Definition and Pathophysiology
• Expectoration of blood or blood-streaked sputum
• Massive hemoptysis: ~>600 mL/24–48 h; gas exchange more important than blood loss
• Massive hemoptysis usually results from tortuous or invaded bronchial arteries
Etiology
1. Infections/Inflammation:
- Bronchitis - the most common cause of trivial hemoptysis
- Bronchiectasis
- Cystic fibrosis
- Tuberculosis
- Aspergilloma
- Pneumonia
- Lung abscess
2. Neoplasms:
- Usually primary lung cancer
- sometimes metastases
3. Cardiovascular causes:
4. Other causes:
- Vasculitis (Wegener's Good pasture)
- Anticoagulant drug therapy
- Cocaine
- Rarely lung endometriosis.
Diagnostic workup
• Localize bleeding site
Rule out GI or ENT source by exam, history; may require endoscopy
Pulmonary source: determine whether unilateral or bilateral, localized or diffuse, parenchymal or airway by CXR or chest CT, bronchoscopy if necessary
• PT, PTT, CBC to rule out coagulopathy
• Sputum culture/stain for bacteria, fungi and AFB; cytology to r/o malignancy
• ANCA, anti-GBM, urinalysis to ✓ for vasculitis or pulmonary-renal syndrome
Treatment
• Mechanism of death is asphyxiation not exsanguination; maintain gas exchange, reverse coagulation and treat underlying condition; cough suppression . may ↑ risk of asphyxiation
• Massive hemoptysis: put bleeding side dependent; selectively intubate nl lung if needed
- Angiography: diagnostic as well as therapeutic (vascular occlusion balloons or selective embolization of bronchial artery)
- Rigid bronchoscopy: allows more interventional options (electrocautery, laser) than flexible bronchoscopy.
- Surgical resection
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