Hemoptysis, clinical picture & examination

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Text of Hemoptysis, clinical picture & examination

  • Clinical picture & examination
  • D.D Examination History Complaint
  • Rare < 6Y. Older children with a focal hemorrhage warmth or bubbling sensation in the chest wall. This can occasionally aid the clinician in locating the area involved.
  • Rapid and large-volume blood loss manifests as symptoms of cyanosis, respiratory distress, and shock. Chronic, subclinical blood loss may manifest as anemia, fatigue, dyspnea, or altered activity tolerance. Less commonly, patients present with symptoms of chronic illness such as failure to thrive.
  • History of Chief Complaint: Seek information regarding the timing and amount of blood. Find out about associated symptoms: Fever, a recent history of infection or cold symptoms (fatigue, runny nose, sore throat, coughing). Recent choking episodes, recent trauma or the possibility of aspiration. Recent weight loss or appetite changes. Inquire about any medications that the child has or may have taken.
  • Past Medical History Does the child have any known underlying diseases (eg. Cystic Fibrosis, congenital diseases, rheumatic heart disease). Is there a history of symptoms that may suggest chronic lung disease (eg. long-term coughing, wheezing, or stridor). Are there any surgeries that the child has undergone? Is the childs growth and development progressing normally?
  • Other important details Are there any familial disorders? Are there any allergies the child has? Are the childs vaccinations up to date? What do they think is the cause of hemoptysis?
  • Hemoptysis is first differentiated from other common sources of bleeding, including the upper airway and the gastrointestinal tract.
  • Table 1: Comparison between hemoptysis and hematemesis Features Hemoptysis Hematemesis Sputum features -bright red or pink-frothy -dark red or brown if lower in GI tract, bright red if higher upusually not frothy -pH: alkaline -consistency: liquid with clotted look -content: mixed in with sputum -pH: acidic -consistency: ground coffee, stale blood appearance -content: may have food particles History -no nausea or vomiting-may have history of lung disease -may be associated with coughing or gurgling -presence of nausea or vomiting -may have history of gastrointestinal or hepatic disease
  • Special attention is given to the oral cavity and nasopharynx as potential sources of bleeding. Fiberoptic laryngoscopy is performed in cooperative children to evaluate the pharynx and larynx.
  • A complete general physical exam that includes vitals and growth parameters must be carried out.
  • MVT chest wall expansion blunt trauma Mass inspection
  • palpation tenderness masses lymph nodes
  • percussion consolidation collapse effusion
  • auscultation Localized wheezing Pleural rub murmurs
  • Psudohemoptysis Hematemesis (GIT bleeding). Bleeding from upper air ways. Factitious hemoptysis.
  • Factitious hemoptysis is considered in the differential diagnosis if no etiology is discernible after a thorough evaluation, especially when the medical history or the patient's behavior is unusual