How can Tuberculosis (TB) cause hemoptysis?

From the Guidelines

Tuberculosis (TB) causes hemoptysis primarily through direct damage to lung tissue and blood vessels, leading to the erosion of bronchial arteries and the formation of abnormal blood vessels prone to rupture. The mechanism of TB-induced hemoptysis involves the formation of granulomas, which can undergo necrosis and cavitation, creating cavities in the lung tissue that contain exposed and damaged blood vessels 1. As the disease progresses, the erosion of these blood vessels results in bleeding into the airways, ranging from mild to severe hemoptysis. Additionally, TB can cause the formation of Rasmussen's aneurysms, which are prone to rupture and cause significant bleeding, and lead to bronchiectasis, a condition that further contributes to hemoptysis 1. The treatment of hemoptysis due to TB requires prompt initiation of a standard anti-TB regimen, and in cases of massive hemoptysis, bronchial artery embolization (BAE) has become a first-line therapy, with high success rates, as reported in recent studies 1. Some of the key studies that support the use of BAE in the treatment of hemoptysis include those by Pei et al, Bhalla et al, Shao et al, Agmy et al, Woo et al, and Shin et al, which demonstrate high success rates and low recurrence rates for BAE in patients with massive hemoptysis due to TB or other causes 1. Overall, the management of hemoptysis due to TB requires a comprehensive approach that includes prompt treatment with anti-TB medications and consideration of BAE in cases of severe bleeding. Key points to consider in the management of TB-induced hemoptysis include:

• Prompt initiation of anti-TB therapy
• Consideration of BAE in cases of massive hemoptysis
• Monitoring for complications such as bronchiectasis and Rasmussen's aneurysms
• Individualized treatment approaches based on the severity of hemoptysis and the presence of underlying lung disease.

From the Research

Causes of Hemoptysis in Tuberculosis

• Tuberculosis (TB) can cause hemoptysis due to the damage it inflicts on the lungs and airways 2, 3.
• The most common causes of hemoptysis are tuberculosis, lung carcinoma, and bronchiectasis, but idiopathic forms are frequent 3.
• In TB, hemoptysis can occur due to inflammatory hypervascularity, contrast material extravasation, and pseudoaneurysms 2.

Mechanism of Hemoptysis in TB

• Blood originates most often from bronchial circulation, which can be affected by TB 3.
• The disease can cause damage to the lung tissue, leading to the formation of cavities and the rupture of blood vessels, resulting in hemoptysis 2, 4.

Treatment and Management

• The management of life-threatening hemoptysis is mainly based on either surgical approach or bronchial artery embolization 3.
• Bronchial artery embolization is an effective and safe technique in the management of life-threatening hemoptysis secondary to tuberculosis 2, 4.
• The treatment of TB itself involves the use of antibiotics, such as isoniazid, rifampin, pyrazinamide, and ethambutol, which can help to reduce the risk of hemoptysis 5, 6.

Outcomes and Complications

• The hemoptysis control rate was 86.6% at 14 days, 84.8% at 30 days, 78.6% at 240 days, and 75.9% at 360 days, respectively, after bronchial artery embolization 4.
• Patients with active tuberculosis had a significantly longer recurrence-free duration than did patients with inactive tuberculosis 4.
• The most common complication of bronchial artery embolization was transient chest pain 4.