Hemoptysis case presentation
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Transcript of Hemoptysis case presentation
HemoptysisDMC
Hussain AlsheefENT resident
Case scenario 25 y/o Saudi male, smoker , medically free c/o coughing blood for 3days No SOB or chest pain No hoarsness , dysphagia , odynophagia or chocking No nasal obstruction or epistaxis No bleeding disorder No contact with TB pt. No fever or wt. loss
O/E Laying comfortably on bed not on distress Not pale V/S : BP=124/80 , P=84 , O2 sat=99% on room air ,
T=36.7 Throat : no post nasal bleeding Nose :
Ant. Rhinoscopy : free
Flexible scope : no bleeding points seen in nasal septum or turbinates
Pharynx and larynx free
Neck : no lymph nodes
Investigations
Blood inv. CBC
Chemistry
Coagulation profile
Imaging studies CXR
CT scan
Scope
DDx
Airway diseases
Inflammatory
(bronchitis , bronchiectasis)
F.B
Airway trauma
Neoplasms(bronchogenic
ca.)
Lungs
InfectionsTb. ,
pneumonia
Autoimmune diseases
(wegner ,goodpasture
syndrome , SLE
Pul.vasculature
Lt. heart failure
Pulmonary AV
malformation
Thrombo-embolism
Others
Coagulopathy
Cocaine use
Iatrogenic
Hemoptysis expectoration of blood
typically from the lower respiratory tract,
upper (respiratory & GI) tracts can be expectorated and mimic blood coming from the lower respiratory tract
Hemoptysis is classified as nonmassive or massive based on the volume of blood loss Massive hemoptysis > 200cc / day
The low-pressure pulmonary system tends to produce small-volume hemoptysis, whereas bleeding from the bronchial system, which is at systemic pressure, tends to be profuse
most common causes of hemoptysis areacute and chronic bronchitis, pneumonia, tuberculosis, and lung cancer
Infection : 60-70% of cases
Cancer : 23% of cases in US
Evalutation of hemoptysis
CBC , coagulation , RFT
CXRFlexible bronchoscopyCT
Key points
Hemoptysis needs to be distinguished from hematemesis and nasopharyngeal or oropharyngeal bleeding.
Bronchitis, bronchiectasis, TB, and necrotizing pneumonia or lung abscess are the most common causes in adults.
Lower respiratory tract infection and foreign body aspiration are the most common causes in children.
Patients with massive hemoptysis require treatment and stabilization before testing.
Bronchial artery embolization is the preferred treatment for massive hemoptysis.
References Uptodate.com
Etiology and evaluation of hemoptysis in adults Merck Manual
Hemoptysis .. Last reviewed literature on July 2014
Thank you