Massive Haemoptysis — RACP Adult Medicine MCQ

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ModerateRespiratoryMassive HaemoptysisRACP Adult Medicine

A 50-year-old man with bronchiectasis and chronic Pseudomonas colonisation develops massive haemoptysis (>600 mL in 24 hours). He is haemodynamically unstable despite resuscitation. What is the most appropriate immediate intervention?

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Correct answer: C — Emergency thoracotomy

Massive haemoptysis (>600 mL/24 hrs or haemodynamically significant) is a life-threatening emergency. The immediate priorities are airway protection (intubation with a large ETT or double-lumen tube), positioning bleeding side DOWN, and haemodynamic resuscitation. Bronchial artery embolisation (BAE) by interventional radiology is the definitive first-line treatment and achieves immediate haemostasis in 70–90% of cases. If BAE fails or is unavailable, surgical resection (lobectomy) may be required. IV tranexamic acid is an adjunct. Endobronchial balloon tamponade is a temporising measure while arranging BAE.

Reference: eTG – 2025 – Respiratory; BTS – 2015 – Massive Haemoptysis Guidelines