Hemoptysis

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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
    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. Cack cocaine
    B. Iatrogenic
    C. Tracheal-arterial fistula


Bold: Most common in US


Treatment

MASSIVE = >100-500cc/day

  • 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)