Hemoptysis

Workup

0) Icon

1) CBC

2) Chem 7

3) Coags

4) T&S/T&C

5) UA (autoimune)

6) ECG (pulm HTN/PE)

7) CXR (30% will be nl)

8) Consider D-Dimer/Spiral CT

9) IVF/blood/correct coagulop as nec

DDx

I. Airway

    A. Bronchitis (acute/chronic)

    B. Bronchietctasis

    C. Neoplasm (primary/met)

    D. Trauma

    E. Foreign body

II. Parenchymal Dz

    A. Infectious

         1. TB

         2. PNA

         3. Fungal

         4. Abcess

    B. Autoimmune

         1. Goodpasture's

         2. SLE

         3. Wegener's

         4. Pulmonary Hemosiderosis

III. Vascular

    A. PE (3-20%)

    B. AV malformation

    C. Pulm HTN

    D. Aortic dissection

IV. Hematologic Dz

    A. Coagulopathy

    B. DIC

    C. Platelet dysfx

    D. Thrombocytopenia

V. Cardiac

    A. Mitral stenosis

    B. Tricuspid endocarditis

VI. Misc

    A. Crack cocaine

    B. Iatrogenic

    C. Tracheal-arterial fistula

Bold: Most common in US

Treatment

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

ADMISSION

1) Massive

2) Minor + high risk of massive bleed

Source

3/19/06 DONALDSON (adapted from Rosen)