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Massive Haemoptysis Aspergilloma — SCE Infectious Diseases MCQ

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HardRespiratory InfectionMassive Haemoptysis AspergillomaSCE Infectious Diseases

An unstable patient with a known aspergilloma has life-threatening haemoptysis. Resuscitation and airway protection are underway. Which haemostatic intervention is the preferred urgent bridge?

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Correct answer: D — Emergency bronchial-artery embolisation, with definitive surgical assessment after bleeding control with review after review

The best answer is “Emergency bronchial-artery embolisation, with definitive surgical assessment after bleeding control with review after review”. Most aspergilloma bleeding arises from hypertrophied bronchial arteries; embolisation can rapidly control haemorrhage while definitive resection is considered. “Diagnostic bronchoscopy alone despite uncontrolled haemorrhage” is less appropriate because it conflicts with the clinical discriminator or cited guidance. “Intravenous voriconazole as the sole immediate haemostatic measure” is less appropriate because it conflicts with the clinical discriminator or cited guidance. “Tranexamic acid alone despite ongoing shock” is less appropriate because it conflicts with the clinical discriminator or cited guidance. “Bilateral chest drains” is less appropriate because it conflicts with the clinical discriminator or cited guidance.

Reference: BTS clinical statement on chronic pulmonary aspergillosis: https://www.brit-thoracic.org.uk/clinical-resources/clinical-statements/aspergillus-related-chronic-lung-disease/