8. Haemoptysis Flashcards
What are 2 things you are worried about in a patient who presents with haemoptysis?
- Life threatening lung disease
2. Massive haemoptysis: asphyxation or shock
Using the surgical sieve what are the causes of haemoptysis?
Infective: TB, bronchitis, pneumonia, lung abscess, mycetoma
Neoplastic: lung cancer
Vascular: PE, LVF, bleeding tendency, AV malformation, vascular-bronchial fistula
Inflammatory: Granulomatosis with polyangiitis, goodpasture’s syndrome, SLE, hereditary haemorrhagic telangiectasia, polyarteritis nodosa
Traumatic: Iatrogenic, wound
Endocrine: none
Degenerative: bronchiectasis
Metabolic: none
Drugs: warfarin, crack cocaine
What questions should you ask in someone with haemoptysis?
What are they coughing up? frank blood/ blood streaked/ frothy sputum
Amount?
Onset?
Progression?
What 6 associated symptoms should you ask about in someone with haemoptysis? What do these indicate?
Sputum? indicates LRTI or bronchiectasis
Fever? LRTI, night sweats may indicate TB
Weight loss? Cancer/ TB
Pleuritic chest pain? Pneumonia/ PE
SOB? (Quantify by asking how far they can walk before feeling out of breath)
Haematuria/ oliguria? (Rare: pulmonary renal syndrome)
What 3 signs might you look out for on general inspection in someone with haemoptysis?
Hoarse voice: invasion of recurrent laryngeal nerve
Cachexia
Purpuric rash/ petechiae: vasculitis affecting lungs
What 3 signs might you look out for on the hands in someone with haemoptysis?
Clubbing
Tar stains
Wasting of dorsal interossei: invasion of T1 nerve root by apical lung cancer
What 3 signs might you look out for in the arms in someone with haemoptysis? What are these caused by?
Hypotonic, hyporeflexive, weak arms
Hypercalcemia due to bone mets
What 6 signs might you look out for in the face of someone with haemoptysis?
Swollen face: SVC obstruction by tumour
Bleeding from oral/ nasal mucosa
Saddle nose: granulomatosis with polyangiitis
Horner’s syndrome: miosis, ptosis, anhydrosis
Jaundice: liver mets
Focal neuology: brain mets from lung cancer
What 3 signs might you look out for in the neck of someone with haemoptysis?
Non-tender cervical lymphaednopathy: TB, bronchial carcinoma
Virchow’s node: GI malignancy mets
Tracheal deviation
What 6 signs might you look out for in the chest of someone with haemoptysis?
Asymmetrical lung expansion Dullness Stridor Crackles Pleural rub: mesothelioma Pleuritis: Pneumonia
What may haemoptysis be mistaken with?
Haematemesis (GIT)
Epistaxis
Bleeding gums
What is associated with frank blood, blood-streaked sputum and frothy sputum?
FB: Invasive cancer, TB, Bronchiectasis, AV fistula
BSS: Infection, bronchiectasis
FS: Pulmonary oedema
What information in a history can narrow down the differential for haemoptysis?
Smoking Hx: Lung cancer
Inhaled industrial substances e.g. Asbestos: lung cancer
Hx lung disease: chronic condition/ susceptibility
Grow up abroad/ recent travel?
Risk factors for DVT/PE?
Anticoagulants/ known bleeding tendencies
What are the signs of DVT?
Unilaterally inflamed leg, pitting oedema, tenderness over deep veins, distended non varicose superficial veins
What is the most common finding OE in PE?
Tachycardia
