Bilateral concurrent massive hemoptysis successfully controlled with double endobronchial tamponade. A case report

Massive hemoptysis is a potentially lethal situation for which emergency diagnosis and treatment are necessary. Endobronchial tamponade is widely used as a method for conservative management of massive hemoptysis by occluding the bleeding bronchus with a balloon catheter. Some balloon catheters can be introduced through the inner channel of a flexible bronchoscope. The main challenge in performing this procedure is how to remove the bronchoscope without displacing the catheter. Another technique is to place a catheter next to the fiberoptic bronchoscope and then advance the catheter to the hemorrhaging bronchial division. An advantage of this ''parallel technique'' is that the working channel is available for suction, lavage and for a biopsy forceps, that can be used to facilitate the positioning of the catheter. We used this technique to perform bilateral endobronchial tamponade with two 5 Fr Swan-Ganz catheters. This case shows that bilateral concurrent massive hemoptysis can be successfully controlled with the placement of more than one balloon catheter. This is a rare event and in the literature we found only one reference. The procedure was relatively easy to perform and well tolerated by the patient. In our opinion, this technique should be considered as a viable option in the treatment of massive hemoptysis especially in hospitals or patients where other treatments are impossible or contraindicated.