Hemoptysis

Question 1

Where can the blood with coughing be originating from?

Answer 1

the supralaryngeal airways
the larynx
the upper gastrointesinal tract
the lower respiratory tract

Question 2

What is hemotypsis?

Answer 2

Hemoptysis refers specifically to the expectoration of blood from a source within the lower respiratory tract (distal to the larynx)

Question 3

T or F: hemotypsis requires prompt assessment

Answer 3

T

Question 4

What determines the urgency of assessment of hemotypsis?

Answer 4

The urgency of the assessment is determined largely by the rate of bleeding

Question 5

Whats the approach to hemoptysis?

Answer 5

ABCs-->
History -->
Physical exam -->
CXR/Lab Evaluations -->
Special procedures (bronchoscopy)-->
Therapeutic interventions -->
Evaluation of response

Question 6

T or F: hemoptysis can cause asphyxiation

Answer 6

T

Question 7

How to stabilize the patient?

Answer 7

Supplemental oxygen
Cough suppression (codeine)
Suctioning of secretions
Intubation and ventilation if necessary
  --> helps restore gas exchange, facilitates airway suctioning, and prevents contamination of normal lung areas with blood

Question 8

Can anemia occur with hemoptysis?

Answer 8

Yes, Anemia can occur with ongoing, subacute or chronic hemoptysis

Question 9

Why does cardiac failure occur in patients with hemoptysis?

Answer 9

Circulatory collapse is usually the result of the acute, asphyxia-induced respiratory failure (hypoxemia and hypercapnia with acidosis)

Question 10

What dictates if hemoptysis is life-threatening?

Answer 10

The rate of bleeding into the airway
The patient’s ability to expectorate the blood
The underlying cardiopulmonary status of the patient

Question 11

What are some infectious causes of hemoptysis?

Answer 11

Bronchitis
Bronchiectasis
Cystic fibrosis
Bacterial pneumonia
M. tuberculosis
Fungus (mycetoma)
Lung abscess
Pulmonary gangrene
Septic emboli

Question 12

What is a neoplastic cause of hemoptysis?

Answer 12

Primary: bronchogenic carcinoma, carcinoid

Question 13

What are some vascular causes of hemoptysis?

Answer 13

Pulmonary thromboembolism
Primary and secondary pulmonary hypertension
Cardiac failure

Question 14

What are some immunological causes of hemotypsis?

Answer 14

Goodpasture’s, Wegener’s, systemic lupus erythematosus

Question 15

T or F: iatrogenic and hematologic causes can cause hemotypsis?

Answer 15

T

Question 16

What percentage of hemoptysis is caused by idiopathic reasons?

Answer 16

10-20%

Question 17

What is the most common cause of hemoptysis?

Answer 17

bronchitis (either acute or chronic) is the most common cause of hemoptysis (usually bloody streaking of sputum; rarely more life-threatening hemoptysis)
in smokers lung cancer must be ruled out

Question 18

Which vasculature is more often implicated in hemotypsis?

Answer 18

Most often the communication is at the level of the more central, large airways supplied by the high pressure systemic circulation

Question 19

If hemoptysis is seen as localised infiltrates, what does it mean?

Answer 19

Pneumonia/infection
Pulmonary infarct (pleural based)
Aspirated blood

Question 20

If hemoptysis is seen as diffuse and bilateral infiltrates, what does it mean?

Answer 20

Diffuse alveolar hemorrhage
Congestive heart failure
Toxic gas inhalation

Question 21

If hemoptysis is accompanied with mass lesion or lymphadenopathy on chest imaging what does it mean?

Answer 21

neoplasm

Question 22

T or F: in a chest imaging of a hemoptysis patient with multlple lesions mean they have asthma

Answer 22

F
means they may have:
Septic emboli
Wegener’s granulomatosis

Question 23

What do cavities on chest imaging mean?

Answer 23

Tuberculosis (apico-posterior segments of upper lobes or superior segements of lower lobes)
Squamous cell carcinoma
Cavitating pulmonary infarct

Question 24

What do cavity with “air-crescent” mean on chest imaging?

Answer 24

mycetoma

Question 25

What do ring shadows or tramlines mean?

Answer 25

Bronchiectasis

Question 26

What does atelectasis of major lobe/segment mean?

Answer 26

Obstructing carcinoma
Blood clot
Foreign body

Question 27

Why is bronchospy important for hemoptysis?

Answer 27

Direct visualization:
Identification of active bleeding
Localization of bleeding
Presumptive diagnosis of visible lesions
A
cquisition of specimens for diagnostic study:
Brushings
Bronchoalveolar lavage
Biopsy

Question 28

T or F: bronchoscopy is only restricted to diagnosis in hemoptysis?

Answer 28

F:
Bronchoscopy can also be used therapeutically in some cases:

Cessation of bleeding
Stabilization of critically ill patients as a means of temporizing the situation until more definitive procedures can be performed

Question 29

Which procedure can be used to both identify lesions not captured in endoscopy or imaging AND temporally stop bleeding?

Answer 29

Transcutaneous angiographic embolization (aka bronchial artery embolization)

Question 30

Which patients require thoraoctomy and lung resection (pneumonectomy or lobectomy) ?

Answer 30

when there is a structural problem with the lung that is not treatable with more conservative therapy (localized, severe bronchiectasis not responding to medical therapy)

Question 31

When would emergency surgical intervention would be necessary?

Answer 31

Hemoptysis cannot be controlled by endoscopy and/or embolotherapy
When these treatment modalities are not available

Question 32

T or F: lung resections have significant morbidity and mortality

Answer 32

T