Haemoptysis Flashcards
What other symptoms may be mistaken for haemoptysis?
Haematemesis
Nose-bleed
Bleeding gums
Use the surgical sieve to construct a differential diagnosis for haemoptysis.
- Infection TB Pneumonia (e.g. Klebsiella) Lung abscess Mycetoma Bronchitis - Neoplastic Lung cancer - Vascular PE Left ventricular failure Bleeding diathesis Arteriovenous malformation Vascular-bronchial fistula - Inflammatory/Autoimmune Granulomatosis with polyangiitis Goodpasture’s syndrome SLE Osler-Weber-Rendu syndrome Polyarteritis nodosa - Trauma Iatrogenic - Endocrine - Degenerative Bronchiectasis - Metabolic - Drugs Warfarin Crack cocaine use
Which of the mechanisms listed in the surgical sieve is the most common cause of haemoptysis?
Infection
What is haemoptysis?
the coughing up of blood or blood-stained mucus from the bronchi, larynx, trachea, or lungs
List three key features of the history of presenting complaint.
Describe what you are coughing up.
How much was coughed up?
Did the haemoptysis occur suddenly or come on gradually?
Which differentials are associated with coughing up:
Frank blood
Blood-streaked sputum
Frothy sputum
Frank blood
Suggest vascular problem (e.g. erosion of cancer into a blood vessel)
Blood-streaked sputum
Lung infections can cause this
Chronic production of large amounts of blood-stained sputum suggests bronchiectasis
Frothy sputum
Pulmonary oedema
Which disease is classically associated with the production of a large amount of sputum?
Bronchiectasis
List some causes of sudden-onset haemoptysis.
PE
Erosion of cancer into a blood vessel
List a cause of gradual-onset haemoptysis.
Bronchiectasis (and other progressive diseases)
List some important symptoms that may be associated with haemoptysis. State the underlying pathology that may cause the symptoms.
Cough productive of sputum – suggests lower respiratory tract infection or bronchiectasis
Fever – associated with lower respiratory tract infections
Weight loss – systemic feature of lung cancer and TB
Pleuritic chest pain – PE or pneumonia
Shortness of breath – clarify whether it is sudden-onset (e.g. PE) or gradual-onset (e.g. heart failure)
Haematuria/Oliguria
Why is it important to ask about renal symptoms (haematuria/oliguria)?
Pulmonary-renal syndromes can cause haemoptysis
List the main causes of pulmonary-renal syndrome.
Vasculitides (e.g. Granulomatosis with polyangiitis)
SLE
Goodpasture’s syndrome
List some key features of the past medical history.
Smoking Exposure to asbestos and other inhaled substances Prior lung disease (e.g. TB) Growing up abroad and recent travel Risk factors for DVT/PE Anticoagulant use or bleeding diathesis
List some respiratory causes of clubbing.
Lung cancer
Bronchiectasis
Interstitial lung disease
Empyema
Which respiratory disease can cause wasting of the dorsal interossei?
Pancoast lung tumours can invade the T1 nerve root
Which metabolic imbalance is important to watch out for in patients with potential lung cancer?
Hypercalcaemia of malignancy
This is due to spread of the cancer to bone
NOTE: keep and eye out for signs of hypercalcaemia (e.g. hypotonia, Hyporeflexia, weak arms)
What symptom can occur as a result of obstruction of the superior vena cava by an apical lung tumour?
Swelling of the face, neck and arms
List some signs of respiratory pathology that can be seen in the neck.
Cervical lymphadenopathy
Tracheal deviation
List some blood tests that may be useful in investigating a patient with haemoptysis.
FBC – check for anaemia, raised WCC
CRP
Clotting screen
U&Es – renal derangement may raise suspicion of pulmonary-renal syndrome
Why might it be useful to perform urinalysis on a patient presenting with haemoptysis?
Haematuria may increase index of suspicion of pulmonary-renal syndrome
What form of imaging is most useful in a patient presenting with haemoptysis?
CXR – look for mass lesions, diffuse alveolar infiltrate, hilar lymphadenopathy etc.
Why might it be useful to check calcium, phosphate and ALP in a patient with haemoptysis?
Bone metastases can lead to hypercalcaemia
Which criterion is used to decide the next step in the management of a patient presenting with a possible PE?
Wells criteria
How is the Wells score interpreted?
4+ = CTPA
< 4 = D-dimer to rule out PE
Describe the typical presentation of a tuberculosis patient.
History of growing up/recent travel to a TB-endemic region
Haemoptysis
Night sweats
Weight loss
Outline the management plan for TB.
4 months: rifampicin + isoniazid
2 month: ethambutol and pyrazinamide
Describe the typical presentation of a patient with bronchiectasis.
Recurrent cough productive of large amounts of green/rusty sputum with occasional haemoptysis
Which imaging modality is most useful for diagnosing bronchiectasis?
CT chest – shows dilated bronchi
What is primary ciliary dyskinesia?
Autosomal recessive disorder that affects the protein machinery used by epithelial cells to beat their cilia
What are the consequences of primary ciliary dyskinesia?
NOTE: most consequences are due to the inability of the cilia to clear mucus Bronchiectasis Rhinitis and sinusitis Otitis media Male infertility (sperm are immobile) Situs inversus (Kartagener’s syndrome)
