haemoptysis Flashcards
A 52-year-old man who was born in India presents with episodic haemoptysis. His only history is tuberculosis as an adolescent. Chest x-ray shows a rounded opacity in the right upper zone surrounded by a rim of air.
Aspergilloma
A 71-year-old woman presents with dyspnoea and haemoptysis for the past two weeks. Clinical examination reveals a loud first heart sound, a diastolic murmur and new-onset atrial fibrillation.
mitral stensosis
A 62-year-old woman who is being investigated for renal impairment presents with haemoptysis. On examination she has a flat nose.
granulomatosis with polyangitis
The combination of pulmonary haemorrhage (haemoptysis), renal impairment (rapidly progressive glomerulonephritis) and flat or saddle nose (due to a collapse of the nasal septum) is characteristic of granulomatosis with polyangiitis.
History of smoking
Symptoms of malignancy: weight loss, anorexia
lung cancer
Dyspnoea
Bibasal crackles and S3 are the most reliable signs
pulmonary oedema
Fever, night sweats, anorexia, weight loss
TB
Pleuritic chest pain
Tachycardia, tachypnoea
PE
usually acute history of purulent cough
LRTI
Usually long history of cough and daily purulent sputum production
bronchiectasis
Dyspnoea
Atrial fibrillation
Malar flush on cheeks
Mid-diastolic murmur
mitral stensosi
Often past history of tuberculosis.
Haemoptysis may be severe
Chest x-ray shows rounded opacity
aspergilloma
Upper respiratory tract: epistaxis, sinusitis, nasal crusting
Lower respiratory tract: dyspnoea, haemoptysis
Glomerulonephritis
Saddle-shape nose deformity
granuomatosis with polyangitis
Haemoptysis
Systemically unwell: fever, nausea
Glomerulonephritis
goodpastures
Tb creates a cavitating lesion what lobes
upper
difference in vomit between bornchial circulation and pulmonary
pulmonary - low pressure high vol - larger quantity of blood
Bronchial circulation - smaller volume, off the aorta so high pressure - much more likely to be forced sudden bloody vomit
Cx of haemoptysis
Airway disease
Tb
Lung cancer
Bronchiectasis widened and scarred
Neoplasma
Pulmonary vascular disorder
Pe
Parenchymal disease
Pneumonia
Lung abscess
TB
Coagulaopathies
Vasculitis
Rarer - trauma, foreign body, fistula, AVM , mistral stenosis, osler weber - telangiectasis if seen on mouth then can also be seen in lungs
Cocaine and catamenial(menstruation- haemoptysis cyclically in women)
catamenial pneumothorax
Women with catamenial pneumothorax have recurrent episodes of pneumothorax that occur within 72 hours before or after the start of menstruation.
endometrial tissues outside uterus
catamenia
mensutratoon - haemopytiss during this time for women
Haematesmeis
if cough then vomit straight after
Massive haemoptysis - more than half a cup of blood
bronchiectasis - CF - because of bronchial artery dilation - as getting bigger aneurysm affect then one cough from bursting
Mx of massive haemoptysis
Protect airway - intubation
Stabilise and correct coagulation
Protect non-bleeding lung - double lumen tube
Identify source of bleeding - imaging ( CT contrast - CTA -inject into aorta ) and bronchoscopy
Treat bleeding - endobronchial, embolisation, surgery
difference between monophonic and polyphonic wheeze
Fixed airflow obstruction that does not change like a cancer - monophonic phase
Polyphonic wheeze - lungs empty at different times through different airways - different tones
Ix for haemoptysis
CTPA is the investigation of choice for hemoptysis to look for underlying vascular or pulmonary causes.