8. Haemoptysis

Question 1

What are 2 things you are worried about in a patient who presents with haemoptysis?

Answer 1

1. Life threatening lung disease

2. Massive haemoptysis –> asphyxation or shock

Question 2

Using the surgical sieve what are the causes of haemoptysis?

Answer 2

INVITED MD

Infective- TB, bronchitis, pneumonia, lung abscess, mycetoma
Neoplastic- lung cancer
Vascular- PE, LVF, bleeding diathesis, AV malformation, vascular- bronchial fistula
Inflammatory- Granulomatosis with polyangitis, goodpasture’s syndrome, SLE, hereditary haemorrhagic telangiectasia, polyarteritis nodosa
Traumatic- Iatrogenic
Endocrine- none
Degenerative- bronchiectasis
Metabolic- none
Drugs- warfarin, crack cocaine

Question 3

What questions should you ask in someone with haemoptysis?

Answer 3

COCSAPT

Clarify- what are they coughing up? frank blood/ blood streaked/ frothy sputum
Onset- sudden may be PE
Colour
Site- gum bleeding/ epistaxis
Amount
Progression
Travel

Question 4

What associated symptoms should you ask about in someone with haemoptysis?

Answer 4

Any sputum? indicates LRTI or bronchiectasis
Fever? LRTI, night sweats may indicate TB
Weight loss?
Chest pain?
SOB? (Quantify by asking how far they can walk before feeling out of breath)
Haemature/ oliguria? (Rare: pulmonary renal syndrome)

Risk factors of DVT/ PE

Question 5

What signs might you look out for on general inspection in someone with haemoptysis?

Answer 5

Hoarse voice- invasion of recurrent laryngeal nerve
Cachexia
Purpuric rash/ petechiae- vasculitis affecting lungs

Question 6

What signs might you look out for on the hands in someone with haemoptysis?

Answer 6

Clubbing, tar stains, wasting of dorsal interossei- invasion of T1 nerve root by apical lung cancer

Question 7

What signs might you look out for in the arms in someone with haemoptysis?

Answer 7

Hypotonic, hyporeflexive weak arms- hypercalcemia due to bone metastases

Question 8

What signs might you look out for in the face of someone with haemoptysis?

Answer 8

Swollen face- SVC obstruction by tumour
Bleeding from oral/ nasal mucosa
Saddle nose- granulomatosis with polyangiitis
Horner’s syndrome- miosis, ptosis, anhydrosis
Jaundice- liver cancer spreading to the lungs
Focal neuology- brain metastases from lung cancer

Question 9

What signs might you look out for in the neck of someone with haemoptysis?

Answer 9

Cervical lymphaednopathy, non-tender- TB, bronchial carcinoma
Virchow’s node- GI malignancy mets
Tracheal deviation

Question 10

What signs might you look out for in the chest of someone with haemoptysis?

Answer 10

Asymmetrical lung expansion, dullness, stridor, crackles, pleural rub- mesothelioma, pleuritis from pneumonia