• Journal of Chest Surgery
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• 제25권7호
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• pp.711-715
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• 1992

Massive hemoptysis is defined as pulmonary hemorrhage of more than 600ml to 800ml within 24hours. Among the many causes, the most common include pulmonary tuberculosis, abscess, bronchiectasis, cystic fibrosis bronchial carcinoma. Most acute episodes of hemoptysis last less than 24 hours and gradually subside. However, when the hem-optysis is massive, it carries a mortality rate of 50% to 100%. It is generally agreed that surgery is the treatment of choice for patients with massive hemoptysis. We had the one case of 39 year-old male with recurrent massive hemoptysis. In the past history, he had pulmonary tuberculosis 20 years ago but no chest trauma, Previous chest CT showed well defined cavitary lesion with calcification on RUL Under the bronchoscope finding, we indentified active bleeding from right upper lobe bronchus without end-obronchial lesion. Therefore, emergency thoracotomy was done with impression of hem-optysis due to pulmonary tuberculosis. But operative findings were as follows ; the 4th fractured rib was impacted into the lung parenchyme with severe adhesion and middle lobe was not inflated. So, Upper and middle lobectomy were performed. He was diagnosed finally by operative and pathological findings as massive hemoptysis due to impaction of fractured rib into the lung parenchyme and discharged without complication.

• Journal of Chest Surgery
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• 제21권6호
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• pp.1124-1136
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• 1988

Massive hemoptysis, usually rapid flooding of tracheobronchial tree and asphyxia, is associated with high mortality. We have controlled massive hemoptysis in two cases with use of bronchial artery angiography & selective bronchial artery embolization with Gelfoam particle. One case was inoperable case that was confirmed as TOF c severe pulmonary artery hypoplasia with massive hemoptysis due to hypertrophied bronchial artery and its collaterals. Another case was congenital ASD with pulmonary Aspergillosis, postop. empyema and BPF associated with massive bleeding due to erosion of hypervascular bronchial artery. We experienced dramatic improvement of general condition and cessation of massive hemoptysis for above two cases. No other problems and complication were noted during postop. hospitalization and follow-up period.

• Tuberculosis and Respiratory Diseases
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• 제38권4호
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• pp.396-400
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• 1991

Massive and untreated hemoptysis is associated with a mortality of greater than 50 percents. Since the bleeding was from a bronchial arterial source in the vast majority of patients, embolization of the bronchial arteries has become an accepted treatment in the management of massive hemoptysis because it achieves immediate control of the patients. We have controlled massive hemoptysis in a case with selective bronchial arteral embolization with Gelfoam.

• Tuberculosis and Respiratory Diseases
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• 제63권5호
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• pp.430-434
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• 2007

저자들은 71세 여자환자가 대량객혈을 주소로 내원하여 폐동맥과 기관지의 누공을 확인한 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제28권12호
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• pp.1139-1143
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• 1995

We experienced 29 cases of patients with a chief complaint of hemoptysis who were performed pulmonary resection at the Department of Thoracic and Cardiovascular Surgery, Pusan Medical Center Hospital for 3 years from May 1990 to April 1993. The mean age of hemoptysis patients was 34.7 year old, and hemoptysis was most prevalent in third and fourth decades. The underlying lung diseases of hemoptysis patients were tuberculosis in 12[41.4% , bronchiectasis in 9[31.0% , lung cancer in 4[13.8% , aspergyllosis in 3[10.3% and pneumonia in 1[3.5% . Modes of hemoptysis were blood tinged in 7[24.1% , massive in 22[75.9% . Operation times were elective in 7[24.1% of all blood tinged hemoptysis, delayed in 20[69.0% , emergency in 2[6.9% out of massive hemoptysis. The cases of the definite bleeding focus found by bronchoscopy were 19 cases[65.5% . The operative procedures of hemoptysis were single lobectomy in 14[48.3% , pneumonectomy in 6[20.7% , lobectomy with segmentectomy in 5[17.2% , bilobectomy in 3[10.3% and segmentectomy in 1[3.5% . The postoperative results of hemoptysis were complete recovery in 27[93.0% , rehemoptysis in 1[3.5% which was treated by anti-Tbc medication completely, and hospital death in 1[3.5% which was brain metastasis of lung cancer. It was concluded that definitive diagnosis, preoperative control of hemoptysis and operation were important in the management of hemoptysis patients.

