Haemoptysis

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Haemoptysis

• Mudher Al-khairalla

2
Mrs Reddy coughed up blood

• What would you like to know?

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Haemoptysis

• Source?
• Onset?
• Duration?
• Character?
• Amount?

4
Haemoptysis

• Source?
• Onset?
• Duration?
• Character?
• Amount?

• Nose?
• GI?
• Vomit?
• Coffee Ground
• Haematemesis
• Dark and acidotic
• Melaena (also swallowed blood)
• Bronchial

5
Haemoptysis

• Source?
• Onset?
• Duration?
• Character?
• Amount?

6
Haemoptysis

• Source?
• Onset?
• Duration?
• Character?
• Amount?

7
Haemoptysis

• Source?
• Onset?
• Duration?
• Character?
• Amount?

• Frothy
• Old
• Rusty
• Streaks
• Mixed with sputum?
• If not consider infarction and trauma

8
Haemoptysis

• Source?
• Onset?
• Duration?
• Character?
• Amount?

• Massive
• 600 mls in 24h
• Admission
• May need emergency treatment
• Non massive
• lt 600 mls in 24h
• Usually Ix as OP

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What could be causing Mrs Reddys haemoptysis?
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Causes

• Trauma
• Infective
• Neoplastic
• Vascular
• Parenchymal
• Non pulmonary

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Causes

• Trauma
• Infective
• Neoplastic
• Vascular
• Parenchymal
• Non pulmonary

• Wounds
• Post intubation
• Foreign Body

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Causes

• Trauma
• Infective
• Neoplastic
• Vascular
• Parenchymal
• Non pulmonary

• Pneumonia
• Abscess
• Acute Bronchitis
• Tuberculosis
• Bronchiectasis
• Fungi

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Causes

• Trauma
• Infective
• Neoplastic
• Vascular
• Parenchymal
• Non pulmonary

• Primary
• Secondary
• Lung
• Breast
• Brain
• Prostate
• Colon
• Other

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Causes

• Trauma
• Infective
• Neoplastic
• Vascular
• Parenchymal
• Non pulmonary

• Pulmonary Embolism
• Vasculitis
• SLE
• Wegeners
• RA
• Osler-Weber-Rendu
• Arteriovenous malformation (AVM)

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Causes

• Trauma
• Infective
• Neoplastic
• Vascular
• Parenchymal
• Non pulmonary

• Interstitial Lung Disease (ILD)
• Sarcoid
• Haemosiderosis
• Goodpastures syndrome
• Cystic Fibrosis

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Causes

• Trauma
• Infective
• Neoplastic
• Vascular
• Parenchymal
• Non pulmonary

• CVS
• Pulmonary oedema
• Mitral stenosis
• Aortic aneurysm
• Eisenmengers Syndrome
• Bleeding Diathesis
• Including Drug induced

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Mrs Reddy is 42. She presents with haemoptysis,
weight loss of 10 kg over 2 months and night
sweats.She has never smoked
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Her CXR shows cavitation in the right upper zone.
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What are the possible diagnoses?

1. Tumour
2. TB
3. Pneumonia
4. Mycobateria other than TB (MOTT)
5. Any of them

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What are the possible diagnoses?

1. Tumour
2. TB
3. Pneumonia
4. Mycobateria other than TB (MOTT)
5. Any of them

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What would you like to do next?

1. Sputum MCS
2. Induced sputum x3 for AFB
3. CT Chest
4. Commence Antibiotics
5. Blood Cultures

22
What would you like to do next?

1. Sputum MCS
2. Induced sputum x3 for AFB
3. CT Chest
4. Commence Antibiotics
5. Blood Cultures

23
Sputum samples are negative for AFBYou still
have high index of suspicionwhat next?

• Bronchial Biopsy
• Bronchiio-Alveolar Lavage (BAL)
• CT biopsy
• Mantoux test
• Repeat CXR in 2 months

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Sputum samples are negative for AFBYou still
have high index of suspicionwhat next?

• Bronchial Biopsy
• Bronchio-Alveolar Lavage (BAL)
• CT biopsy
• Mantoux test
• Repeat CXR in 2 months

25
Peter is 31.He is a non smoker , suffers from
heartburn and works in a job centre.He presents
with coughing up 3 glass-fulls of fresh blood
over 24 hours.He normally keeps well and his
mother has had problems with DVT in the past.
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His CXR is normal and you note that his RR is
24/min, HR 96/min and BP 121/63.His pO2 on room
air is 8.3 kPa
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You put him on oxygen and start him on

1. Warfarin
2. Low Molecular Weight Heparin
3. Aspirin
4. Streptokinase
5. Traneximic acid

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You put him on oxygen and start him on

1. Warfarin
2. Low Molecular Weight Heparin
3. Aspirin
4. Streptokinase
5. Traneximic acid

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Which investigation would you arrange?

1. CTPA
2. CT chest
3. HRCT
4. PFTs DLCO
5. V/Q scan

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Which investigation would you arrange?

1. CTPA
2. CT chest
3. HRCT
4. PFTs DLCO
5. V/Q scan

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If Peter was 30 years older,smoked all his life
and had emphysema on his CXR
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Which test would you choose?

• CTPA
• CT chest
• HRCT
• PFTs DLCO
• V/Q scan

33
Which test would you choose?

• CTPA
• CT chest
• HRCT
• PFTs DLCO
• V/Q scan

34
George is 73. He presents acutely with
breathlessness and coughing up frothy pink
sputum. He has been suffering from orthopnoea,
PND and ankle oedema over several days.
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He has fine inspiratory crackles at the bases and
midzones,raised jugular venous pressure and has a
heart rate of 110
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This is his ECG
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www.med.umich.edu/lrc/baliga/case01/LBBB.html
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What does this show?

1. Normal sinus rhythm
2. Left Bundle Branch Block (LBBB)
3. Right Bundle Branch Block (RBBB)
4. ST elevation myocardial infarction
5. Ventricular tachycardia

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What does this show?

1. Normal sinus rhythm
2. Left Bundle Branch Block (LBBB)
3. Right Bundle Branch Block (RBBB)
4. ST elevation myocardial infarction
5. Ventricular tachycardia

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!
www.med.umich.edu/lrc/baliga/case01/LBBB.html
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Which of the following is likely to be present on
his CXR?

• Cardiomegaly
• Upper lobe venous diversion
• Pleural effusion
• Kerley B Lines
• Perhilar patchy opacification (Bats wing)

42
Which of the following is likely to be present on
his CXR?

• Cardiomegaly
• Upper lobe venous diversion
• Pleural effusion
• Kerley B Lines
• Perhilar patchy opacification (Bats wing)

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What has caused his deterioration?

1. Acute Bronchitis
2. Cryptogenic organising pneumonia
3. Pulmonary embolism
4. Acute pulmonary oedema
5. Aspiration pneumonia

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What has caused his deterioration?

1. Acute Bronchitis
2. Cryptogenic organising pneumonia
3. Pulmonary embolism
4. Acute pulmonary oedema
5. Aspiration pneumonia

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End!