Surgery for hemoptysis - one year experience of 72 patients

Objective: To determine aetiology of patients presenting with hemoptysis and evaluate their management and outcome. Study Design: An observational prospective descriptive study. Place and Duration: Department of Cardiothoracic Surgery, Postgraduate Medical Institute, Lady Reading Hospital from 1st Jan 2003 to 31st December 2003. Materials and Methods: This prospective study included 72 patients; 51(71%) were males and 21(29%) were females. Male: female ratio was 2.5:1 Age range was from 7 years to 81 years with a mean age of 36.3 years. All the patients had hemoptysis o n presentation while 25(35%) also experienced dyspnoea. Chest radiograph was obtained in all, CT Thorax in 60 (83%) while pulmonary function tests were performed in 68(94%) patients. Out of 72 cases 09 patients had to undergo immediate surgery, 27 underwent surgery within one week after initial stabilization and 36 were operated upon electively. All patients, except 6 pediatrics cases, had one lung ventilation during surgery. Results: The mean operative time was 55(+/-20) minutes. Out of 72 patients 30 had lobectomy, 24 had hydatid cystectomy, 9 had wedge excision, 3 had pneumonectomy and 6 had thoracoplasty. Mortality was 2/72 while morbidity was 6/72 comprising 4 wound infections (in the emergency group) and 2 each had persistent air leak and empyema. Hospital stay ranged from 7 - 36 days with mean of 12.6 days. Pathological breakup of the 72 cases was bronchiectasis 30, mycetoma 2, lung abscess 9, hydatid cysts 24, carcinoma 6 and AV malformation 1. Conclusion: Inflammatory lung disease, especially TB and its sequelae is the commonest cause of hemoptysis. Elective surgery with one lung ventilation after initial stabilization in a well equipped & well staffed cardiothoracic unit (OT & ICU) is a safe option for hemoptysis, not responding to medical management.