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Hemoptysis , or the expectoration of blood, originating from below the vocal cords,
can range from blood-streaking of sputum to the presence of gross blood in the
absence of any accompanying sputum.
Bronchitis, bronchogenic carcinoma, and bronchiectasis are the most common
causes of hemoptysis
massive hemoptysis: is reserved for bleeding that is potentially acutely lifethreatening; often ranging from more than 100 to more than 600 mL of blood over
a 24 hour period
Three etiologies accounted for 90 percent of the cases of massive hemoptysis:
tuberculosis, bronchiectasis, and lung abscess
EVALUATION OF HEMOPTYSIS
Further evaluation is next directed toward confirming the suspected diagnosis if the history,
physical examination, or any of the above studies suggests a particular cause for the
hemoptysis.
flexible bronchoscopy: its role in patients with normal chest radiographs, to rule out
endobronchial malignancy that is radiographically silent
high-resolution CT scanning (HRCT)
Treatment
Airway:
o
Disposition
Healthy, minimal bleeding: Get CXR; if negative: Home, outpt f/u
High-risk pt, minor bleeding: Get CT, consider admit for
observation, bronchoscopy
Related topics
Wegeners granulomatosis
Necrotizing granulomatous inflammatory disease with systemic vasculitis, particularly
involving the upper and lower respiratory tract, and kidney
Can occur at any age, but incidence in young and middle-aged adults
Clinical manifestations
pulmonary (90%) upper: sinusitis, otitis (rare in adults), rhinitis, nasal mucosal ulceration,
saddlenose deformity
lower: pleurisy, pulmonary infiltrate, nodules, hemorrhage, hemoptysis
renal (80%): hematuria, RPGN (pauci-immune)
ocular (50%): episcleritis, uveitis, & proptosis from orbital granulomas, corneal ulcer
neurologic: cranial and peripheral neuropathies, mononeuritis multiplex
hematologic: incidence DVT/PE (20) when disease active
Dx studies:
90% ANCA (8095% c-ANCA, remainder p-ANCA)
CXR or CT nodules, infiltrates, cavities; sinus CT sinusitis
BUN & Cr, proteinuria, hematuria; sediment w/ RBC casts, dysmorphic RBCs
biopsy necrotizing granulomatous inflammation of arterioles, capillaries, veins
Treatment
Induction: cyclophosphamide PO (2 mg/kg/d 36 mo or pulse 1 5 mg/kg/d q23 wk)&
prednisone (1 2 mg/kg/d taper over 61 8 mo)..RPGN: consider adding plasma
exchange to regimen
Maintenance: MTX or AZA for 2 y
for mild disease MTX/prednisone may be adequate for induction
disease relapses: match aggressive disease with aggressive Rx as needed
ANCA w/o clinical evidence of flare should not prompt Rx TMP-SMX may prevent
upper airway disease relapse incited by respiratory infections