Non-massive versus massive hemoptysis and the impact of preoperative embolization in patients with destroyed lung parenchyma: a single-center experience.

Background: Pulmonary architectural destruction often leads to significant clinical manifestations, including productive cough, recurrent infections, and hemoptysis, which may range from mild to life-threatening. This study aimed to compare perioperative outcomes between patients with non-massive and massive hemoptysis undergoing surgical resection for hemoptysis secondary to inflammatory/infectious lung diseases with pulmonary parenchymal destruction and to evaluate the impact of preoperative bronchial artery embolization (BAE) in those with massive hemoptysis. Methods: A retrospective analysis was conducted on patients treated between 2019 and 2024. Patients were categorized into two groups based on hemoptysis severity. A subgroup analysis was performed among those with massive hemoptysis, comparing outcomes between patients who underwent preoperative BAE and those who did not. All patients were followed up for 1 year. Exclusion criteria included incomplete records and loss to follow-up. Results: Fifty-one patients were included (mean age 42 years, 57% female). Non-massive hemoptysis was observed in 32 patients: 19 presented with massive hemoptysis. Among the latter, 8 underwent preoperative BAE. Massive hemoptysis was associated with increased need for transfusion (P=0.046) and prolonged intensive care unit (ICU) stay (P=0.02). In the embolization subgroup, patients without BAE had significantly longer pleural drainage (P=0.01), greater intraoperative blood loss (P=0.050), longer ICU stay (P=0.02), and higher transfusion rates (P=0.03). Conclusions: Massive hemoptysis is associated with greater perioperative morbidity. Preoperative BAE appears to be a beneficial and safe adjunct, improving surgical outcomes by reducing bleeding, transfusion needs, and ICU length of stay.