How to treat interventional embolization of hemoptysis

  1. Overview of the disease: When the amount of blood coughed up from the respiratory tract exceeds 300 ml/24 hours and is life-threatening, it is called hemoptysis. The most common cause is prolonged pulmonary tuberculosis, followed by bronchiectasis and lung cancer. In addition to hemoptysis, the corresponding symptoms of the underlying disease may also appear, such as low fever, night sweats, weakness, and emaciation in tuberculosis, recurrent respiratory infections, chronic cough and pus sputum in bronchiectasis, and the aforementioned symptoms of lung cancer.  2. Diagnostic points: The diagnosis needs to clarify its etiology and the site of bleeding. Traditional frontal and lateral chest films and bronchography can often meet the diagnostic requirements, and CT and MRI can sometimes provide more information. Fiberoptic bronchoscopy and bronchial arteriography can better define the site of hemorrhage.  3. Treatment options: massive hemoptysis can lead to death due to asphyxia or blood loss, requiring emergency treatment and timely and effective hemostasis; medical hemostatic treatment is less effective, and open-heart surgery (for those with limited lesions) is too risky; simple embolization of the bronchial artery or other corresponding blood supply branches to stop the hemorrhage has been recognized as the safest and most effective treatment, and immediate hemostasis can be obtained in about 90% of cases.  4. Complications and treatment: After embolization of bronchial artery or other corresponding blood supplying branches, fever, chest tightness, burning sensation behind the sternum, intercostal pain, painful swallowing and other symptoms may occur, which are caused by temporary ischemia of mediastinal and intercostal tissues and can be relieved in a few days after symptomatic treatment. In addition to the aforementioned spinal cord injury, serious complications such as intercostal skin necrosis and esophagobronchial fistula due to misplaced embolism can occasionally be seen. The recurrence rate of hemoptysis is 15%-20%, which may be related to the re-vascularization due to the absorption of embolic material (such as gelatin sponge), partial blood supply branch not completely embolized, and the emergence of new traffic branches or new lesions, etc. The original cause and site of bleeding can be clarified by bronchial arteriography review, and the target vessel can be embolized again, which can often be cured.  5. Health care and rehabilitation treatment: After the interventional treatment of bang help through the acute and critical period, the general condition is improved or recovered, and further treatment of the underlying disease is needed.