Short outcome and evaluation of hemoptysis in patients with old pulmonary TB

ABSTRACT

Data concerning the evaluation of hemoptysis in patients affected by Tuberculosis backs to 1940-1960. Remarkable advances in anti TB agents together with effective treatment strategies such as DOTS [Directly Observed Treatment Short Course] has made the feature of the disease to be less associated with severe complications like hemoptysis due to bronchiectasis or fibrocavernous lesions. The objective of this study was to evaluate the short outcome of the patients with hemoptysis due to old tuberculosis and also the relation of the severity of hemoptysis with length of stay [LOS] in hospital and the severity of the pulmonary lesion in high quality imaging techniques. Forty-five patients with old TB and cardinal sign of hemoptysis were evaluated and after excluding the mycetoma and suggestive tumor formation, the coefficient correlation between the severity of hemoptysis and the LOS and also the correlation of the severity of hemoptysis and different pictures of pulmonary lesions in CT- scan were evaluated with Spearman's rho statistical analysis. All patients were discharged except one who had died because of the reasons other than asphyxia due to hemoptysis. One patient had undergone bronchial artery embolization. Pulmonary resection had been performed in none of the patients. According to the non-parametric coefficient correlation analysis, there were significant correlations between age and the first evidence of residual TB in the lung parenchyma [P=0.00, Spearman rho 0.00] and also between severity of hemoptysis and pulmonary lesions in CT scan at the level of 0.05; but no correlation was observed between the LOS and the severity of hemoptysis [P=0.0769] Hemoptysis due to old destructive pulmonary TB usually has a benign course. This is probably due to lung fibrosis and scarring caused by a prolonged inflammatory process which has led to an increase in vascular anastomosis. In old TB the source of bleeding is usually brochiectatic lesions which are directly correlated with the radiologic features found in chest- x- ray. The authors believe that although pulmonary resection in patients with life threatening hemoptysis is of considerable attention, conservative management of hemoptysis associated with arrested pulmonary TB is the first option