Haemoptysis Flashcards
What could haemoptysis be confused with?
- Haematemesis: brownish red blood that is vomited from the Gi tract
- Epistaxis: particualrly posterior nosebleed
- Bleeding gums: combined with cough, may be confused with true haemopytsis
What could the infective causes of haemoptysis be?
- Pulmonary TB
- Bronchitis
- Pneumonia
- Lung abscess
- Mycetoma
What could the neoplastic causes of haemoptysis be?
- Primary lung cancer
2. Metastatic lung cancer
What could the vascular causes of haemoptysis be?
- PE
- Left Ventricular failure
- Bleeding diathesis e.g. coagulopathy + severe thrombocytopenia
- Atriovenous malformation
- Vascular-bronchial fistula
What could the inflammatory causes of haemoptysis be?
- Granulomatosis with polyangiitis
- Goodpastures syndrome
- SLE
- Hereditary Haemorrhagic telangiectasia
- Polyarertitis nodosa
- Microscopic polyangiitis
What could the traumatic causes of haemoptysis be?
- Iatrogenic (post lung-biopsy or intubation)
2. Woulds (rib fracture, stab injury
What are the degenerative causes of haemopytsis?
- Bronchiectasis
What could the drug causes of haemoptysis be?
- Warfarin
2. crack cocaine use
If he is coughing up frank blood what could this indicate?
- vascular erosion of a blood vessel (invasive cancer, bronchiectasis, TB)
- ruptured av malformation
- vascular-bronchial fistula
If he is coughing up blood-streak sputum what could this indicate?
infection of lungs but if chronic suggest bronchiectasis
If he is coughing up frothy sputum what could this indicate?
pulmonary oedema (secondary to left ventricular heart failure or severe mitral stenosis) - can be pink
How do you get the patient to quantify how much they cough up?
teaspoon, tablespoon, egg
What would onset of haemoptysis indicate?
- Sudden onset: PE or erosion of a cancer into a pulmonary blood vessel
- Gradual, progressive: bronchiectasis
What would a cough productive of sputum with haemoptysis indicate?
indicates lower respiratory tract infection (TB, penumona, bronchitis) or bronchiectasis
What would a fever with haemoptysis indicate?
associated with lower respiratory tract infection and night sweats with TB
What would weight loss with haemopysis indicate?
cancer and TB (check if planned or not)
What would pleurtic chest pain with haemoptysis indicate?
arise following PE or pneumonia that has spread to pleura
What would shortness of breath with haemoptysis indicate?
how far can walk etc, sudden onset SOB PE and more gradual onset heart failure
What would haemturia/oliguria with hhaemoptysis indicate?
If affects kidney and lungs:
- Goodpastrues syndrome
- Vasculitides e.g. granulomatosis with polyangitism microscopic polyangitis, polyarteritis nodioa
- SLE
What do you check with haemoptysis with lifestyle?
CHECK SMOKING HITORY AND EXPOSURE TO ASBESTOS OR OTHER INHALED INDUSTRIAL SUBSTANCES -> lung cancer
What would prior lung disease with haemoptysis indicate?
TB or bronchiectasis or vulnerability to repeated infections
What would recent travel indicate with haemoptysis?
Which country and vaccinated - TB
What would anticoagulant medication or known bleeding diathesis with haemopytsis indicate?
can increase risk/magnitude or internal haemorrhage
What are the risk factors for DVT/PE?
- Prolonged stasis
- Recent trauma or surgery (blood vessel damage)
- Malignancy causing hypercoagulable blood
- Other clotting abnormalities
- History of pervious venous thromboembolism
- Painful swollen leg?
What would a hoarse voice on general inspection with haemoptysis indicate?
invasion of reccurent laryngeal nerve by cancer
What would purpuric rash or petechia on general inspection with haemoptysis indicate?
vasculitis affecting lungs
What else do you look for in general inspection with haemoptysis?
Cachexia
What would hypotonic, hypo-reflexive, weak arms with haemoptysis indicate?
hypercalcaemia due to bone metases from lung cancer
What would a swollen face on a facial exam with haemoptysis indicate?
obstruction of superior vena cava by tumour
Why do you check bleeding from oral or nasal mucosa in facial exam with haemoptysis?
source of blood (check if true haemptysis)
What would a saddle nose with haemotysis suggest?
granulomatosis with polyangiitis
What would horners syndrome with haemoptysis indicate?
invasion of sympathetic supply to face by apical lung cancer
What would jaundice with haemoptysis indicate?
liver cancer that has spread to lung or vice versa
What would focal neurology with haemoptysis indicate?
brain metastasis from lung cancer
What would cervical lymphadenopathy, non tender with haemoptysis indicate?
- TB
2. bronchial carcinoma
What would left supraclavicular lymphadenopathy with haemoptysis indicate?
GI malignancy which may have metastised to the lungs
What would tracheal deviation with haemoptysis indicate?
- pleural effusion due to cancer
2. lung collapse secondary to a large mass such as tumour of abcess
What does asymetrical lung expansion with haemoptysis indicate?
lung pathology in side of reduced expansion
What does dullness on percussion of chest with haemoptysis indicate?
- pneumonia
- lung abscess
- malignant pleural effusion
What does stridor with haemopytsis indicate?
tumour or foreign body obstructing bronchus
What does crackles with haemoptysis indicate?
- pneumonia
- left ventricular failure
- bronchiectasis
What does pleural rub with haemoptysis indicate?
- mesothelioma
2. pleuritis from pneumonia
What would hepatomegaly with haemoptysis indicate?
liver malignancy spread from lungs and vice versa
What would unilateral signs of DVT on legs with haemoptysis indicate?
may have caused PE
What would you look for in FBC with haemoptysis?
- Anemia
2. High WBC
What would you look for in CRP with haemoptysis?
raised in infection, inflammation or malignancy
What would you look for in clotting screen with haemoptysis?
for bleeding disorder which could be cause/exacerbating
What would you look for in U+Es with haemoptysis?
renal involvement
What would you look for in ALP with haemoptysis?
bone metastasis from a primary lung cancer
What would you look for in liver enzymes with haemoptysis?
for liver involvement of a cancer
Why do you do a urine test in haemoptysis?
look for haemturia for pulmonary-renal syndrome
What imaging do you do with haemoptysis?
Chest XR
What would mass lesion/nodules on chest radiograph with haemoptysis indicate?
- carcinoma
- TB
- abscess
- vasculitides
What would diffuse alveolar infilatrates on chest radiograph with haemoptysis indicate?
pulmonary oedema
What would hilar lymphadenompathy on chest radiograph with haemoptysis indicate?
- Carinoma
- Infection
- TB
What would lobar or segmental infiltrates on chest radiograph with haemoptysis indicate?
1, pneumonia
- infarction due to PE
- TB
- adenocarcinoma causing malignant consolidation
What would patch alveolar infilatrates on chest radiograph with haemoptysis indicate?
- bleeding disorders
- goodpastures syndromes
- idiopathic
- pulmonary haemosiderosis
What would lobar collapse on a chest radiograph with haemoptysis indicate?
obstructing carcinoma
How would you confirm the diagnosis of lung cancer?
- cytology of sputum and bonchoscopic washing - by CT guided PFNB or on a bronchscopy
- Stage cancer with Ct scan and bone scan
