Cryptogenic hemoptysis - From a benign to a life-threatening pathologic vascular condition

Rationale: Data on hemoptysis of unknown origin (i.e., "cryptogenic") are scarce and the outcome of patients affected is controversial. Objectives: To describe the clinical spectrum and course of patients with cryptogenic hemoptysis, as well as pathologic findings when surgery is performed. Methods: A cohort of 81 patients referred for cryptogenic hemoptysis after clinical evaluation, chest radiography, fiberoptic bronchoscopy, and computed tomographic scan to a respiratory intermediate care and intensive care unit, from December 1995 to August 2004, with a prospective follow-up by visit or telephone interview. Measurements and Main Results: The 81 patients (69 males) had a mean cumulative volume of hemoptysis averaging 190 ml on admission. First-line conservative measures and bronchial artery embolization controlled hemoptysis in 73 patients (90%). Emergency surgery was performed in six patients (7%) because of failure of bronchial artery embolization, and secondary surgery was scheduled in a seventh patient. A total of 73 patients were followed for a mean of 47 ( 35) months. No lung cancer developed. Hemoptysis recurred in 10 patients (4 within the first year; 6 between I and 8 yr later), 2 of whom underwent surgery. A specific bronchial vascular involvement (Dieulafoy disease) was demonstrated in five of the nine patients who had undergone surgery,, especially in those with high amounts of bleeding. Conclusions: Cryptogenic hemoptysis may be a life-threatening condition. Nonsurgical approaches provide immediate control of bleeding in most patients with cryptogenic hemoptysis, with few recurrences in both short and long terms. Dieulafoy disease of the bronchus, unsuspected after routine imaging investigations, may be involved in a subset of patients yet to be determined.