Hemoptysis case presentation

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Hemoptysis case scenario DDx How to diagnose Guidlines and protocols

Text of Hemoptysis case presentation

  • 1. HemoptysisDMCHussain AlsheefENT resident

2. Case scenario 25 y/o Saudi male, smoker , medically free c/o coughing blood for 3days No SOB or chest pain No hoarsness , dysphagia , odynophagia or chocking No nasal obstruction or epistaxis No bleeding disorder No contact with TB pt. No fever or wt. loss 3. O/E Laying comfortably on bed not on distress Not pale V/S : BP=124/80 , P=84 , O2 sat=99% on room air , T=36.7 Throat : no post nasal bleeding Nose : Ant. Rhinoscopy : free Flexible scope : no bleeding points seen in nasal septum orturbinates Pharynx and larynx free Neck : no lymph nodes 4. Investigations Blood inv. CBC Chemistry Coagulation profile Imaging studies CXR CT scan Scope 5. DDx 6. Airway diseasesInflammatory(bronchitis ,bronchiectasis)F.BAirway traumaNeoplasms(bronchogenicca.)LungsInfectionsTb. ,pneumoniaAutoimmunediseases(wegner,goodpasturesyndrome , SLEPul.vasculatureLt. heartfailurePulmonary AVmalformationThrombo-embolismOthersCoagulopathyCocaine useIatrogenic 7. Hemoptysis expectoration of blood typically from the lower respiratory tract, upper (respiratory & GI) tracts can be expectorated and mimic bloodcoming from the lower respiratory tract Hemoptysis is classified as nonmassive or massive based on thevolume of blood loss Massive hemoptysis > 200cc / day The low-pressure pulmonary system tends to produce small-volumehemoptysis, whereas bleeding from the bronchial system, which is atsystemic pressure, tends to be profuse most common causes of hemoptysis areacute and chronic bronchitis, pneumonia, tuberculosis, and lung cancerInfection : 60-70% of casesCancer : 23% of cases in US 8. Evalutation of hemoptysisCBC , coagulation , RFTCXRFlexible bronchoscopyCT 9. Key points Hemoptysis needs to be distinguished from hematemesis andnasopharyngeal or oropharyngeal bleeding. Bronchitis, bronchiectasis, TB, and necrotizing pneumonia or lungabscess are the most common causes in adults. Lower respiratory tract infection and foreign body aspiration are themost common causes in children. Patients with massive hemoptysis require treatment and stabilizationbefore testing. Bronchial artery embolization is the preferred treatment for massivehemoptysis. 10. References Uptodate.comEtiology and evaluation of hemoptysis in adults Merck ManualHemoptysis .. Last reviewed literature on July 2014 11. Thank you