Haemoptysis in adults Flashcards
Probability diagnosis
Acute chest infection:
- URTI (24%)
- bronchitis
- Chronic bronchitis
Trauma: chest contusion, prolonged coughing
Cause often unknown (22%)
Serious disorders not to be missed
Vascular:
- pulmonary infarction/embolus
- LHF / pulmonary oedema
- mitral stenosis
Infection:
- lobar pneumonia (rusty sputum)
- tuberculosis
- lung abscess
Cancer/tumour (4%):
- bronchogenic carcinoma
- tumour of the larynx or trachea
Other:
- blood disorders including anticoagulants
Pitfalls (often missed)
Foreign body
Bronchiectasis (13%)
Iatrogenic (e.g. endotracheal intubation)
Spurious haemoptysis (blood from nose or throat)
Factitious e.g. Münchausen syndrome
Rarities:
- idiopathic pulmonary haemosiderosis
- pulmonary AV malformation
- Goodpasture syndrome
- connective tissue disorder
Key history
Presenting symptom clarification—is it
- haemoptysis ?
- haematemesis ?
- bleeding from the nose or throat?
General symptoms e.g.
- weight loss
- fever
- pain, esp. pleuritic pain
Respiratory and cardiac hx including past history and exposure to TB (e.g. refugees).
Drug history especially smoking, alcohol, anticoagulation.
Key examination
General appearance and vital signs
Full respiratory and CVS exam including upper airways and mouth
Check legs for evidence of DVT
Key investigations
Chest X-ray
FBE
ESR/CRP
Sputum M&C
Other tests according to clinical findings e.g.
- CT
- bronchoscopy
- ECG
- echocardiogram
- ventilation/perfusion scan
Diagnostic tips
Blood originating from any area can be aspirated throughout lung.
Bright red haemoptysis in a young person may be the initial symptom of pulmonary TB.
Large haemoptyses are usually due to bronchiectasis or TB.
The commonest causes of haemoptysis are:
- URTI (24%)
- acute or chronic bronchitis (17%)
- bronchiectasis (13%)
- TB (10%)
- Unknown causes (22%)
