Comparison of medical v surgical treatment of major hemoptysis.

One hundred thirteen patients hospitalized with substantial hemoptysis were studied. Thirty-one patients underwent surgery and 82 were treated medically, and the two groups had similar diagnoses and bleeding patterns. There were four deaths in the surgical group and 18 deaths in the medical group. Of these, eight patients had a sudden first hemoptysis with instantaneous death. Ten patients had a terminal hemoptysis after prior bleeding, but nine of these patients had absolute contraindications for surgery. In 64 patients hemoptysis was controlled with medical treatment. Most patients showed a steady decrease of bleeding, with cessation of hemoptysis after four days. Our experience indicates that the majority of patients with serious hemoptysis can be successfully treated conservatively. Massive hemoptysis, aspiration, or recurrence of bleeding in and of themselves are not indications for surgery. Where the hemoptysis remains uncontrolled in spite of a trial of adequate medical care or where the aspiration is severe and progressive, surgery may be indicated and can be lifesaving.