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