Introduction

Optimum management involves a team approach including the intensive care specialist, the pulmonologist, the radiologist, the anesthetist, and the thoracic surgeon. The greatest immediate vital risk to the patient is asphyxia. Therefore control of the airway is the most important aspect of initial management. Bronchoscopy is usually the single most valuable diagnostic procedure. Medical treatment, including systemic vasopressors, topical treatment such as endobronchial tamponade, and/or intrabronchial instillation of a fibrin sealant, may help to stabilize the patient. In the majority of cases, definitive treatment will involve arteriography followed by embolization or, if embolization is not available or is unsuccessful, pulmonary resection if the patient has adequate pulmonary reserves and no major contraindications to surgery.

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