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Massive Haemoptysis Management — RACP Adult Medicine MCQ

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HardRespiratoryMassive Haemoptysis ManagementRACP Adult Medicine

A 35-year-old woman presents with massive haemoptysis (>500 mL in 24 hours). She has known bronchiectasis. She is haemodynamically stable but continues to cough blood. CXR shows bilateral bronchiectasis with new alveolar opacification in the left lower lobe. What is the most appropriate urgent intervention?

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Correct answer: D — Bronchial artery embolisation

Massive haemoptysis (>500 mL/24 hours or >100 mL/hour) from bronchiectasis requires urgent bronchial artery embolisation (BAE) as the first-line intervention. BAE has >90% immediate success rate. While arranging BAE: positioning (bleeding side down), airway protection (intubation if needed), tranexamic acid (IV 1g), and resuscitation. Surgery is reserved for BAE failure or life-threatening bleeding with identifiable source.

Reference: BTS – 2024 – Massive Haemoptysis; eTG Respiratory 2024