HemoptysisDMC

Hussain AlsheefENT 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

DDx

Airway diseases

Inflammatory

(bronchitis , bronchiectasis)

F.B

Airway trauma

Neoplasms(bronchogenic

ca.)

Lungs

InfectionsTb. ,

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 areacute 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

CXRFlexible bronchoscopyCT

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