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2006

2006 A single centre experience of aetiologies, angiographic findings and outcomes of life-threatening haemopytsis in Hong Kong

Dr. Judy Lam, Department of Medicine and Geriatrics, United Christian Hospital

Background
Life-threatening haemoptysis is one of the most dreaded of all respiratory emergencies. Recent local data concerning life-threatening haemoptysis and their outcomes are lacking. This study aims to provide a comprehensive account of aetiologies, angiographic findings and outcomes of life-threatening haemoptysis in a local centre in Hong Kong.

Methods
A retrospective cohort of consecutive patients with life-threatening haemoptysis admitted to the United Christian Hospital from January 2000 to January 2005 was studied. The patient characteristics, aetiologies of haemoptysis, radiographic and bronchoscopic findings, angiographic findings, any interventions and their outcomes were recorded. The results of bronchial artery embolization (BAE) were further analyzed; and any factors associated with recurrence of haemoptysis were explored.

Results
There were 94 patients included in the cohort. Tuberculosis (68%) and bronchiectasis (43.6%) were the two commonest causes of life-threatening haemoptysis. There were 62 patients who received specific interventions; including one received emergency surgery while BAE were attempted for the remaining cases. The technical success rate of BAE was 88.5%. Fifty-four patients completed BAE and were available for further analysis. Ninety-eight percent of cases achieved control of bleeding till discharge. No major complications occurred. The 1-year and 3-year recurrence rate were 22.2% and 36.0% respectively. All recurrence of life-threatening haemoptysis was either due to sequelae of tuberculosis (87.5%) or idiopathic bronchiectasis (12.5%). The presence of systemic-pulmonary shunt was associated with a high chance of recurrence (p=0.027).

Conclusions
Tuberculosis and bronchiectasis account for more than two-third of life-threatening haemoptysis and its recurrence. The immediate success and long term outcome of BAE is satisfactory in our centre; while the complication rate is low. BAE is proved to be a safe and effective mean for control of life-threatening haemoptysis. Being able to identify systemic-pulmonary shunt may help earlier and allow more aggressive treatment of these cases.

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