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Hämoptysen

Hemoptysis

  • Leitthema
  • Published:
Der Pneumologe Aims and scope

Zusammenfassung

Hämoptysen sind potenziell lebensbedrohliche Komplikationen unterschiedlichster Krankheiten. Häufigste Ursachen sind entzündliche und infektiöse Erkrankungen, gefolgt von Neoplasmen, Lungenembolien, Herzklappenfehlern, Gerinnungsstörungen und zahlreichen Systemerkrankungen. Routineuntersuchungen sind: Thoraxröntgenbild, (Angio-)CT und Bronchoskopie sowie evtl. eine Kontrastdarstellung der Bronchialarterien. Gefährdet ist der Patient durch Verschlüsse der Atemwege mit Koageln. Die wichtigsten Maßnahmen bei Hämoptoe sind daher Sauerstoffgabe, Lagerung auf die blutende Seite, bronchoskopische Absaugung von Blut und Gerinnseln. Gerinnungsstörungen müssen ausgeglichen werden. Kurzfristig helfen vasokonstriktive Medikamente. Bei zentralen Prozessen kann man über das Bronchoskop mit dem Argon-Plasma-Beamer oder dem Laser koagulieren. Bei schweren Blutungen aus der Peripherie muss eine Ballon- oder Tubustamponade durchgeführt werden. Je nach Ursache und Schweregrad der Hämoptoe folgt eine antientzündliche Behandlung, eine hämostyptische Strahlentherapie, eine Bronchialarterienembolisation oder eine Operation.

Abstract

Hemoptysis is a potentially life-threatening complication of various diseases. The most common causes are infectious and inflammatory processes, followed by neoplasms, pulmonary embolisms, mitral stenoses, coagulopathies, and multiple systemic disorders. Primary examinations include chest X-ray, angio CT, and bronchoscopy. Sometimes, a bronchial artery angiogram is required. The patient is at risk of suffocation because blood and clots can severely obstruct his airways. Thus, the most important measures are supplemental oxygen, positioning the patient with the bleeding side down, bronchoscopic suctioning, and removal of blood and clots. Coagulopathies have to be corrected. Application of vasoactive drugs may help temporarily. In cases of bleeding from central lesions, coagulation with laser or argon plasma coagulator is feasible. Heavy bleeding from the periphery requires a balloon or tube tamponade. Depending on the cause and the severity of the bleeding anti-inflammatory medical treatment, hemostyptic radiation therapy, bronchial artery embolization, or a surgical procedure must follow.

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Authors and Affiliations

  1. Thoraxklinik am Universitätsklinikum Heidelberg, Amalienstraße 5, 69126 , Heidelberg

    F. Herth & R. Eberhardt

  2. Lungenklinik Hemer

    L. Freitag

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  1. F. Herth
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  2. R. Eberhardt
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  3. L. Freitag
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Correspondence to F. Herth.

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Herth, F., Eberhardt, R. & Freitag, L. Hämoptysen. Pneumologe 3, 188–196 (2006). https://doi.org/10.1007/s10405-006-0095-y

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