[Massive Hemoptysis; Clinical Approach and Surgical Treatment]

Massive hemoptysis is a life-threatening condition which is defined by the American College of Radiology as more than 300-400 ml expectorated hemoptysis in 24 hours. The major causes of massive hemoptysis are benign diseases including tuberculosis, aspergillosis, and pulmonary abscess. Bronchoscopy is mandatory for the initial assessment of hemoptysis and several transbronchial interventions may be performed in some cases. In addition, arteriography is another important modality for hemoptysis especially for the patients with poor general condition that have contraindications for surgery. Because of the progression of interventional vascular approach such as bronchial artery embolization (BAE), the number of patients who require emergency lung resection is decreasing. However, surgical resection is still should be considered the main approach for the patients with massive hemoptysis. In emergency circumstances, the combination of BAE and surgery will improve the patients' mortality and morbidity. This is especially true for elderly patients with tuberculosis, aspergillosis, and pulmonary abscesses, where early surgical approaches are warranted.