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Panminerva Medica 2018 December;60(4):139-44

DOI: 10.23736/S0031-0808.18.03478-X

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Early or delayed bronchoscopy in patients admitted to the emergency department for mild-to-moderate hemoptysis?

Filippo PATRUCCO 1, 2 , Francesco GAVELLI 3, Gian C. AVANZI 3, Anna STAINER 2, 4, Bruno D. BODINI 2, Luigi M. CASTELLO 3, Piero E. BALBO 2

1 Pneumology Unit U, Department of Translational Medicine, Sant’Andrea Hospital, University of Piemonte Orientale, Vercelli, Italy; 2 Division of Respiratory Diseases, Department of Medicine, Maggiore della Carità Hospital, University of Piemonte Orientale, Novara, Italy; 3 Unit of Emergency Medicine, Department of Translational Medicine, Maggiore della Carità Hospital, University of Piemonte Orientale, Novara, Italy; 4 Division of Respiratory Medicine, Cardio-Thoracic Vascular Department, San Gerardo Hospital, University of Milan Bicocca, Monza, Monza-Brianza, Italy



BACKGROUND: The correct timing for bronchoscopy in massive hemoptysis is well established, whereas in mild-to-moderate hemoptysis there still is uncertainty. The aim of our study was to evaluate if performing a fibrobronchoscopy (FBS) within 48 hours after the onset of mild-to-moderate hemoptysis was related to a higher possibility to identify the site and the cause of bleeding, compared to a delayed one.
METHODS: We conducted a retrospective study over one-year period from March 2015, in which consecutive patients admitted to the emergency department underwent FBS for spontaneous mild-to-moderate hemoptysis in our medium-size teaching hospital.
RESULTS: We included 69 patients. Definitive diagnosis was achieved in 52 cases (75%) combining clinical, imaging and endoscopic data (neoplastic diseases 22%, infections 20%, alveolar hemorrhage 13%). FBS was performed within 48 hours of symptoms onset in 41 patients (59%). The site of bleeding was identified in 28 cases (41%), 64% of which underwent FBS within 48 hours. Endoscopic diagnosis was reached in 45 patients (65%), 60% of which underwent FBS within 48 hours. No statistical association with localization (P=0.62) or diagnosis (P=1.00) was found with early FBS. Despite a high prevalence in our cohort of patients treated with anticoagulant or antiplatelet drugs (39%), we found no statistical association with bronchoscopy localization (P=0.12) and diagnosis (P=0.21).
CONCLUSIONS: In conclusion, in case of mild to moderate hemoptysis, an early bronchoscopy in the emergency department setting does not seem to improve the possibility to find neither the cause nor the localization of the bleeding source.


KEY WORDS: Hemoptysis - Bronchoscopy - Emergency medicine - Airways management - Interventional pulmonology

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