Hemoptysis Flashcards
What are the (3) common causes of hemoptysis in children?
Infection, foreign body, and bronchiectasis (especially CF-associated).
What are (11) less common causes of hemoptysis in children?
Henoch-Schonlein purpura, Granulomatosis with Polyangiitis (GPA), Goodpasture syndrome, SLE, congenital heart and lung defects, neoplasm, arteriovenous malformation (AVM), hemangioma, trauma, pulmonary embolism, and idiopathic pulmonary hemosiderosis.
What etiologies would you expect in a patient who presents with hemoptysis and fever or chills?
Pneumonia, lung abscess
What etiologies would you expect in a patient who presents with hemoptysis and drug use?
Cocaine, smoking
What etiologies would you expect in a patient who presents with hemoptysis and microscopic hematuria?
Granulomatosis with Polyangiitis (GPA) or Goodpasture’s
What etiology would you expect in a patient who presents with hemoptysis and skin telangiectasia?
Pulmonary AVM (with hereditary hemorrhagic telangiectasia (HHT))
What etiologies would you expect in a patient who presents with hemoptysis and recurrent nose bleeds?
Hereditary hemorrhagic telangiectasia (HHT) or Granulomatosis with Polyangiitis (GPA)
What etiology would you expect in a previously healthy patient who presents with hemoptysis, wheezing, and cough?
Foreign body
What etiologies would you expect in a patient who presents with hemoptysis and clubbing?
Chronic lung disease (e.g. cystic fibrosis) or congenital heart disease
What is diagnostic for a pulmonary source of hemoptysis?
Bronchoscopy with bronchoalveolar lavage is the best next step after bleeding is controlled; the finding of hemosiderin-laden macrophages is diagnostic for a pulmonary source of bleeding - they usually appear 3 days after bleeding.
What is the recommended treatment for mild hemoptysis?
Supportive care. A majority of patients with mild disease resolve spontaneously and do not recur.
What is the recommended treatment for massive hemoptysis?
Treat with hemostasis and embolotherapy (requires specialist intervention).
What is idiopathic pulmonary hemosiderosis (IPH)?
It is rare, but is characterized by recurrent pulmonary bleeding and resultant hemosiderosis with no apparent cause.
How do children with idiopathic pulmonary hemosiderosis usually present?
Children usually present before 10 years of age with either abrupt hemoptysis or a progressive course of anemia, dyspnea, fatigue, and recurrent cough. Most patients have iron deficiency anemia at time of presentation.
What would sputum or BAL show in patients with idiopathic pulmonary hemosiderosis (IPH)?
Hemosiderin-laden macrophages
