رویکرد هموپتیز در عصر مدرن Approach to Hemoptysis in the Modern Era

1. Introduction Hemoptysis is often an alarming and worrisome symptom for the patient and the physician. Although massive hemoptysis occurs in less than 20% of the cases [1], it can have devastating consequences. Technological advances have enabled a more e0ective management, especially with the introduction of bronchial artery embolization and the improvements in computed tomography and bronchoscopy. Bronchoscopy remains an important diagnostic and therapeutic procedure in hemoptysis. New techniques to control bleeding have been reported with interesting results, and older approaches have been improved. (is review addresses the approach of hemoptysis in the modern era, with particular emphasis on bronchoscopy. 2. Definition Hemoptysis can be of variable severity ranging from slightly blood-streaked sputum to life-threatening hemorrhage [2, 3]. Severe hemoptysis should be promptly identi1ed as it presents a signi1cant mortality risk which has been reported to be as high as 80% without appropriate management [4–8]. Nearly all de1nitions of severe or massive hemoptysis in the literature rely on the reported volume of expectorated blood in a 24-hour period. (ere is no consensus on a speci1c volume threshold for an hemoptysis to be considered massive [9, 10]. Studies use di0erent thresholds ranging from 100 mL [11] to over 1000 mL [12]. De1nitions relying on selfreported volumes are imperfect as patients may overestimate or underestimate volume as massive hemoptysis, understandably, causes signi1cant stress [10]. We recommend to measure hemoptysis volume when patients are admitted to the hospital to have an objective assessment of clinical evolution, but unfortunately, such precise measures are seldom available on initial presentation.