Difference between revisions of "Hemoptysis"

(Differential Diagnosis)
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==Differential Diagnosis==
 
==Differential Diagnosis==
*Infectious
+
{{Hemoptysis DDX}}
**Bronchitis
 
**[[Pneumonia|PNA]]
 
**Lung abscess
 
**[[Tuberculosis (TB)|TB]]
 
**[[Plague]]
 
*Neoplastic
 
**Lung cancer
 
**Metastatic cancer
 
*CV
 
**[[Pulmonary Embolism (PE)|PE]]
 
**[[Congestive Heart Failure (CHF)|CHF]]
 
**[[Pulmonary Hypertension (Decompensation)|Pulmonary HTN]]
 
**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
 
  
 
=Diagnosis==
 
=Diagnosis==

Revision as of 05:18, 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

Hemoptysis

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