Hemoptysis

Workup

1. Icon
2. CBC
3. Chem 7
4. Coags
5. T&S/T&C
6. UA (autoimune)
7. ECG (pulm HTN/PE)
8. CXR (30% will be nl)
9. Consider D-Dimer/Spiral CT
10. IVF/blood/correct coagulop as nec

DDx

1. Airway
   1. Bronchitis (acute/chronic)
   2. Bronchietctasis
   3. Neoplasm (primary/met)
   4. Trauma
   5. Foreign body
2. Parenchymal Dz
   1. Infectious
      1. TB
      2. PNA
      3. Fungal
      4. Abcess
   2. Autoimmune
      1. Goodpasture's
      2. SLE
      3. Wegener's
      4. Pulmonary Hemosiderosis
3. Vascular
   1. PE (3-20%)
   2. AV malformation
   3. Pulm HTN
   4. Aortic dissection
4. Hematologic Dz
   1. Coagulopathy
   2. DIC
   3. Platelet dysfx
   4. Thrombocytopenia
5. Cardiac
   1. Mitral stenosis
   2. Tricuspid endocarditis
6. Misc
   1. Crack cocaine
   2. Iatrogenic
   3. Tracheal-arterial fistula

Bold: Most common in US

Treatment

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

1. angle head down with affected lung low
2. consider angio embolization
3. 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)