Lung

, Volume 196, Issue 1, pp 33–42 | Cite as

Severe Hemoptysis Associated with Bacterial Pulmonary Infection: Clinical Features, Significance of Parenchymal Necrosis, and Outcome

  • Guillaume Carteaux
  • Damien Contou
  • Guillaume Voiriot
  • Antoine Khalil
  • Marie-France Carette
  • Martine Antoine
  • Antoine Parrot
  • Muriel Fartoukh
RESPIRATORY INFECTION
  • 81 Downloads

Abstract

Purpose

Severe hemoptysis (SH) associated with non-tuberculosis bacterial lower respiratory tract infection (LRTI) is poorly described, and the efficacy of the usual decision-making process is unknown. This study aimed at describing the clinical, radiological patterns, mechanism, and microbiological spectrum of SH related to bacterial LRTI, and assessing whether the severity of hemoptysis and the results of usual therapeutic strategy are influenced by the presence of parenchymal necrosis.

Methods

A single-center analysis of patients with SH related to bacterial LRTI from a prospective registry of consecutive patients with SH admitted to the intensive care unit of a tertiary referral center between November 1996 and May 2013.

Results

Of 1504 patients with SH during the study period, 65 (4.3%) had SH related to bacterial LRTI, including non-necrotizing infections (n = 31), necrotizing pneumonia (n = 23), pulmonary abscess (n = 10), and excavated nodule (n = 1). The presence of parenchymal necrosis (n = 34, 52%) was associated with a more abundant bleeding (volume: 200 ml [70–300] vs. 80 ml [30–170]; p = 0.01) and a more frequent need for endovascular procedure (26/34; 76% vs. 9/31; 29%; p < 0.001). Additionally, in case of parenchymal necrosis, the pulmonary artery vasculature was involved in 16 patients (47%), and the failure rate of endovascular treatment was up to 25% despite multiple procedures.

Conclusions

Bacterial LRTI is a rare cause of SH. The presence of parenchymal necrosis is more likely associated with bleeding severity, pulmonary vasculature involvement, and endovascular treatment failure.

Keywords

Hemoptysis Pulmonary vasculature Endovascular treatment Parenchymal necrosis Necrotizing pneumonia 

Notes

Compliance with Ethical Standard

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Assistance Publique-Hôpitaux de Paris, Groupe Henri Mondor-Albert Chenevier, Service de Réanimation MédicaleCHU Henri MondorParisFrance
  2. 2.Faculté de Médecine de Créteil, Groupe de recherche clinique CARMASUniversité Paris Est CréteilParisFrance
  3. 3.Service de reanimation polyvalenteCentre Hospitalier d’ArgenteuilParisFrance
  4. 4.Assistance Publique-Hôpitaux de Paris, Unité de Réanimation médico-chirurgicale, Groupe hospitalier des Hôpitaux Universitaires de l’Est ParisienHôpital TenonParisFrance
  5. 5.Assistance Publique-Hôpitaux de Paris, Service d’Imagerie Médicale, Groupe Hospitalier des Hôpitaux Universitaires de l’Est ParisienHôpital TenonParisFrance
  6. 6.Assistance Publique-Hôpitaux de Paris, Service d’Imagerie MédicaleHôpital Bichat-Claude-BernardParisFrance
  7. 7.Université Paris 07ParisFrance
  8. 8.Sorbonne UniversitésUPMC Université Paris 06ParisFrance
  9. 9.Assistance Publique-Hôpitaux de Paris, Service d’anatomopathologie, Groupe Hospitalier des Hôpitaux Universitaires de l’Est ParisienHôpital TenonParisFrance

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