Massive hemoptysis of pulmonary arterial origin: diagnosis and treatment.

Among 189 patients treated for massive or repeated hemoptysis by transcatheter techniques between 1973 and 1983, a prospective study was attempted between 1979 and 1983 (72 patients) to search for bleeding of pulmonary arterial origin. Among these 72 patients, six were treated by surgical (one) or angiographic (five) occlusion of segmental pulmonary arteries. Pulmonary erosive pseudoaneurysms were seen in five cases (one with intracavitary aspergilloma, two with cavitary tuberculosis, and two with pyogenic abscesses). Among these six cases, one patient died from massive hemoptysis, one from unknown causes, and four are still alive. They are compared with five other patients who died from massive hemoptysis among 117 patients treated only by embolization of their systemic arteries between 1973 and 1979 (one with cavitary tuberculosis, two with intracavitary aspergillomas, one with an abscess of the lung, and one with a necrotic hilar cancer). A pulmonary arterial source of bleeding should be considered in addition to systemic arterial sources in the setting of destructive lung disease.