• Tuberculosis and Respiratory Diseases
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• 제78권2호
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• pp.106-111
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• 2015

Tracheal hemangioma is a rare benign vascular tumor in adults. We reported a case of massive hemoptysis caused by a cavernous hemangioma in a 75-year-old man. This is the first report, to our knowledge, of a tracheal cavernous hemangioma that presented with massive hemoptysis. The lesion was removed with a $CO_2$ laser under rigid laryngoscopy. Endovascular tumors, such as tracheobronchial hemangiomas, should be considered a diagnostic option in cases of massive hemoptysis without a significant underlying lung lesion.

• Journal of Chest Surgery
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• 제24권10호
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• pp.1011-1018
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• 1991

From September, 1985 to March, 1991, 33 patients under went thoracotomy for treatment of pulmonary aspergilloma with Pulmonary tuberculosis on the department of Thoracic and Cardiovascular Surgery, National Kongju Hospital. 1. There were 25 male and 8 female patients ranging from 19 to 57 years old [mean age, 36.2 years]. 2. Hemoptysis was the most common symptom [recurrent minor hemoptysis: 24cases, severe hemoptysis [200cc /day]: 4 cases, massive hemoptysis [600/day]: 4 cases]. 3. In the chest X-ray films, intracavitary fungus balls [air meniscus sign] were noted in 20 cases [61%] and upper lobe involvements were 29 cases [88%]. 4. All cases had a history of treatment with antituberculosis drugs under diagnosis of pulmonary tuberculosis for an average of 10 years and 2 months. 5. The most common indication for operation was hemoptysis [32 cases] - hemoptysis with total destroyed lung or lobe: 12cases, hemoptysis with open AFB [t-] cavity: 6cases, recurrent or massive hemoptysis: 14 cases. 6. The operative procedures was as follows - - - lobectomy . 16 cases, pneumonectomy: 8 cases, bilobectomy, segmentectomy, cavernoplasty and lobectomy with segmentectomy: each 2 cases, lobectomy with cavernoplasty: 1 case. 7. 6 complications appeared postoperatively which included empyema with BPF [2 cases], empyema [2 cases] and wound infection [2 cases]. In conclusion, surgical resection is the treatment of choice in the management of pulmonary aspergilloma associated pulmonary tuberculosis.

• Tuberculosis and Respiratory Diseases
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• 제73권6호
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• pp.325-330
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• 2012

High-dose-rate endobronchial brachytherapy (HDREB) have been used as the treatment of early endobronchial cancer, as well as for palliation of advanced cancer. However, fatal hemoptysis can occur after HDREB at the rate of 7~32%. We report a case of massive hemoptysis due to radiation bronchitis developed after HDREB. A 67-year-old man was treated with HDREB for early endobronchial cancer on the left upper lobe bronchus. He complained of persistent cough from 4 weeks after completion of HDREB. Radiation bronchitis was observed on the bronchoscopy at 34 weeks, and it was progressed from mucosal swelling and exudate formation to necrosis and ulceration without local relapse. In addition, he died of massive hemoptysis after 15 months. The patient had no sign or radiologic evidences to predict the hemoptysis. This case implies that HDREB directly contributes to an occurrence of a fatal hemoptysis, and follow-up bronchoscopy is important to predict a progression of radiation bronchitis and fatal hemoptysis.

