Zusammenfassung
Hämoptysen sind potenziell lebensbedrohliche Komplikationen unterschiedlichster Krankheiten. Häufigste Ursachen sind entzündliche und infektiöse Erkrankungen, gefolgt von Neoplasmen, Lungenembolien, Herzklappenfehlern, Gerinnungsstörungen und zahlreichen Systemerkrankungen. Routineuntersuchungen sind: Thoraxröntgenbild, (Angio-)CT und Bronchoskopie sowie evtl. eine Kontrastdarstellung der Bronchialarterien. Gefährdet ist der Patient durch Verschlüsse der Atemwege mit Koageln. Die wichtigsten Maßnahmen bei Hämoptoe sind daher Sauerstoffgabe, Lagerung auf die blutende Seite, bronchoskopische Absaugung von Blut und Gerinnseln. Gerinnungsstörungen müssen ausgeglichen werden. Kurzfristig helfen vasokonstriktive Medikamente. Bei zentralen Prozessen kann man über das Bronchoskop mit dem Argon-Plasma-Beamer oder dem Laser koagulieren. Bei schweren Blutungen aus der Peripherie muss eine Ballon- oder Tubustamponade durchgeführt werden. Je nach Ursache und Schweregrad der Hämoptoe folgt eine antientzündliche Behandlung, eine hämostyptische Strahlentherapie, eine Bronchialarterienembolisation oder eine Operation.
Abstract
Hemoptysis is a potentially life-threatening complication of various diseases. The most common causes are infectious and inflammatory processes, followed by neoplasms, pulmonary embolisms, mitral stenoses, coagulopathies, and multiple systemic disorders. Primary examinations include chest X-ray, angio CT, and bronchoscopy. Sometimes, a bronchial artery angiogram is required. The patient is at risk of suffocation because blood and clots can severely obstruct his airways. Thus, the most important measures are supplemental oxygen, positioning the patient with the bleeding side down, bronchoscopic suctioning, and removal of blood and clots. Coagulopathies have to be corrected. Application of vasoactive drugs may help temporarily. In cases of bleeding from central lesions, coagulation with laser or argon plasma coagulator is feasible. Heavy bleeding from the periphery requires a balloon or tube tamponade. Depending on the cause and the severity of the bleeding anti-inflammatory medical treatment, hemostyptic radiation therapy, bronchial artery embolization, or a surgical procedure must follow.
Literatur
Abal AT, Nair PC, Cherian J (2001) Haemoptysis: aetiology, evaluation and outcome – a prospective study in a third-world country. Respir Med 95: 548–552
Ackerman MJH, Warakarn V, Jirasakuldech B (2002) Intralesional epinephrine injection for bleeding endobronchial tumor. J Bronchol 9: 19–21
Antonelli M, Midulla F, Tancredi G et al. (2002) Bronchial artery embolization for the management of nonmassive cystic fibrosis. Chest 121: 796–801
Arney KL, Judson MA, Sahn SA (1999) Airway obstruction arising from blood clot: three reports and review of the literature. Chest 115: 293–300
Ayed A (2003) Pulmonary resection for massive hemoptysis of benign etiology. Eur J Cardiothorac Surg 24: 689–693
Bernard A, Ciallot D, Couaillier JF et al. (1997) Surgical management of invasive pulmonary aspergillosis in neutropenic patients. Ann Thorac Surg 64: 1441–1447
Botnick W, Brown H (1994) Endobronchial urokinase for dissolution of massive clot following transbronchial biopsy. Chest 105: 953–954
Conlan AA, Hurwitz SS, Krige L et al. (1983) Massive hemoptysis. Review of 123 cases. J Thorac Cardiovasc Surg 85: 120–124
Crocco JA, Rooney JJ, Fankushen DS (1968) Massive hemoptysis. Arch Intern Med 121: 495–498
Endo S, Otani S, Saito N et al. (2003) Management of massive hemoptysis in a thoracic surgical unit. Eur J Cardiothorac Surg 23: 467–472
Freitag L, Tekolf E, Stamatis G et al. (1994) Three years experience with a new balloon catheterfor the management of hemoptysis. Eur Resp J 7: 2033–2037
Fujimoto T, Hillejahn L, Stamatis G (2001) Current strategy for surgical management of bronchiectasis. Ann Thorac Surg 72: 1711–1715
Gerasin VA, Shafirovsky BB (1988) Endobronchial electrosurgery. Chest 93: 270–274
Håkanson E, Konstantinov IE, Fransson SG, Svedjeholm R (2002) Management of life-threatening haemoptysis. Br J Anaesthesia 88: 291–295
