Hämoptysen

 

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Kernaussagen

Bedeutung. Hämoptysen sind potenziell vital bedrohlich. Die Gefährdung des Patienten ergibt sich in der Regel nicht aus dem Blutverlust, sondern aus dem Verschluss der Atemwege durch koagulierendes Blut mit nachfolgender respiratorischer Insuffizienz. Patienten mit stärkeren Hämoptysen sind daher intensivpflichtig.

Diagnostik. Pulmonale Blutungen erfordern unabhängig von ihrer Intensität immer eine die Ursachen klärende Diagnostik. Neben der obligaten Röntgen-Thoraxuntersuchung, ggf. auch der CT, spielt die Bronchoskopie die entscheidende Rolle.

Therapie. Die Blutstillung wird in der Regel ebenfalls bronchoskopisch durchgeführt. Verschiedene Verfahren und Techniken stehen zur Verfügung. Eine Operation muss bei starken Blutungen erwogen werden, z. B. bei Gefäßrupturen und blutenden Tumoren. Bei rezidivierenden Blutungen aus dem Lungenparenchym ist die Bronchialarterienembolisation eine Alternative.

Literatur

• 1 Prakash U BS, Freitag L. Hemoptysis and bronchoscopy induced hemorrhage. In: Prakash UBS (ed) Bronchoscopy. New York; Raven 1994: 227-251
  Google Scholar
• 2 Garzon A A, Gourin A. Surgical management of massive hemoptysis: a 10-year experience.  Ann Surg. 1978;  187 267-271
  CrossrefPubMedGoogle Scholar
• 3 Cahill B C, Ingbar D II. Massive hemoptysis: assessment and management.  Clin Chest Med. 1994;  15 147-167
  PubMedGoogle Scholar
• 4 Crocco J A, Rooney J J, Fankushen D S. et al . Massive hemoptysis.  Arch Intern Med. 1968;  121 495-498
  CrossrefPubMedGoogle Scholar
• 5 Jean-Baptiste E. Clinical assessment and management of massive hemoptysis.  Crit Care Med. 2000;  28 1642-1647
  CrossrefPubMedGoogle Scholar
• 6 Ferretti G R, Arbib F, Bertrand B, Coulomb M. Haemoptysis associated with pulmonary varices: demonstration using computed tomographic angiography.  Eur Respir J. 1998;  12 989-992
  CrossrefPubMedGoogle Scholar
• 7 Abal A T, Nair P C, Cherian J. Haemoptysis: aetiology, evaluation and outcome – a prospective study in a third-world country.  Respir Med. 2001;  95 548-552
  CrossrefPubMedGoogle Scholar
• 8 Sidman J D, Wheeler W B, Cabalka A K, Soumekh B, Brown C A, Wright G B. Management of acute pulmonary hemorrhage in children.  Laryngoscope. 2001;  111 33-29
  CrossrefPubMedGoogle Scholar
• 9 Conlan A A, Hurwitz S S, Krige L, Nicolaou N, Pool R. Massive hemoptysis. Review of 123 cases.  J Thorac Cardiovasc Surg. 1983;  85 120-124
  CrossrefPubMedGoogle Scholar
• 10 Flower C DR, Jackson J E. The role of radiology in the investigation and management of patients with hemoptysis.  Clin Radiol. 1996;  51 391-400
  CrossrefPubMedGoogle Scholar
• 11 Haponik E F, Fein A, Chin R. Managing life-threatening hemoptysis. Has anything really changed?.  Chest. 2000;  118 1431-1435
  CrossrefPubMedGoogle Scholar
• 12 Wong M L, Szkup P, Hopley M J. Percutaneous embolotherapy for life-threatening hemoptysis.  Chest. 2002;  121 95-102
  CrossrefPubMedGoogle Scholar
• 13 Schmidt B, Liebers U, Kröncke T, John M, Witt C. Bronchial artery embolisation using platinum coils in 52 patients wirh severe pulmonary hemorrhage.  Dtsch Med Wochenschr. 2005;  130 440-443
  Article in Thieme ConnectPubMedGoogle Scholar
• 14 Knott-Craig C J, Oostuizen J G, Rossouw G, Joubert J R, Barnard P M. Management and prognosis of massive hemoptysis. Recent experience with 120 patients.  J Thorac Cardiovasc Surg. 1993;  105 394-397
