Management of Massive Hemoptysis in Patient with Bronchogenic Carcinoma

Bronchogenic carcinoma is one of the most causes of hemoptysis. Hemoptysis occurs inapproximately 20% of lung cancer patients at some point during their disease course, with massiveepisodes developing as the terminal event in 3% cases. Reported mortality rates for massivehemoptysis range from 9% to 38% with highest mortality rate in patients with advanced carcinoma.Risk factors for hemoptysis in patients with bronchogenic carcinoma including a variety ofcoagulopathies (uremia), medications ( clopidogrol, bevacizumab), bronchoscopic findings such ashypervascularization or aberrant vessels or submucosal arterioles, tumoral invasion to mediastinalstructures with bronchoarterial fistula formation, brachytherapy, or external beam radiation therapy.Of course, hemoptysis may caused by granulation tissue overgrowth and erosion of bronchialmucosa from indwelling metal, hybrid, and silicone airway stent.The goals of treating massive hemoptysis are to establish and maintain an open airway toavoid severe hypoxia and asphyxiation, bronchoscopic interventions to stop the bleeding, and alsoprevent and treat respiratory, cardiac, and hemodynamic complications.Bronchoscopic treatment options for hemoptysis in patients with bronchogenic carcinoma includeof probe elctrocuatery, argon plasma coagulation, laser photocoagulation, cryotherapy, airway stentinsertion via flexible or rigid bronchoscope. Non-brochoscopic interventions including bronchialartery embolization, or surgical resection.I present a 59-year-old man who had been diagnosed with stage IV lung squamous cellcarcinoma with brain metastasis admitted with respiratory distress and massive hemoptysis. He hada history of COPD and automated implantable cardiovertor/defibrillator. Chest radiography showedatelectasis of the left lower lobe and lingual.The aim of this presentation is discussion about a variety of treatment modalities formanagement of massive hemoptysis in patients with bronchogenic carcinoma.