Free Content Management of life-threatening haemoptysis in an area of high tuberculosis incidence

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Abstract:

BACKGROUND: Emergency admissions with life-threatening haemoptysis in an area of high tuberculosis (TB) incidence at the University of Stellenbosch and Tygerberg Academic Hospital, South Africa. It is unclear if lung resection is regularly indicated to prevent recurrence following bronchial artery embolisation (BAE).

OBJECTIVE: To prospectively evaluate risk factors for recurrence as selection criteria for surgery following embolisation: lack of complete cessation of haemoptysis, need for blood transfusion, presence of aspergilloma and absence of active TB.

DESIGN: Prospective interventional study with 1-year follow-up.

RESULTS: Within a 7-month period, 101 consecutive patients were admitted. Seven were excluded and 12 died shortly after admission. Haemoptysis ceased on medical treatment alone within 24 h in 21 of the remaining 82 patients. Their 1-year mortality was 10%. Eleven of 61 patients referred for emergency embolisation died before discharge. Of the 50 patients remaining at risk of recurrence, 38 (76%) were at low risk and 12 (24%) at high risk. Five of these patients (10% of those at risk) underwent surgery. Patients at low risk and operated patients had an uneventful course over 1 year, but two deaths occurred among the seven inoperable patients at high risk.

CONCLUSION: Lung resection surgery following successful BAE for life-threatening haemoptysis can safely be avoided in patients at low risk of recurrence.

Keywords: aspergilloma; bronchial arterial embolisation; haemoptysis; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Department of Medicine, Tygerberg Academic Hospital and University of Stellenbosch, Cape Town, South Africa 2: Department of Biomedical Sciences, Tygerberg Academic Hospital and University of Stellenbosch, Cape Town, South Africa 3: Department of Radiology, Tygerberg Academic Hospital and University of Stellenbosch, Cape Town, South Africa 4: Department of Surgery, Tygerberg Academic Hospital and University of Stellenbosch, Cape Town, South Africa

Publication date: July 1, 2009

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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