Mehmet Ali Aslaner, Mustafa Çolak

Hemoptizi Yakınması ile Başvuran Hastalarda Etyolojik Değerlendirme

Amaç Hemoptizi yakınması ile Göğüs Hastalıkları polikliniği ve Acil polikliniğine başvuran hastalarda altta yatan etiyolojik faktörlerin dağılımını değerlendirmekGereç veYöntemler01.01.2018 / 30.06.2018 tarihleri arasında hastanemize hemoptizi yakınması ile başvuran 101 hastanın kayıtları retrospektif olarak incelendi.Bulgular Kayıtları incelenen 101 hastanın %50,50’si (n=51) kadın, %49,50’si (n=50) erkek idi. Hastaların ortanca yaşı 51 (IQR 34-64) saptandı. Hemoptizi miktarına göredeğerlendirildiğinde 99 hastada minör hemoptizi gözlenmiş olup, 2 hastada masif hemoptizi görülmüştür. Hastaların akciğer grafilerinde en sık gözlenen patolojikbulgular; infiltrasyon (%22,77), KOAH (%7,92) ve bronşektazi (%6,93) idi. Toraks bilgisayarlı tomografilerinde en sık gözlenen patolojik bulgular ise infiltrasyon (%21,73),bronşektazi (%10,14) ve pulmoner tromboemboli (%8,69) idi. Tanısal değerlendirme amaçlı 16 (%17,80) hastaya fiberoptik bronkoskopi uygulandı. 9 hastada kanama odağısaptanırken, 7 hastada kanama bulgusuna rastlanılmadı. Hastalarda saptanan en sık hemoptizi nedenleri; akut bronşit (%36,63), idiyopatik hemoptizi (%21,78) ve pnömoni(%20,79) idi. Göğüs Hastalıkları polikliniğine başvuran hastalarda akut bronşit, idiyopatik hemoptizi ve pnömoni daha sık izlenirken, Acil polikliniği başvurularındabronşektazi ve pulmoner tromboemboli tanılarının daha sık izlendiği görüldü.Sonuç İkinci basamak sağlık kuruluşlarına hemoptizi yakınması ile başvurularda olguların çoğunluğunu enfeksiyöz nedenler ve idiyopatik hemoptizi oluşturmaktadır. Zamaniçerisinde hemoptizi etiyolojisinde yer alan hastalıkların sıklığında değişiklik gözlenmiş ve daha benign hastalıklara bağlı oluşan hemoptiziler ön plana çıkmıştır.

Etiological Evaluation in Patients Presenting with Hemoptysis

Objective The aim of study is to evaluate the distribution of the underlying etiologic factors in patients admitted to the Chest Diseases outpatient clinic and emergency department with the complaint of hemoptysis. Materials and Methods 101 patients, who were admitted to our hospital for hemoptysis between 01.01.2018 / 30.06.2018, were retrospectively reviewed. Results Of the 101 patients whose records were examined, %50,50 (n=51) were female and %49,50 (n=50) were male. The median age of the patients was 51 (IQR 34-64). According to the amount of hemoptysis, 99 patients had minor hemoptysis and 2 patients had massive hemoptysis. The most common pathological findings in patients with chest radiographs; infiltration (%22,77), COPD (%7,92) and bronchiectasis (%6,93). The most common pathological findings in thorax computed tomography were infiltration (%21,73), bronchiectasis (%10,14) and pulmonary thromboembolism (%8,69). Fiberoptic bronchoscopy was performed in 16 (%17,80) patients for diagnostic evaluation. Bleeding was detected in 9 patients and no bleeding was observed in 7 patients. The most common causes of hemoptysis in patients were; acute bronchitis, idiopathic hemoptysis and pneumonia. Acute bronchitis (%36,63), idiopathic hemoptysis (%21,78) and pneumonia (%20,79) were more common in the patients admitted to the Chest Diseases outpatient clinic; however, bronchiectasis and pulmonary thromboembolism diagnoses were more frequent in emergency polyclinic applications. Conclusion The majority of the cases with infectious causes and idiopathic hemoptysis are present in the second step health institutions with complaints of hemoptysis. There was a change in the frequency of diseases in the etiology of hemoptysis and haemoptysis due to more benign diseases was come into prominence.

