Hemoptysis

Question 1

Hemoptysis

Answer 1

• Coughing blood from lower respiratory tract
• Massive if enough to compromise respiration or gas exchange
  
  • > 600cc/24h or 150-200cc/episode

Question 2

Hematemesis

Answer 2

-Vomiting blood from source in GI tract

Question 3

Epistaxis

Answer 3

• Bleeding from upper airway

- Usually the nose

Question 4

Anatomy and Physiology of hemoptysis

Answer 4

• Lungs have duel blood supple
• Pulmonary artery: low pressure high volume of dexoxy blood
  
  • allows gas exchange in capillaries
• Bronchial circulation: high pressure systemic circuit
  
  • Provides oxy blood to middle of lungs
  • Can be hypertrophied w. pulmonary inflammation
  • Most hemoptysis arises from this system

Question 5

Causes for Hemoptysis

Answer 5

• Infection
• Cardiovascular
• Neoplasia
• Trauma
• Congenital and iatrogenic
• Most Common:
  
  1. Infection: TB and pneumonia
  2. Bronchietasis: often associated w/ infection
  3. Bronchogenic carcinoma

Question 6

Clinical Approach to Massive hemoptysis

Answer 6

• Admit to ICU
• Control the airway
• Place involved side down to prevent blood aspiration to uninvolved lung
• Start antibiotics empirically
• Bronchoscopy to isolate bleeding site
  
  • Bronchial arterial embolization used for immediate control
  • Later perform tamponade catherter

Question 7

Clinical approach to moderate hemoptysis

Answer 7

• 30-100cc/day
• Admit to hospital
• Bronchoscopy to localize bleeding site
• Therapy for suspected cause
  
  • COnsider embolization or surgery

Question 8

Clinical approach to minor hemoptysis

Answer 8

• 15-30 cc/day
• Treat as out patient
• CXR: if focal abnormal w/o evidence of infection then get bronchoscopy
• Infections treated w/ antibiotics
• Non focal CXR evaluated further if:
  
  • > 40 y/o, male, or smoking history
  • If more than 2 then get bronchoscopy to rule out cancer