Hemoptysis: Difference between revisions
No edit summary
Line 4: Line 4:
*Easy to confuse w/ epistaxis or oropharynx bleeding
*Easy to confuse w/ epistaxis or oropharynx bleeding


==Clinical Features==


==Workup==
==Differential Diagnosis==
#Imaging
*Infectious
##CXR
**Bronchitis
###Nml in 30% (most of whom end up having bronchitis)
**[[Pneumonia|PNA]]
##Chest CT w/ IV contrast
**Lung abscess
###Indicated for gross hemoptysis or suspicious CXR
**[[Tuberculosis (TB)|TB]]
##Bronchoscopy
**[[Plague]]
#Labs
*Neoplastic
##CBC
**Lung cancer
##Coags
**Metastatic cancer
##Sputum stain/cx
*CV
##Chem (cr)
**[[Pulmonary Embolism (PE)|PE]]
##T&S/T&C
**[[Congestive Heart Failure (CHF)|CHF]]
##UA (autoimmune)
**[[Pulmonary Hypertension (Decompensation)|Pulmonary HTN]]
##ECG (pulm HTN/PE)
**AV malformation
*Mitral stenosis
*Alveolar hemorrhage syndromes
**Goodpasture
**Wegener
**[[Lupus|SLE]]
*Hematologic
**Uremia
**Plt dysfunction (ASA, clopidogrel)
**Anticoagulant therapy
*Traumatic
**Foreign body aspiration
**Ruptured bronchus
*Inflammatory
**Bronchiectasis
**Cystic Fibrosis
*Miscellaneous
**Cocaine inhalation (crack lung)
**Catamenial pneumothorax


==DDx==
=Diagnosis==
#Infectious
*Imaging
##Bronchitis
**CXR
##[[Pneumonia|PNA]]
***Nml in 30% (most of whom end up having bronchitis)
##Lung abscess
**Chest CT w/ IV contrast
##[[Tuberculosis (TB)|TB]]
***Indicated for gross hemoptysis or suspicious CXR
##[[Plague]]
**Bronchoscopy
#Neoplastic
*Labs
##Lung cancer
**CBC
##Metastatic cancer
**Coags
#CV
**Sputum stain/cx
##[[Pulmonary Embolism (PE)|PE]]
**Chem (cr)
##[[Congestive Heart Failure (CHF)|CHF]]
**T&S/T&C
##[[Pulmonary Hypertension (Decompensation)|Pulmonary HTN]]
**UA (autoimmune)
##AV malformation
**ECG (pulm HTN/PE)
#Mitral stenosis
#Alveolar hemorrhage syndromes
##Goodpasture
##Wegener
##[[Lupus|SLE]]
#Hematologic
##Uremia
##Plt dysfunction (ASA, clopidogrel)
##Anticoagulant therapy
#Traumatic
##Foreign body aspiration
##Ruptured bronchus
#Inflammatory
##Bronchiectasis
##Cystic Fibrosis
#Miscellaneous
##Cocaine inhalation (crack lung)
##Catamenial pneumothorax


==Treatment==
==Treatment==
#Pt Placement
*Pt Placement
##Placing pt w/ affected lung down may actually worsen V-Q mismatch
**Placing pt w/ affected lung down may actually worsen V-Q mismatch
##Some advocate for prone positioning
**Some advocate for prone positioning
#Intubation
*Intubation
##Use 8-0 tube to allow for subsequent bronchoscopy
**Use 8-0 tube to allow for subsequent bronchoscopy
##If possible can selectively intubate the unaffected bronchus to prevent aspiration
**If possible can selectively intubate the unaffected bronchus to prevent aspiration
###After tube passes through cords rotate 90degrees left or right and advance
***After tube passes through cords rotate 90degrees left or right and advance
#Coagulopathy
*Coagulopathy
##FFP
**FFP
#Emergenct bronchoscopy or embolization for life-threatening hemorrhage
*Emergenct bronchoscopy or embolization for life-threatening hemorrhage


MASSIVE = A single expectoration of ≥ 50cc OR >600cc/24h
MASSIVE = A single expectoration of ≥ 50cc OR >600cc/24h


#angle head down with affected lung low
*angle head down with affected lung low
#consider angio embolization
*consider angio embolization
#intubate with >8.0 (for bronch)
*intubate with >8.0 (for bronch)


==Disposition==
==Disposition==
#Gross hemoptysis:
*Gross hemoptysis:
##Admit
**Admit
#Young pt (<40yr) w/ scant hemoptysis, nl CXR, no smoking history:
*Young pt (<40yr) w/ scant hemoptysis, nl CXR, no smoking history:
##Discharge
**Discharge
#Risk factors for neoplasm (even if CXR nl) or suspicious CXR:
*Risk factors for neoplasm (even if CXR nl) or suspicious CXR:
##Discuss w/ pulmonologist before d/c
**Discuss w/ pulmonologist before d/c


==Source==
==References==
Tintinalli


[[Category:Pulm]]
[[Category:Pulm]]

Revision as of 05:17, 28 September 2015

Background

  • Coughing of blood that originates from respiratory tract below level of larynx
  • Death usually occurs from asphyxiation, not exanguination
  • Easy to confuse w/ epistaxis or oropharynx bleeding

Clinical Features

Differential Diagnosis

  • Infectious
  • Neoplastic
    • Lung cancer
    • Metastatic cancer
  • CV
  • Mitral stenosis
  • Alveolar hemorrhage syndromes
    • Goodpasture
    • Wegener
    • SLE
  • Hematologic
    • Uremia
    • Plt dysfunction (ASA, clopidogrel)
    • Anticoagulant therapy
  • Traumatic
    • Foreign body aspiration
    • Ruptured bronchus
  • Inflammatory
    • Bronchiectasis
    • Cystic Fibrosis
  • Miscellaneous
    • Cocaine inhalation (crack lung)
    • Catamenial pneumothorax

Diagnosis=

  • Imaging
    • CXR
      • Nml in 30% (most of whom end up having bronchitis)
    • Chest CT w/ IV contrast
      • Indicated for gross hemoptysis or suspicious CXR
    • Bronchoscopy
  • Labs
    • CBC
    • Coags
    • Sputum stain/cx
    • Chem (cr)
    • T&S/T&C
    • UA (autoimmune)
    • ECG (pulm HTN/PE)

Treatment

  • Pt Placement
    • Placing pt w/ affected lung down may actually worsen V-Q mismatch
    • Some advocate for prone positioning
  • Intubation
    • Use 8-0 tube to allow for subsequent bronchoscopy
    • If possible can selectively intubate the unaffected bronchus to prevent aspiration
      • After tube passes through cords rotate 90degrees left or right and advance
  • Coagulopathy
    • FFP
  • Emergenct bronchoscopy or embolization for life-threatening hemorrhage

MASSIVE = A single expectoration of ≥ 50cc OR >600cc/24h

  • angle head down with affected lung low
  • consider angio embolization
  • intubate with >8.0 (for bronch)

Disposition

  • Gross hemoptysis:
    • Admit
  • Young pt (<40yr) w/ scant hemoptysis, nl CXR, no smoking history:
    • Discharge
  • Risk factors for neoplasm (even if CXR nl) or suspicious CXR:
    • Discuss w/ pulmonologist before d/c

References

Retrieved from "https://www.wikem.org/w/index.php?title=Hemoptysis&oldid=46945"