Hemoptysis

Question 1

What conditions can mimic hemoptysis?

Answer 1

Hematemesis

Question 2

What patient historical features can help distinguish hemoptysis from hematemesis?

Answer 2

Hematemesis: nausea, vomiting, Hx of gastric or hepatic disease, brown, black coffee ground looking blood.

Hemoptysis: absence of nausea and vomiting, preexisting lung disease, frothy bright red liquid or clotted appearing blood

Question 3

What imaging should be ordered for hemoptysis? (2)

Answer 3

1. Chest radiograph initially

2. CT w contrast is more sensitive

Question 4

Which two body systems are involved in hemoptysis?

Answer 4

cardiovascular or pulmonary

Question 5

What are the cardiovascular causes of hemoptysis? (4)

Answer 5

1. Acute pulmonary arterial hypertension caused by PE and infarction
2. Elevated left atrial pressure leading to rupture of alveolar capillaries caused by heart failure.
3. Vasculitis
4. Iatrogenic from bronchoscopy with bx

Question 6

What are the pulmonary causes of heart failure?

Answer 6

1. Pneumonia
2. Lung abscess
3. Tuberculosis
4. Aspergillosis
5. Staph, Klebsiella, pseudomonas infections.

Question 7

What organisms are commonly associated with lung abscess?

Answer 7

Anaerobic organisms of the oral cavity including gram neg bacteroides and gram pos peptostreptococcus.

Question 8

What are the 6 airway causes of hemoptysis?

Answer 8

1. Acute bronchitis
2. bronchiectasis
3. Malignancy (weight loss, night sweats and hemoptysis)
4. Foreign body aspiration
5. Iatrogenic from endobronchial biopsy
6. Bronchiovascular fistula

Question 9

What is the threshold for life-threatening, emergent massive hemoptysis?

Answer 9

300 mL/d