Hemoptysis is a frequent manifestation of a wide variety of diseases, with mild to life-threatening presentations. The diagnostic workup and the management of severe hemoptysis are often challenging. Advances in endoscopic techniques have led to different new therapeutic approaches. Cold saline, vasoconstrictive and antifibrinolytic agents, oxidized regenerated cellulose, biocompatible glue, laser photocoagulation, argon plasma coagulation, and endobronchial stents and valves are amongst the tools available to the bronchoscopist. In this article, we review the evidence regarding the definition, etiology, diagnostic modalities, and treatment of severe hemoptysis in the modern era with emphasis on bronchoscopic techniques.

Hemoptysis is coughing up blood from the respiratory tract. Blood come from the respiratory tract such as nose, mouth, throat, the airway passages leading to the lungs, or the lungs. The word "hemoptysis" derived from the Greek "haima," meaning "blood," and "ptysis," which means "a spitting". Massive hemoptysis is production of ≥ 600 mL of blood within 24 h. The open access journals are peer reviewed scholarly journals of Clinical & Experimental Pathology.

It is estimated that 5–14% of patients presenting with hemoptysis will have life-threatening hemoptysis, with a reported mortality rate between 9 and 38%. This manuscript provides a comprehensive literature review on life-threatening hemoptysis, including the etiology and mechanisms, initial stabilization, and management of patients. There is no consensus on the optimal diagnostic approach to life-threatening hemoptysis, so we present a practical approach to utilizing chest radiography, computed tomography, and bronchoscopy, alone or in combination, to localize the bleeding site depending on patient stability. The role of angiography and embolization as well as bronchoscopic and surgical techniques for the management of life-threatening hemoptysis is reviewed. Through case presentation and flow diagram, an overview is provided on how to systematically evaluate and treat the bronchial arteries, which are responsible for hemoptysis in 90% of cases. Treatment options for recurrent hemoptysis and definitive management are discussed, highlighting the role of bronchial artery embolization for recurrent hemoptysis. It is estimated that 5–14% of patients presenting with hemoptysis will have life-threatening hemoptysis [1,2,3]. Life-threatening hemoptysis, also called massive hemoptysis, has been variably defined based upon criteria such as the volume per hour of bleeding, the total volume of bleeding per 24 h, or the presence of abnormal gas exchange or hemodynamic instability