ABSTRACT
This article presents the case of a young woman with massive hemoptysis (1,000 mL in 6 hours) due to tuberculosis, which could not be controlled by insertion of a Fogarty catheter through a fiber-optic bronchoscope. Because of asphyxia and persistent bleeding risk we instilled fibrinogen-thrombin through a fiber-optic bronchoscope inserted catheter, achieving bleeding cessation and permitting the placing of a double-lumen oro-tracheal tube. Later on, the patient underwent lobectomy and anti-tuberculosis treatment. The fibrinogen-thrombin could be considered as a bridge, transitory measure for massive hemoptysis, while definitive treatment could be established.
Subject(s)
Aprotinin/therapeutic use , Factor XIII/therapeutic use , Fibrin Tissue Adhesive/therapeutic use , Fibrinogen/therapeutic use , Hemoptysis/therapy , Hemostatic Techniques , Thrombin/therapeutic use , Adult , Antitubercular Agents/therapeutic use , Aprotinin/administration & dosage , Balloon Occlusion , Bronchoscopy/methods , Catheters , Cholangiopancreatography, Endoscopic Retrograde/instrumentation , Combined Modality Therapy , Drug Combinations , Emergencies , Factor XIII/administration & dosage , Female , Fiber Optic Technology , Fibrin Tissue Adhesive/administration & dosage , Fibrinogen/administration & dosage , Hemoptysis/etiology , Hemoptysis/surgery , Hemostatic Techniques/instrumentation , Humans , Intubation, Intratracheal/instrumentation , Pneumonectomy , Thrombin/administration & dosage , Tuberculosis, Pulmonary/complications , Tuberculosis, Pulmonary/drug therapy , Tuberculosis, Pulmonary/surgeryABSTRACT
Se presenta el caso de una paciente joven con hemoptisis masiva por tuberculosis que no pudo ser controlada de forma efectiva con la inserción de un catéter Fogarty por un fibrobroncoscopio. Ante esto y el alto riesgo de asfixia o desangramiento, se decidió infundir fibrinógeno-trombina a través de un catéter, introducido por el fibrobroncoscopio; con esto se logró controlar el sangrado, intubarla con un tubo orotraqueal de doble luz y estabilizarla para remitirla a otra institución, donde fue sometida a lobectomía y se le proporcionó tratamiento antituberculoso. La infusión de fibrinógeno-trombina podría considerarse como una opción terapéutica transitoria, de tipo puente, mientras se practica el manejo definitivo.
This article presents the case of a young woman with massive hemoptysis (1,000 mL in 6 hours) due to tuberculosis, which could not be controlled by insertion of a Fogarty catheter through a fiber-optic bronchoscope. Because of asphyxia and persistent bleeding risk we instilled fibrinogen-thrombin through a fiber-optic bronchoscope inserted catheter, achieving bleeding cessation and permitting the placing of a double-lumen oro-tracheal tube. Later on, the patient underwent lobectomy and anti-tuberculosis treatment. The fibrinogen-thrombin could be considered as a bridge, transitory measure for massive hemoptysis, while definitive treatment could be established.
