Diffuse alveolar hemorrhage: Difference between revisions
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**[[Polymyositis]]/[[Dermatomyositis]] | **[[Polymyositis]]/[[Dermatomyositis]] | ||
*Acute [[lung transplant]] rejection | *Acute [[lung transplant]] rejection | ||
*Drug induced (ie. chemotherapy, [[amiodarone]], propylthiouracil) | *Drug induced (ie. chemotherapy, [[amiodarone]], [[propylthiouracil]]) | ||
*[[ARDS]] | *[[ARDS]] | ||
*Multilobar [[Pneumonia]] | *Multilobar [[Pneumonia]] | ||
Revision as of 01:14, 14 November 2016
Background
- Diffuse Alveolar Hemorrhage (DAH) is a life-threatening condition
- It is a subset of Pulmonary hemorrhage involving the microcirculation involving alveolar microvasculature
- Most commonly the result of systemic vasculitis [1]
Clinical Features
- Hemoptysis ( may be initially absent in up 33% of DAH presentations [2]
- Anemia
- Diffuse lung infiltrates
- Acute hypoxemic respiratory failure
Differential Diagnosis
- Idiopathic small vessel vasculitis
- Granulomatosis with polyangiitis (Wegener's)
- Churg-Straus syndrome
- Microscopic polyangitis
- Primary immune complex-mediated vasculitis
- Goodpasture's syndrome
- Henoch-Schonlein purpura
- Secondary vasculitis
- Systemic lupus erythematosus
- Rheumatoid arthritis
- Mixed connective tissue disease
- Polymyositis/Dermatomyositis
- Acute lung transplant rejection
- Drug induced (ie. chemotherapy, amiodarone, propylthiouracil)
- ARDS
- Multilobar Pneumonia
- Coagulopathy
- Pulmonic veno-occlusive disease
- Mitral stenosis
Evaluation
- Clinical suspicion with falling hematocrit
- Radiographic imaging consistent with bilateral infiltration (CXR, CT) - can be patchy, focal or diffuse
- Bronchoscopy with BAL showing sequentially increasing RBC counts
Management
- Airway stabilization if large volume hemoptysis or problems with oxygenation/ventilation (>8.0 ETT preferable)
- IV corticosteroids - high dose Methylprednisolone Q6H[3]
- Bronchoscopy to obtain BAL and localize source of bleeding if localizable
- Management of Hemoptysis
Disposition
- Typically requires upper level of care
See Also
Exteernal Links
Life in the Fast Lane: Diffuse Alveolar Hemorrhage