Diffuse alveolar hemorrhage: Difference between revisions
ClaireLewis (talk | contribs) |
ClaireLewis (talk | contribs) No edit summary |
||
| Line 8: | Line 8: | ||
*[[Anemia]] | *[[Anemia]] | ||
*Diffuse lung infiltrates | *Diffuse lung infiltrates | ||
*Acute hypoxemic respiratory failure | *Acute hypoxemic [[respiratory failure]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Idiopathic small vessel vasculitis | *Idiopathic small vessel vasculitis | ||
**[[Granulomatosis with polyangiitis]] (Wegener's) | **[[Granulomatosis with polyangiitis]] (Wegener's) | ||
**Churg- | **[[Churg-Strauss syndrome]] | ||
**Microscopic polyangitis | **Microscopic polyangitis | ||
*Primary immune complex-mediated vasculitis | *Primary immune complex-mediated vasculitis | ||
**Goodpasture | **[[Goodpasture syndrome]] | ||
**[[Henoch-Schonlein purpura]] | **[[Henoch-Schonlein purpura]] | ||
*Secondary vasculitis | *Secondary vasculitis | ||
| Line 33: | Line 33: | ||
==Evaluation== | ==Evaluation== | ||
*Clinical suspicion with falling hematocrit | *Clinical suspicion with falling hematocrit | ||
*Radiographic imaging consistent with bilateral infiltration (CXR, CT) - can be patchy, focal or diffuse | *Radiographic imaging consistent with bilateral infiltration ([[CXR]], CT) - can be patchy, focal or diffuse | ||
*Bronchoscopy with BAL showing sequentially increasing RBC counts | *Bronchoscopy with BAL showing sequentially increasing RBC counts | ||
==Management== | ==Management== | ||
*Airway stabilization if large volume hemoptysis or problems with oxygenation/ventilation (>8.0 ETT preferable) | *Airway stabilization if large volume hemoptysis or problems with oxygenation/ventilation (>8.0 ETT preferable) | ||
*IV corticosteroids - high dose [[Corticosteroids|Methylprednisolone]] Q6H<ref>Park M. Diffuse Alveolar Hemorrhage. Tuberc Resp Dis (Seoul) 2013. 74(4):151-162</ref> | *IV [[corticosteroids]] - high dose [[Corticosteroids|Methylprednisolone]] Q6H<ref>Park M. Diffuse Alveolar Hemorrhage. Tuberc Resp Dis (Seoul) 2013. 74(4):151-162</ref> | ||
*Bronchoscopy to obtain BAL and localize source of bleeding if localizable | *Bronchoscopy to obtain BAL and localize source of bleeding if localizable | ||
*[[Hemoptysis|Management of Hemoptysis]] | *[[Hemoptysis|Management of Hemoptysis]] | ||
| Line 48: | Line 48: | ||
*[[Hemoptysis]] | *[[Hemoptysis]] | ||
== | ==External Links== | ||
[http://lifeinthefastlane.com/ccc/diffuse-alveolar-haemorrhage/ Life in the Fast Lane: Diffuse Alveolar Hemorrhage] | [http://lifeinthefastlane.com/ccc/diffuse-alveolar-haemorrhage/ Life in the Fast Lane: Diffuse Alveolar Hemorrhage] | ||
Revision as of 21:24, 22 August 2019
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-Strauss syndrome
- Microscopic polyangitis
- Primary immune complex-mediated vasculitis
- 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
External Links
Life in the Fast Lane: Diffuse Alveolar Hemorrhage