Manifestations of hemoptysis. How to manage minor, moderate, and massive bleeding.

Hemoptysis is a frightening symptom for patients and often is a manifestation of significant underlying disease. The chest radiograph, history and examination findings, comorbid illnesses, and demographic factors guide evaluation of patients with minor hemoptysis. Massive hemoptysis occurs in less than 5% of patients with hemoptysis and is almost always due to serious pulmonary or systemic illness. Massive hemoptysis is a life-threatening event that requires ICU admission and urgent bronchoscopic evaluation for lateralization or localization of the bleeding site. Management should be individualized and requires prompt consultation with appropriate cardiothoracic surgery, pulmonary medicine, anesthesia, and interventional radiology staff. The availability of endobronchial techniques and bronchial arterial embolization has enhanced our ability to control massive bleeding short-term and decreased the need for emergency surgical treatment. Massive hemoptysis may recur without warning. Prompt workup and treatment are required for all patients.