Life threatening haemoptysis controlled by laser photocoagulation.

Abstract

We have recently described the use of the neodymium yttrium aluminium garnet laser in palliative treatment of carcinoma of the bronchus. ' We now report a case of acute massive haemoptysis controlled by emergency laser photocoagulation as a primary treatment. Case reportA 70 year old man presented in October 1982 with a six week history of left shoulder pain and exertional dyspnoea, with one episode of coughing up blood streaked sputum. He had smoked 15 cigarettes a day until 1980. Examination revealed a firm, mobile nodule below the left eye but no lymphadenopathy or hepatomegaly. Histological examination of the resected facial nodule showed the appearances of a mucin secreting adenocarcinoma and the chest radiograph showed an ill defined opacity above the right hilum, which was considered to be the primary tumour.His symptoms were insufficient to merit radiotherapy and he was given no specific treatment. He began to have further blood streaking of the sputum and in early December he was readmitted to hospital after coughing up about two cupfuls of frank blood containing clots. The chest radiograph showed enlargement of the shadow above the right hilum and in addition there were multiple discrete nodular opacities throughout the lung fields. While in the ward he expectorated an estimated 200 ml of fresh blood and emergency fibreoptic bronchoscopy was performed.During this procedure a further 900 ml of fresh blood were aspirated and he became shocked, with a pulse rate of 130 beats/min and a blood pressure of 100/60 mm Hg. An intravenous line was inserted and blood was taken for grouping and cross matching. A large clot was found in the orifice of the right main bronchus at the carina, and when this had been removed a nodular haemorrhagic tumour was seen to be partially occluding the bronchus. Topical adrenaline was applied but haemostasis was only partial and transient and brisk bleeding soon developed again. A flexible glass fibre was passed through the biopsy channel of the bronchoscope and a laser beam was transmitted along it and on to the tumour. The system used was a

The pulmonary physician in critical care * Illustrative case 7: Assessment and management of massive haemoptysis

“…Neodymium-yttrium-aluminium-garnet (Nd-YAG) laser photocoagulation has been used with some success in the management of massive haemorrhage associated with directly visualised endobronchial lesions. 30 However, targeting the cul-prit vessel with the laser beam can be difficult in the presence of ongoing bleeding.…”

Massive Hemoptysis: An Update on the Role of Bronchoscopy in Diagnosis and Management

“…However, the use of laser photocoagulation for massive bleeding has provided mixed results [94,95]. Edmondstone et al [94 ]described successful management of life-threatening hemoptysis with bronchoscopic laser photocoagulation. Infrared light was applied on a hemorrhagic tumor in the right mainstem bronchus with complete hemostasis.…”

“…3). It allows photocoagulation of the bleeding mucosa with resulting hemostasis, and can help achieve photoresection and vaporization of the underlying lesion, thus providing a definitive approach to hemoptysis management [1,94]. However, the use of laser photocoagulation for massive bleeding has provided mixed results [94,95].…”

New Procedure: Bronchoscopic Endobronchial Sealing

“…10,11 The ND-Yag laser used bronchoscopically can effectively stop bleeding from endobronchial pathology and can also allow more definite therapy at the same sitting. 12,13 Balloon tamponading of the bleeding bronchial segment is also helpful, with variable success rates. 14 -16 None of these procedures is completely satisfactory.…”