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1. .Jeudy J, Khan AR, Mohammed TL, et al: ACR. Appropriateness Criteria hemoptysis. J Th orac Imaging 2010; 25:67-69.
2. Özlu T. Massif hemoptizi. İçinde: Ekim N, Turktaş H, editör. Goğüs hastalıkları acilleri. 1. Baskı. Ankara: Bilimsel Tıp Yayınevi; 2000. s.241-246.
3. Hirsberg B, Biran I, Glazer M, et al: Hemoptysis: etiology, evaluation, and outcome in a tertiary referral hospital.Chest 1997; 112(2):440-444.
4. Corey R, Hla KM. Major and massive hemoptysis: reassessment of conservative management. Am J Med Sci 1987; 294(5):301-309.
5. Patel SR. Stoller JK: Th e role of bronchoscopy in hemoptysis. İn: Wang K, Mehta AC (eds). Flexible Bronchoscopy. Cambridge: Blackwell Science, 1995: p.298-321.
6. Lordan JL, Gascoigne A, Corris PA. Th e pulmonary physician in criticalcare. Illustrative case 7: Assessment and management of massive hemoptysis. Th orax 2003; 58(9):814-819.
7. Weinberger SE, Braunwald E. Cough and hemoptysis. In: Braunwald E, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL (eds). Harrison’s Principles of Internal Medicine, 15 th ed. New York: McGraw-Hill. 2001: p.203-206.
8. Reisz G, Stevens D, Boutwell C, et al: Th e causes of hemoptysis revisited. A review of the etiologies of hemoptysis between 1986 and 1995. MoMed 1997; 94:633-637.
9. Santiago S, Tobias J, Williams AJ. A reappraisal of the causes of hemoptysis. Arch Intern Med 1991; 151(12):2449-2451.
10. Herth F, Ernst A, Becker HD. Long-term outcome and lung cancer incidence in patients with hemoptysis of unknown origin. Chest 2001; 120(5):1592-1594.
11. Lee BR, Yu JY, Ban HJ, et al. Analysis of patients with hemoptysis in a tertiary referral hospital. Tuberc Respir Dis (Seoul) 2012; 73(2):107-114.
12. Doğan ÖT, Berk S, Engin A, Akkurt İ. Hemoptizide etiyolojk faktörler. Cumhuriyet Tıp Dergisi 2010; 32:48-53.
13. Özgül MA, Turna A, Yıldız P, Ertan E, Kahraman S, Yılmaz V. Risk factors and recurrence patterns in 203 patients with hemoptysis Tüberküloz ve Toraks Dergisi 2006; 54(3): 243- 248.
14. McGuinness G, Beacher JR, Harkin TJ, Garay SM, Rom WN, Naidich DP. Hemoptysis: prospective high-resolution CT/bronchoscopic correlation. Chest 1994; 105(4):1155-1162.
15. Set PA, Flower CD, Smith IE, Chan AP, Twentyman OP, Shneerson JM. Hemoptysis: comparative study of the role of CT and fiberoptic bronchoscopy. Radiology 1993; 189(3):677-680.
16. Yoon W, Kim JK, Kim YH, Chung TW, Kang HK. Bronchial and nonbronchial systemic artery embolization for life threatening hemoptysis: a comprehensive review. Radiographics 2002; 22(6):1395-1409.
17. İntepe Y.S, Aydın Y. Hemoptizi: Tanısal yöntemlerin karşılaştırılması ve Akciğer Kanseri için risk faktörlerinin belirlenmesi. Bozok Tıp Dergisi 2016; 6(2):38-47.
18. Garzon AA, Gourin A. Surgical management of massive hemoptysis. A ten-year experience. Ann Surg. 1978; 187(3):267-271.
19. Conlan AA, Hurwitz SS, Krige L, Nicolaou N, Pool R. Massive hemoptysis. Review of 123 cases. J Th orac Cardiovasc Surg. 1983; 85(1):120-124.
20. Knott-Craig CJ, Oostruizen JG, Rossouw G, Joubert JR, Barnard PM. Management and prognosis of massive hemoptysis. Recent experience with 120 patients. J Th orac Cardiovasc Surg. 1993; 105(3):394-397.
21. Lee TW, Wan S, Choy DK, Chan M, Arifi A, Yim AP. Management of massive hemoptysis: a single institution experience. Ann Th orac Cardiovasc Surg. 2000; 6(4):232-235.
22. Jougon J, Ballester M, Delcambre F, et al: Massive hemoptysis: what place for medical and surgical treatment. Eur J Cardiothorac Surg. 2002; 22(3):345-351.
23. Ünsal E, Köksal D, Çimen F, Hoca NT, Şipit T. Analysis of patients with hemoptysis in a reference hospital for chest diseases. Tüberküloz ve Toraks Dergisi 2006; 54(1):34-42.
24. Çelik P, Gönlügür U, Akın M, Orman A. “Hemoptizili Olgularımızın Analizi”.Heybeliada Tıp Bülteni Ocak 1997; 3:45-48.
25. Nawal SK, Heda MR. Hemoptysis: A prospective analysis of 110 cases. Asian J Biomed Pharm Sci 2013; 3:1-3.
26. Şenyiğit A, Bayram H, Asan E, Bukte Y, Topçu F. “Akciğer Radyografisi Normal Saptanan Hemoptizili Olgularda Fiberoptik Bronkoskopi ve Yüksek Rezolüsyonlu Bilgisayarlı Tomografinin Tanıdaki Değeri”. Solunum Hastalıkları 2001; 12:123-128.
27. Tsoumakidou M, Chrysofakis G, Tsiligianni I, Maltezakis G, Siafakas NM, Tzanakis N. Prospective Analysis of 184 Hemoptysis Cases – Diagnostic Impact of Chest X-Ray, Computed Tomography, Bronchoscophy. Respiration 2006; 73(6):808-814. 28. Seki N, Shiozaki G, Ota M. Risk Factors for a Second Episode of Hemoptysis. Clinical Medicine: Circulatory Respiratory and Pulmonary Medicine 2009; 3:1-7