Haemoptysis

Question 1

What are the differentials of haemoptysis?

Answer 1

Infection (e.g. tuberculosis)
Pulmonary embolism
Malignancy
Pulmonary hypertension (e.g. following mitral stenosis)
Bronchiectasis
Laryngeal cancer

Question 2

What should initial assessment of haemoptysis aim to do?

Answer 2

Differentiate between haematemesis, pseudohaemoptysis and haemoptysis
Identify site and DDx

Question 3

When can pseudohaemopytsis occur?

Answer 3

Haematemesis is aspirated into the lungs
Bleeding from the upper airway/mouth stimulates a cough reflex
Material is expectorated that looks like blood but isn’t (e.g. Serratia marcescens infection, rifampicin use)

Question 4

What are the differences between haemoptysis from pulmonary and extrapulmonary sources?

Answer 4

Pulmonary will be bright red, frothy alkaline sputum

Extrapulmonary will be darker, may have mixed food particles, acidic

Question 5

What does a history of chronic mucopurulent sputum with chronic lung disease suggest in haemopytsis?

Answer 5

Bronchiectasis

Question 6

What does a history of exertion, orthopnoea or paroxysmal nocturnal dyspnoea suggest in haemopytsis?

Answer 6

Congestive heart failure or mitral stenosis

Question 7

What may unilateral wheeze on exam suggest in haemoptysis suggest?

Answer 7

Bronchial adenoma

Endobronchial carcinomas blocking laminar air flow

Question 8

What might the systemic findings of arthralgia, synovitis and/or nose deformity in haemoptysis suggest?

Answer 8

Rheumatological causes such as GPA

Question 9

What investigations should be carried out in haemoptysis?

Answer 9

CXR
CT/CTPA/VQ
Flexible bronchoscopy
Bloods etc based on DDx