[Pulmonary hemorrhages of different etiology: diagnosis and treatment]

Hemorrhage is one of the most pressing problems in lung diseases. The paper analyzes the results of medical and surgical treatments for pulmonary hemorrhages. A total of 724 patients with hemoptysis and bleedings of various etiology were treated at the Thoracic Unit in 1985-2003. Pulmonary hemorrhages occurred in 442 (61%) patients with pulmonary tuberculosis and in 282 (39%) patients with nonspecific lung diseases. X-ray study revealed right-sided lung lesions in 268 (37%) patients; left-sided lung lesions in 203 (28%), bilateral lesions in 170 (23.5%). The visible X-ray changes were not found in 83 (11.5%) patients. Destructive pulmonary parenchymal changes were detected in 366 (50.5%) patients. Bronchological study was conducted in 703 patients with pulmonary hemorrhage: 377 (53.7%) and 214 (30.4%) patients were found to have its direct and indirect signs, respectively. Neither changes nor hemorrhagic traces were detected in 112 (15.9%) patients since they underwent bronchoscopy in a later period when bleeding had already stopped. Foam rubber sponge tamponade of the main and lobar bronchi was made in 75 (10.4%) patients with profuse bleeding; a positive effect was achieved in 61 (81.3%) patients. The treatment policy for pulmonary hemorrhage is determined by its severity and etiology and the health status of the patient. A major role was assigned to medical hemostatic therapy in the treatment of pulmonary hemorrhages. If it was ineffective, surgical treatment was used. The use of hypotension controlled by ganglionic blockers (more commonly pentamine): bleedings were suppressed in 359 (74%) of 485 patients with second- and third-degree hemorrhages yielded good results. They were medically stopped in 558 (77%) patients; death occurred in 14 (2.4%) cases. A hundred and fifty two (20.9%) were operated on; of them 8 patients underwent segmentectomy; 85 had lobectomy. Pulmonectomy, cavernostomy, and thoracoplasty were performed in 48, 4, and 7 patients, respectively. Twenty-six patients were operated on at the peak of hemorrhage. Bleedings were suppressed in 140 (92%) patients (they recovered; 12 (7.9%) patients died. In the postoperative period different complications were noted in 30 (19.7%) patients. The final results of medical and surgical treatment were as follows: bleedings were stopped in 698 (96.4%) patients (they recovered) and 26 (3.6%) died.