Hemoptysis Flashcards
What is Hemoptysis?
Coughing up blood from bleeding into the lower respiratory tract “Hemoptysis” comes from the Greek “haima” meaning “blood”, and “ptysis” which means “spitting of matter”
Approach to hemoptysis? Differentiate between?
Approach to the patient is based on the clinical scenario. This common complaint seen by clinicians in pulmonary medicine should be regarded as a symptom. It is an essential first step to establish that the blood originates from the lower respiratory tract and not from above the vocal cords (pseudohemoptysis).
Two causes of pseudohemoptysis?
Upper GI bleed and Upper respiratory bleed
Explain the history and PE findings for upper GI bleeds?
Hx: Coffee ground emesis, black tarry stools, nausea and vomiting/retching PE exam: Epigastric tenderness, signs of chronic liver disease: spider nevus, palmar erythema
Explain the Hx and PE for upper respiratory bleeds?
Upper Respiratory Tract HX: Bleeding gums, epistaxis, no cough or sputum, sore throat PE exam: Gingivitis, telangiectasia, pharyngitis, ulceration
Common causes of Hemoptysis?
- Infection 2. Neoplastic 3. Vascular 4. Autoimmune 5. Drug-related and other
What are the possible locations of hemoptysis?
- Airway disease 2. Parenchymal disease 3. Vasculature
What are airway diseases that could cause hemoptysis?
- Acute or chronic bronchitis
- Bronchiectasis
- Bronchogenic carcinoma
- Bronchial carcinoid tumor (bronchial adenoma)
- Other endobronchial tumors (Kaposi sarcoma, metastatic carcinoma)
What are parenchymal diseases that could cause hemoptysis?
- Tuberculosis •Lung abscess •Pneumonia •Mycetoma (“fungus ball”)
- Miscellaneous: • Goodpasture syndrome • Idiopathic pulmonary hemosiderosis • Granulomatosis with polyangiitis (Wegener granulomatosis)
What are the vascular diseases that could cause hemoptysis?
•Pulmonary embolism •Elevated pulmonary venous pressure • Left ventricular failure • Mitral stenosis •Vascular malformation
What are two rare causes of hemoptysis?
•Impaired coagulation •Pulmonary endometriosis
What are the first steps in evaluating hemoptysis?
- History
- Physical exam: Lungs, nose, mouth, pharynx
- Chest x-ray (CXR)
- Basic lab: CBC with differential, PT/INR, type and cross (massive)
Explain the role of the chest x-ray?
- Localizing –e.g. a significant finding in less than 40% of patients Malignancy is found in almost 40% of patients with a localizing finding
- Non-localizing 60% + normal or abnormal but nonspecific Cancer is diagnosed in only 6 to 10% of patients with normal-appearing or non-localizing CXR
When nodes or masses are found with Radiology what do we suspect?
Bronchogenic carcinoma or other neoplasm, lung abscess, fungal infection, vasculitis
When Atelectasias are found with Radiology what do we suspect?
Bronchogenic carcinoma or other endobronchial neoplasm, broncholithiasis, foreign body
When hilar or mediastinal adenopathy are found with Radiology what do we suspect?
Bronchogenic carcinoma or other neoplasm, mycobacterial or fungal infection, sarcoidosis
When dilated peripheral airways are found with Radiology what do we suspect?
Bronchiectasis
When airspace consolidation is found with Radiology what do we suspect?
Pneumonia, alveolar hemorrhage, pulmonary contusion
When Reticulonodular densities are found with Radiology what do we suspect?
Sarcoidosis, lymphangitic carcinoma
When a cavity single or multiple are found with Radiology what do we suspect?
Mycobacterial or fungal infection, mycetoma, lung abscess, bronchogenic carcinoma
When a hilar/medistinal calcification is found with Radiology what do we suspect?
Previous mycobacterial or fungal infection, broncholithiasis
Additional testing for hemoptysis?
- Chest CT
- Bronchoscopy Can be diagnostic and therapeutic
- Chest CT superior in detecting and excluding malignancy vs. fiberoptic bronchoscopy (FOB) however, FOB is useful in finding small endobronchial lesions and in establishing a definitive tissue diagnosis
Explain the diagnostic algorithm for hemoptysis?
Important note to remember?
Malignancy is one of the most common causes of hemoptysis, and bronchogenic carcinoma accounts for most of the cases. Extrathoracic malignancies especially melanoma and breast, colon, renal may also cause hemoptysis because of their propensity to metastasize to endobronchial locations.