Hemoptysis case presentation

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Information about Hemoptysis case presentation
Health & Medicine

Published on September 12, 2014

Author: Alsheef

Source: slideshare.net


case scenario
How to diagnose
Guidlines and protocols

Hemoptysis DMC Hussain Alsheef ENT resident

Case scenario  25 y/o Saudi male, smoker , medically free  c/o coughing blood for 3days  No SOB or chest pain  No hoarsness , dysphagia , odynophagia or chocking  No nasal obstruction or epistaxis  No bleeding disorder  No contact with TB pt.  No fever or wt. loss

O/E  Laying comfortably on bed not on distress  Not pale  V/S : BP=124/80 , P=84 , O2 sat=99% on room air , T=36.7  Throat : no post nasal bleeding  Nose :  Ant. Rhinoscopy : free  Flexible scope : no bleeding points seen in nasal septum or turbinates  Pharynx and larynx free  Neck : no lymph nodes

Investigations  Blood inv.  CBC  Chemistry  Coagulation profile  Imaging studies  CXR  CT scan  Scope


Airway diseases Inflammatory (bronchitis , bronchiectasis) F.B Airway trauma Neoplasms (bronchogenic ca.) Lungs Infections Tb. , pneumonia Autoimmune diseases (wegner ,goodpasture syndrome , SLE Pul.vasculature Lt. heart failure Pulmonary AV malformation Thrombo-embolism Others Coagulopathy Cocaine use Iatrogenic

Hemoptysis  expectoration of blood  typically from the lower respiratory tract,  upper (respiratory & GI) tracts can be expectorated and mimic blood coming from the lower respiratory tract  Hemoptysis is classified as nonmassive or massive based on the volume of blood loss  Massive hemoptysis > 200cc / day  The low-pressure pulmonary system tends to produce small-volume hemoptysis, whereas bleeding from the bronchial system, which is at systemic pressure, tends to be profuse  most common causes of hemoptysis are acute and chronic bronchitis, pneumonia, tuberculosis, and lung cancer Infection : 60-70% of cases Cancer : 23% of cases in US

Evalutation of hemoptysis CBC , coagulation , RFT CXR Flexible bronchoscopy CT

Key points  Hemoptysis needs to be distinguished from hematemesis and nasopharyngeal or oropharyngeal bleeding.  Bronchitis, bronchiectasis, TB, and necrotizing pneumonia or lung abscess are the most common causes in adults.  Lower respiratory tract infection and foreign body aspiration are the most common causes in children.  Patients with massive hemoptysis require treatment and stabilization before testing.  Bronchial artery embolization is the preferred treatment for massive hemoptysis.

References  Uptodate.com Etiology and evaluation of hemoptysis in adults  Merck Manual Hemoptysis .. Last reviewed literature on July 2014

Thank you

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