Haponik EF, Fein A, Chin R (2000) Managing life-threatening hemoptysis. Has anything really changed? Chest 118: 1431–1435
Herth FJF, Ernst A, Becker HD (2001) Longterm outcome and lung cancer incidence in patients with hemoptysis of unknown origin. Chest 120(5): 1592–1594
Jean-Baptiste E (2000) Clinical assessment and management of massive hemoptysis. Crit Care Med 28: 1642–1647
Jones DK, Cavanagh P, Sheerson JM, Flower CDR (1985) Does bronchography have a role in the assessment of patients with haemoptysis? Thorax 40: 668–670
Jougon J, Ballester M, Delcambre F et al. (2002) Massive hemoptysis: what place for medical and surgical treatment. Eur J Cardiothorac Surg 22: 345–351
Kallay N, Dunagan DP, Adair N et al. (2001) Hemoptysis in patients with renal insufficiency. The role of flexible bronchoscopy. Chest 119: 788–794
Knott-Craig CJ, Oostuizen JG, Rossouw G et al. (1993) Management and prognosis of massive hemoptysis. Recent experience with 120 patients. J Thorac Cardiovasc Surg 105: 394–397
Lordan JL, Gascoigne A, Corris PA (2003) The pulmonary physician in critical care. Illustrive case 7: Assessment and management of massive haemoptysis. Thorax 58: 814–819
Mal H, Rullon I, Mellot F et al. (1999) Immediate and long-term results of bronchial artery embolization for life-threatening hemoptysis. Chest 115: 996–1001
Ong TH, Eng P (2003) Massive hemoptysis requiring intensive care. Intensive Care Med 29: 317–320
Osaki S, Nakanishi Y, Wataya H et al. (2000) Prognosis of bronchial artery embolization in the management of hemoptysis. Respiration 67: 412–416
Prakash UBS, Freitag L (1994) Hemoptysis and bronchoscopy induced hemorrhage. In: Prakash USB (ed) Bronchoscopy. Raven, New York, pp 227–251
Ramon P, Wallaert B, Derollez M et al. (1989) Treatment of severe hemoptysis with terlipressin. Study of the efficacy and tolerance of this product. Rev Mal Respir 6: 365–368
Reichle G, Freitag L, Kullmann HJ et al. (2000) Erfahrungen mit der Argon-Plasma-Koagulation in der Bronchologie. Bericht über Erfahrungen bei 482 Anwendungen. Pneumologie 54: 508–516
Sahn JJ (1996) Thoracic endometriosis syndrome: new observations from an analysis of 110 cases. Am J Med 100: 164–167
Saw EC, Gottlieb LS,Yokoyama T, Lee BC (1976) Flexible fiberoptic bronchoscopy and endobronchial tamponade in the management of massive hemoptysis. Chest 70: 589–591
Sidman JD, Wheeler WB, Cabalka AK et al. (2001) Management of acute pulmonary hemorrhage in children. Laryngoscope 111: 33–35
Speiser BL, Spratling L (1993) Remote afterloading brachytherapy for the local control of endobronchial carcinoma. Int J Radiation Oncol Biol Phys 25: 579–587
Thompson AB, Teschler H, Rennard SI (1992) Pathogenesis, evaluation, and therapy for massive hemoptysis. Clin Chest Med 13: 69–82
Tsukamoto T, Sasaki H, Nakamura H (1989) Treatment of hemoptysis patients by thrombin and fibrinogenthrombin infusion therapy using a fiberoptic bronchoscope. Chest 48: 272–274
Uziel Y, Laxer RM, Siverman ED (1997) Persistent pulmonary hemorrhage as the sole initial clinical manifestation of pediatric systemic lupus erythematosus. Clin Exp Rheumatol 15: 697–700
Valipour A, Kreuzer A, Koller H et al. (2005) Bronchoscopy-guided topical hemostatic tamponade therapy for the management of life-threatening hemoptysis. Chest 127(6): 2113–2118
Wong ML, Szkup P, Hopley MJ (2002) Percutaneous embolotherapy for life-threatening hemoptysis. Chest 121: 95–102
Savage R (2002) Prone position as a life saving measure for acute pulmonary haemorrhage in a young adult with cystic fibrosis. Anaesth Intensive Care 30: 223–225
Wong ML, Szkup P, Hopley MJ (2002) Percutaneous embolotherapy for life-threatening hemoptysis. Chest 121: 95–102
Zavala MC (1978) Pulmonary hemorrhage in fiberoptic transbronchial biopsy. Chest 70: 384–388
Interessenkonflikt
Keine Angaben
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Herth, F., Eberhardt, R. & Freitag, L. Hämoptysen. Pneumologe 3, 188–196 (2006). https://doi.org/10.1007/s10405-006-0095-y
Issue Date:
DOI: https://doi.org/10.1007/s10405-006-0095-y