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Respiratory 2 > Hemoptysis > Flashcards

Hemoptysis Flashcards

1
Q

What is Hemoptysis?

A

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”

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2
Q

Approach to hemoptysis? Differentiate between?

A

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).

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3
Q

Two causes of pseudohemoptysis?

A

Upper GI bleed and Upper respiratory bleed

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4
Q

Explain the history and PE findings for upper GI bleeds?

A

Hx: Coffee ground emesis, black tarry stools, nausea and vomiting/retching PE exam: Epigastric tenderness, signs of chronic liver disease: spider nevus, palmar erythema

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5
Q

Explain the Hx and PE for upper respiratory bleeds?

A

Upper Respiratory Tract HX: Bleeding gums, epistaxis, no cough or sputum, sore throat PE exam: Gingivitis, telangiectasia, pharyngitis, ulceration

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6
Q

Common causes of Hemoptysis?

A
  1. Infection 2. Neoplastic 3. Vascular 4. Autoimmune 5. Drug-related and other
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7
Q

What are the possible locations of hemoptysis?

A
  1. Airway disease 2. Parenchymal disease 3. Vasculature
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8
Q

What are airway diseases that could cause hemoptysis?

A
  • Acute or chronic bronchitis
  • Bronchiectasis
  • Bronchogenic carcinoma
  • Bronchial carcinoid tumor (bronchial adenoma)
  • Other endobronchial tumors (Kaposi sarcoma, metastatic carcinoma)
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9
Q

What are parenchymal diseases that could cause hemoptysis?

A
  • Tuberculosis •Lung abscess •Pneumonia •Mycetoma (“fungus ball”)
  • Miscellaneous: • Goodpasture syndrome • Idiopathic pulmonary hemosiderosis • Granulomatosis with polyangiitis (Wegener granulomatosis)
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10
Q

What are the vascular diseases that could cause hemoptysis?

A

•Pulmonary embolism •Elevated pulmonary venous pressure • Left ventricular failure • Mitral stenosis •Vascular malformation

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11
Q

What are two rare causes of hemoptysis?

A

•Impaired coagulation •Pulmonary endometriosis

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12
Q

What are the first steps in evaluating hemoptysis?

A
  1. History
  2. Physical exam: Lungs, nose, mouth, pharynx
  3. Chest x-ray (CXR)
  4. Basic lab: CBC with differential, PT/INR, type and cross (massive)
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13
Q

Explain the role of the chest x-ray?

A
  • 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
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14
Q

When nodes or masses are found with Radiology what do we suspect?

A

Bronchogenic carcinoma or other neoplasm, lung abscess, fungal infection, vasculitis

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15
Q

When Atelectasias are found with Radiology what do we suspect?

A

Bronchogenic carcinoma or other endobronchial neoplasm, broncholithiasis, foreign body

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16
Q

When hilar or mediastinal adenopathy are found with Radiology what do we suspect?

A

Bronchogenic carcinoma or other neoplasm, mycobacterial or fungal infection, sarcoidosis

17
Q

When dilated peripheral airways are found with Radiology what do we suspect?

A

Bronchiectasis

18
Q

When airspace consolidation is found with Radiology what do we suspect?

A

Pneumonia, alveolar hemorrhage, pulmonary contusion

19
Q

When Reticulonodular densities are found with Radiology what do we suspect?

A

Sarcoidosis, lymphangitic carcinoma

20
Q

When a cavity single or multiple are found with Radiology what do we suspect?

A

Mycobacterial or fungal infection, mycetoma, lung abscess, bronchogenic carcinoma

21
Q

When a hilar/medistinal calcification is found with Radiology what do we suspect?

A

Previous mycobacterial or fungal infection, broncholithiasis

22
Q

Additional testing for hemoptysis?

A
  • 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
23
Q

Explain the diagnostic algorithm for hemoptysis?

A
24
Q

Important note to remember?

A

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.

25
Q

Major vs. minor hemoptysis? Airway Volume?

A
  • Minors: – Blood streaks or tinge in the sputum
  • Massive: – 150-600mL/4-24 hours – 5-15% of all hemoptysis – Mortality 71% though drops to <5% if > 24-48 hours
  • NB: Airway volume = 150mL
26
Q

Since the volume of blood is hard to quantify what do we look at?

A
  • Volume is difficult to quantitate therefore:
  • Magnitude of effect is important – Hemodynamics – Gas exchange – Aspiration of clots – Need for transfusion
27
Q

Massive Hemoptysis is a medical emergence what do we do?

A

An Airway Code Prompt Urgent Care Goals

  1. Airway control Prevent asphyxiation
  2. Stop the bleeding
  3. Buy time to treat 1°underlying disease
  • Position patient –Bleeding side down
  • Airway protection –Endotracheal intubation
  • IV access –Volume resuscitation
  • ICU transfer
  • If hemodynamic and respiratory compromise – Rigid bronchor – Large endotracheal intubation and FOB
  • Consultation – Interventional radiology – Interventional pulmonary thoracic surgery
28
Q

Explain the hemoptysis flow chart?

A
29
Q

How do we triage the causes of massive hemoptysis?

A
  • Infection: Tuberculosis, aspergilloma/mycetoma, lung abscess
  • Malignant: Endobronchial vs. Parenchymal
  • Inflammatory: Bronchiectasis, sarcoid
  • Vascular Anomalies: AV malformation, aortobronchialfistulas, tracheo-innominate fistula, Kaposi sarcoma

Respiratory 2 (10 decks)

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