Diagnosis and treatment of pulmonary hemorrhage

Background. Pulmonary hemorrhage (PH) presents a complex challenge in various lung diseases. Given the high mortality rate (70%) prior to the introduction of embolization, PH requires rapid assessment and stabilization, airway protection, and identification of the bleeding source for definitive intervention.

Objective: To identify the causes of pulmonary hemorrhage, determine the bleeding source, and evaluate treatment methods.

Materials and Methods. The study included 132 patients admitted and 17 patients transferred to the institute with pulmonary hemorrhage of various etiologies, hospitalized in the intensive care unit (11 patients) and thoracic surgery department (138 patients), requiring diagnosis and various emergency interventions (angiography, embolization, fiberoptic bronchoscopy, bronchial occlusion, bronchial stenting).

Results. Manifestations of PH in various pathologies were demonstrated, and diagnosis and treatment were performed. The Grigoryev E.G. classification (1A, 1B, 1C, 2A, 2B, 3A, 3B) was used to determine PH severity. The primary diagnostic methods for PH were computed tomography with intravenous bolus contrast enhancement, fiberoptic bronchoscopy, and esophagoscopy, based on which, along with clinical presentation data, treatment strategy was determined. Emergency care was based on examination results, including angiography, and utilized endoscopic and minimally invasive treatment methods (angiography, embolization of bronchial and other arteries, aortic stenting) as well as conservative management. The indication for angiography and endovascular embolization in patients with mild or moderate hemoptysis was bleeding unresponsive to conservative management. The prognosis of PH depends on several factors, including the speed of diagnosis and bronchial artery embolization (BAE), the need for bronchial occlusion, considering the patient's general condition and presence of comorbidities. When BAE is ineffective, angiographic investigation is necessary to identify additional sources, specifically non-bronchial arteries.

Conclusions. In mild to moderate PH, treatment is based on comprehensive diagnosis and early detection of PH through angiography and BAE. In cases of massive PH, bronchial occlusion should be performed as part of comprehensive management, and when BAE is ineffective, angiographic investigation is necessary to identify additional bleeding sources: non-bronchial arteries. Temporary hemostasis is advisable to avoid emergency surgery. The high recurrence rate of PH (50%) and PH recurrence (10%) after emergency embolization and previous embolization necessitate performing BAE in all cases, additional angiographic investigation, and subsequent treatment of the underlying pathological process.

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