Situation

A patient with bronchiectasis in the RML and LLL has continuing haemoptysis, and is referred for surgical intervention. What would you do ?

Opinion

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Opinion

You need to do a bronchoscopy at the time of bleeding to assess which lobe the blood is actually coming from.

Ct scan to exclude a mass.

Options depending on clinical setting then are:

1 Observe

2 Aortogram and selective bronchial artery embolisation

3 Lobectomy either RML or LLL, the former being less of a physiological upset to the patient. Pulmonary resection in this setting is high risk, as the patient has not usually been assessed as thoroughly, and the blood in the airway usually damages the remaining pulmonary parenchyma.