  CrossrefPubMedGoogle Scholar
• 15 Herth F JF, Ernst A, Becker H D. Longterm outcome and lung cancer incidence in patients with hemoptysis of unknown origin.  Chest. 2001;  120 1592-1594
  CrossrefPubMedGoogle Scholar
• 16 Speiser B L, Spratling L. Remote afterloading brachytherapy for the local control of endobronchial carcinoma.  Int J Radiation Oncol Biol Phys. 1993;  25 579-587
  PubMedGoogle Scholar
• 17 Fartoukh M, Khalil A, Louis L. et al . An integrated approach to diagnosis and management of severe haemoptysis in patients admitted to the intensive care unit: a case series from a referral centre.  Respir Res. 2007;  8 11
  CrossrefPubMedGoogle Scholar
• 18 Håkanson E, Konstantinov I E, Fransson S G, Svedjeholm R. Management of life-threatening haemoptysis.  Br J Anaesthesia. 2002;  88 291-295
  CrossrefPubMedGoogle Scholar
• 19 Arney K L, Judson M A, Sahn S A. Airway obstruction arising from blood clot: three reports and review of the literature.  Chest. 1999;  115 293-300
  CrossrefPubMedGoogle Scholar
• 20 Ramon P, Wallaert B, Derollez M, D’Odemont J P, Tonnel A B. Treatment of severe hemoptysis with terlipressin. Study of the efficacy and tolerance of this product.  Rev Mal Respir. 1989;  6 365-368
  PubMedGoogle Scholar
• 21 Savage R. Prone position as a life saving measure for acute pulmonary haemorrhage in a young adult with cystic fibrosis.  Anaesth Intensive Care. 2002;  30 223-225
  CrossrefPubMedGoogle Scholar
• 22 Reichle G, Freitag L, Kullmann H J, Prenzel R, Macha H N, Farin G. Argon plasma coagulation in bronchology: a new method – alternative or complementary?.  Pneumologie. 2000;  54 508-516
  Article in Thieme ConnectPubMedGoogle Scholar
• 23 Gerasin V A, Shafirovsky B B. Endobronchial electrosurgery.  Chest. 1998;  93 270-274
  PubMedGoogle Scholar
• 24 Valipour A, Kreuzer A, Koller H, Koessler W, Burghuber O C. Bronchoscopy-guided topical hemostatic tamponade therapy for the management of life-threatening hemoptysis.  Chest. 2005;  127 2113-2118
  CrossrefPubMedGoogle Scholar
• 25 Tsukamoto T, Sasaki H, Nakamura H. Treatment of hemoptysis patients by thrombin and fibrinogen-thrombin infusion therapy using a fiberoptic bronchoscope.  Chest. 1989;  96 473-476
  CrossrefPubMedGoogle Scholar
• 26 Ong T H, Eng P. Massive hemoptysis requiring intensive care.  Intensive Care Med. 2003;  29 317-320
  CrossrefPubMedGoogle Scholar
• 27 Antonelli M, Midulla F, Tancredi G, Salvatori F M, Bonci E, Cimino G, Flaishman I. Bronchial artery embolization for the management of nonmassive hemoptysis in cystic fibrosis.  Chest. 2002;  121 796-801
  CrossrefPubMedGoogle Scholar
• 28 Endo S, Otani S, Saito N, Hasegawa T, Kanai Y, Sato S, Sohara Y. Management of massive hemoptysis in a thoracic surgical unit.  Eur J Cardiothorac Surg. 2003;  23 467-472
  CrossrefPubMedGoogle Scholar
• 29 Fujimoto T, Hillejahn L, Stamatis G. Current strategy for surgical management of bronchiectasis.  Ann Thorac Surg. 2001;  72 1711-1715
  CrossrefPubMedGoogle Scholar
• 30 Jougon J, Ballester M, Delcambre F. et al . Massive hemoptysis: what place for medical and surgical treatment.  Eur J Cardiothorac Surg. 2002;  22 345-351
  CrossrefPubMedGoogle Scholar

Dr. med. Ralf Eberhardt

Abteilung Pneumologie und Beatmungsmedizin
Thoraxklinik am Universitätsklinikum Heidelberg

Amalienstraße 5
69126 Heidelberg

Phone: 06221/396-1204

Fax: 06221/396-1205

Email: ralf.eberhardt@thoraxklinik-heidelberg.de