Published on September 12, 2014
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
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