• Tuberculosis and Respiratory Diseases
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• 제39권1호
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• pp.35-41
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• 1992

연구배경 : 대량 객혈은 내과적 혹은 외과적 치료로도 사망율이 매우 높은 임상증상이다. 대량 객혈은 높은 기관지 동맥 혹은 비기관지성 전신동맥에서 출혈된다고 알려져 있으므로, 최근 상기 혈관들을 색전시키는 것이 치료방법으로 되고 있으나 초기 색전후 일부에서 객혈이 재발되는 것이 문제로 되어 있다. 이에 저자들은 대량출혈환자에서 동맥색전을 하여 즉각적인 지혈정도를 알아보고, 즉시 지혈된 후 객혈이 재발되는 환자들의 임상소견 및 초기 동맥촬영소견을 조사하여 보았다. 방법 : 1988년 1월부터 1991년 7월까지 전부 21명의 환자에서 대량 객혈로 동맥색전술을 시행하였다. 환자 모두에서 대퇴통맥으로 경피하 삽관술을 하여 기관지동맥외에도 비기관지 전신동맥에 혈관촬영을 시행한 후, 병변부위의 혈관에 gelfoam pieces로 색전을 실시하였다. 이후 환자들을 추적관찰하면서 동맥색전술의 효과를 평가하였다. 결과 : 처음 동맥색전후 21명의 전환자에서 즉시 지혈은 성공하였다. 9명의 환자에서 출혈이 재발되었으며, 12예의 환자들에서는 객혈의 재발은 없었다. 합병증으로는 발열, 흉통, 기침, 배뇨 장애, 장마비, 하지마비 및 비장경색증등이 있었으며, 9명의 환자에서는 별 증상을 호소하지 않았다. 출혈이 재발된 환자중, 2명은 대량객혈로 사망하였고, 2명은 폐절제술을 시행받았으며, 4명은 매번 객혈이 재발시마다 반복적인 동맥색전술 혹은 내과적 보존치료를 받고 있다. 결론 : 재출혈의 가능성이 있기는 하지만, 동맥색전술은 대량 객혈환자에서 출혈을 비교적 빠르고 안전하게 멈출 수 있는 치료법이다. 또 수술적 치료가 불가능한 폐질환 환자에서 객혈이 재발시마다, 반복 시행하는 동맥색전술은 일단 급한 출혈을 막고 생명을 연장시키는 데에 도움을 주리라 사료된다.

• Tuberculosis and Respiratory Diseases
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• 제40권6호
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• pp.677-682
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• 1993

연구배경 : 대량객혈은 높은 치명률을 보이는 임상증상이다. 흔한 원인질환으로 결핵, 기관지확장증, 악성종양, 폐국균종등을 들 수 있으며 이러한 폐질환을 가진 환자에서 대량객혈 또는 반복되는 객혈로 생명에 위협을 주는 경우, 원인이 되는 혈관을 찾아 동맥색전술을 시행함으로써 일시적 혹은 영구적인 지혈을 기대할 수 있다. 방법 : 1989년 6월부터 1992년 8월까지 본원에 대량객혈로 입원하여 기관지동맥색전술을 시행받은 환자 20명의 병록과 혈관조영술사진을 조사하여 기저질환, 출혈부위, 색전술의 부위, 합병증 및 재발여부에 대하여 조사하였다. 결과: 1) 대량객혈의 기저질환으로는 폐결핵(14예), 기관지확장증(3예), 폐국균종(2예), 폐흡충증(1예)가 있었다. 2) 색전물질로는 gelform(7예), Ivalon(11예), 그리고 2예에서는두가지를 함께 사용하였다. 3) 색전을 시행한 혈관은 15예에서 기관지동맥, 5예에서는 기타동맥에서 시행하였다. 4) 기관지동맥색전술후 17예(85%)에서는 즉각적인 지혈이 이루어졌고 시행직후 재발한 3예를 포함한 재발율은 50%이었다. 재발한 경우 3예에서 폐엽절제를 시행하였고 1예는 대량객혈로 인한 질식으로 사망하였으며 나머지 6예는 보존적인 치료만으로 추적기간(1~29개월)동안 더 이상의 출혈의 재발이 없었다. 결론 : 기관지동맥색전술은 대량객혈과 재발성 객혈의 경우 즉각적으로 지혈시킬 수 있는 효과적인 방법이다. 특히 만성적인 폐질환 등으로 수술의 위험이 큰 환자에서도 용이하게 일차적으로 시행할 수 있는 방법으로 생각된다.