis, and pleural thickening were revealed as meaningful factors for predicting relapse (p = 0.008, 0.018, and 0.001, respectively). Conclusion : According to our series, patients presenting with larger amount of hemoptysis, pleural thickening of chest radiography and bilateral lesion are associated with increased risk of major hemoptysis in patients treated with BAE.

• Tuberculosis and Respiratory Diseases
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• v.44 no.3
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• pp.629-638
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• 1997

Background : Surgical intervention is known as the principle management for hemoptysis of significant amount. But surgical procedure is applicable to only small number of patients because of increased mortality in emergency surgery and various functional and structural problems after lung resection. Bronchial artery embolization(BAE) has been used as an alternative interventional technique for immediate control of patients with increased risk for surgery due to recurrent or massive hemoptysis. BAE also has limitations such as recurrent bleeding after procedure and its role for the application to small amount of hemoptysis is still not established. Method : To evaluate immediate and long term effectiveness of BAE, we analysed 65 patients with hemoptysis according to therapeutic modalities they received ; BAE versus conservative management. Results : The success rate for immediate control of hemoptysis was significantly higher in BAE group with 43 cases(100%) among 43 cases compared with 17 cases(77%) among 22 cases in conservative group (p < 0.001). The disease control duration was $19.5{\pm}8.06$ months in BAE group and $18.8{\pm}6.06$ months in conservative group(p > 0.05). The therapeutic response in BAE group was 82%(36/43 cases) and 95%(21/22 cases) in conservative group (p > 0.05). According to the amount of hemoptysis, the therapeutic response were seen in 91%(29/32 cases) in less than 100ml and 85%(28/33 cases) in 100~400ml (p > 0.05). According to the manifestation of hemoptysis, the therapeutic response in groups of recurrent and nonrecurent were 87%(20/23 cases) and 88%(37/42 cases)(p > 0.05). Conclusion : The difference of therapeutic response between BAE and conservative group in patients with small amounts of hemoptysis was not found except for immediate control of hemoptysis.

• Tuberculosis and Respiratory Diseases
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• v.59 no.1
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• pp.104-108
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• 2005

A broncholith is a calcified mediastinal lymph node, which partially or completely erodes into the bronchial lumen, and is related to the late tissue response to healing of granulomatous pulmonary infections, most commonly histoplasmosis or tuberculosis. However, there have been a few reports on broncholithiasis caused by Aspergillus. We experienced a case of broncholithiasis caused by Aspergillus, with broncho-obstructive pneumonia and massive hemoptysis. A 39 year-old woman was admitted to our hospital with right middle lobar pneumonia. On the fourth day following admission, massive hemoptysis developed, so an emergent bronchial artery embolization was performed. On the ninth day following admission, a broncholith on the lateral segmental bronchus of the right middle lobe was found by bronchoscopy, which was proved to be Aspergillus hypae with calcification on histological examination. After the simple bronchoscopic removal of the broncholith and empirical antibiotic therapy, the patient recovered without any complications.

• Tuberculosis and Respiratory Diseases
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• v.56 no.1
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• pp.85-90
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• 2004

A 69 year-old female was admitted to the hospital due to intermittent hemoptysis for 1 month. Emergent bronchoscopy revealed mass-like lesion almost completely obstructing right intermediate bronchus with multiple hemorrhagic spots. Bronchial arterial angiography was performed but failed to find out actively bleeding vessel. Spiral computerized tomography of the chest showed contrast enhanced bulging of the posterior portion of right main bronchus into the lumen of right intermediate bronchus suggesting Rasmussen aneurysm. The AFB smear of bronchial washing fluid was positive. Pulmonary arterial angiography and embolization were not performed due to improvement of clinical course with medical conservative care. Here we report a case of endobronchial mass-like Rasmussen aneurysm grossly suspected by bronchoscopy and diagnosed by spiral CT, which successfully managed by medical conservative care with antituberculous agents.

• Journal of Chest Surgery
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• v.38 no.1 s.246
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• pp.72-75
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• 2005

A bronchopleural fistula after pulmonary resection is still showing high mortality and morbidity despite of advancing of treatment. Several treatment options have been developed including surgical treatment. In 1990, endobronchial closure using vascular occluding coils was introduced. These coils can occlude a bronchial air-leakage by mechani­cal obstruction as well as inducing fibrosis. We report, herein, the experience using a vascular occluding coils in treating postoperative bronchopleural fistula.

• Journal of Chest Surgery
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• v.37 no.8
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• pp.711-714
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• 2004

We report a case of mature cystic teratoma of the anterior mediastinum that ruptured into the pulmonary artery requiring an emergent surgical treatment. A 39-year-old woman presented an episode of massive hemoptysis and treated with bronchial artery embolization (BAE). On the 10th day after BAE, however, she developed sudden massive hemoptysis and had a deteriorated mental status. For a definitive treatment, she underwent the left pneumonectomy and the tumor resection in the anterior mediastinum. On histologic examination, the tumor disclosed cystic structures composed of mature squamous epithelium, pilosebaceous glands, mature fat tissue, cartilage and bone tissue. Also, there was intrapulmonary hemorrhage due to left pulmonary artery invasion of the tumor.

• Tuberculosis and Respiratory Diseases
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• v.72 no.1
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• pp.68-71
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• 2012

Untreated massive hemoptysis, especially in patients with tuberculous-destroyed lung, is a serious complication resulting in considerable morbidity and mortality. We report a case of a patient who had active tuberculosis and a destroyed left lung with massive bleeding. He was transferred to our clinic with intubation of a right-sided Robertshaw double lumen tube and right upper lobe collapse likely due to tube malposition that was presented on chest X-ray. Because hemoptysis had persisted after bronchial arterial embolizaton, we replaced the double lumen tube with a conventional endotracheal tube and inserted an endobronchial blocker into the left main bronchus through an endotracheal tube guided by bronchoscopy to prevent aspiration of blood into the right lung. Left pneumonectomy was performed and hemotpysis was ceased. We suggest that the use of an endobronchial blocker followed by surgery may be a safe and effective modality of treatment in patients with persistent bleeding after bronchial arterial embolization.

• Tuberculosis and Respiratory Diseases
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• v.39 no.2
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• pp.180-185
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• 1992

The most common symptom associated with an pulmonary aspergilloma is hemoptysis, with estimates of frequency ranging from 50 to 85 percent of patients. Hemoptysis may be infrequent and minimal in amount or it may be severe with a fatal outcome. The major options available for the treatment of pulmonary aspergilloma include sugical resection of the lesion, a number of medical therapies, or simple observation of the patient for a time. Surgery is the treatment of choice but it is not feasible in some patients who have diffuse or advanced pulmonary disease that makes them poor candidates for thoracotomy. As an alternative to it, some categories of therapy including bronchial artery embolization and parenteral or endobronchial administration of antifungal drugs were tried without remarkable success. But percutaneous instillation of intracavitary amphotericin B for symptomatic aspergilloma has been reported with better result. The authors present a case of percutaneous intracavitary instillation of amphotericin B for the treatment of pulmonary aspergilloma and its successful result for the repetitive hemoptysis.