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
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)