Ann Thorac Surg 2005;79:1464
© 2005 The Society of Thoracic Surgeons
Correspondence
Hemoptysis
Sameh Ibrahim Sersar, MD,
Hytham Elsayed AbdelMooty, MBBCH,
Mona Mohammed Hafez, MD,
Mohammed Fouad Ismail, MS
Department of Cardiothoracic Surgery, Mansoura University, Elgomhoria St 123Mansoura, Egypt
sameh001{at}yahoo.com
To the Editor:
We read with interest the article by Toker and co-workers[1] on life-threatening hemoptysis in a child, and have a few comments.
First, we agree that the definitions of hemoptysis should be reevaluated and that the amount of hemoptysis in pediatric patients should be defined according to body size index or weight [1]. Infact, we prefer to use this method for all patients regardless of age, sex, or body weight. The anatomical dead space of the major airway is a major determinant and equals 2 to 3 cm/kg of body weight. The literature does provide strategies for the management of massive hemoptysis, defined as more than 600 mL in 24 hours, and exsanguinating hemoptysis, which is considered the loss of at least 1,000 mL of blood at a rate of more than 150 mL/h. Another definition of massive hemoptysis is the expectoration of more blood than could be contained in the anatomical dead space (2 to 3 mL/kg) [3]. However, there is little in the current surgical literature on immediate treatment of catastrophic hemoptysis, which we define as major bleeding from the airway causing an immediate threat to life and requiring immediate surgical intervention [2].
In their case report, Toker and colleagues wrote that hemoptysis was categorized as mild (<150 mL/d), large (150 to 400 mL/d), or massive (>400 mL/d) (this classification was from a series of patients ranging from 0 to more than 20 years old [4]). We believe that the amount of hemoptysis should be defined according to the body size index or weight of the pediatric patient. In our study, we considered 3 consecutive days of hemoptysis of 50 mL for a girl weighing 30 kg to be an indication for endobronchial evaluation. This could be accepted as a sign of life-threatening hemoptysis, which could be considered to be 200 mL in a single episode. In a study [4] cited by Toker and associates, the amount of hemoptysis was reported to be a significant predictor of death only for patients with congenital heart disease. We do not agree at all; otherwise, the accepted definitions of hemoptysis are of no clinical or therapeutic value. That statement means that the treatment of all cases of hemoptysis should be the same, and we do not believe this to be true. Toker and coauthors thought that 3 consecutive days of hemoptysis of 50 mL for a girl weighing 30 kg to be an indication for endobronchial evaluation. In our opinion, 3 days of a marked amount of hemoptysis is too long to wait.
Last in a patient with hemoptysis and hydatid disease, what about routine medical treatment with albendazole either before or after operation, as the clinical course of hydatid disease differs depending on whether the cyst is in the liver or lung? Albendazole is widely used as a primary treatment in hydatid disease of the liver, and successful results have been reported. However, in the case of a hydatid cyst in the lung, albendazole usually results in suppuration and abscess formation with rupture of the cyst. Chemotherapy alone is not reliable in controlling pulmonary hydatid disease. Even if the parasite in the lung dies, the membranes in the lung become the source of recurrent infection [5].
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References
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- Toker A, Tanju S, Bayrak Y, et al. Life-threatening hemoptysis in a child: the only symptom. Ann Thorac Surg. 2004;77:336–338[Abstract/Free Full Text]
- Maguire MF, Berrya CB, Gellett L, Berrisford RG. Catastrophic haemoptysis during rigid bronchoscopy: a discussion of treatment options to salvage patients during catastrophic haemoptysis at rigid bronchoscopy. Interactive Cardiovasc Thorac Surg 2004;3:222–5
- Lordan JL, Gascoigne A, Corris PA. The pulmonary physician in critical care. Illustrative case 7: assessment and management of massive haemoptysis. Thorax. 2003;58:814–819[Free Full Text]
- Coss-Bu JA, Sachdeva RC, Brickes JT, Harrison GM, Jefferson LS. Hemoptysis: a 10-year retrospective study. Pediatrics. 1997;100:E7
- Kurkcuoglu IC, Eroglu A, Karaoglanoglu N, Polat P. Complications of albendazole treatment in hydatid disease of lung. Eur J Cardio-thorac Surg. 2002;22:649–650[Abstract/Free Full Text]
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