Haemoptysis

1. Haemoptysis Mudher Al-khairalla

2. Mrs Reddy coughed up blood What would you like to know?

3. Source? Onset? Duration? Character? Amount? Haemoptysis

4. Source? Onset? Duration? Character? Amount? Nose? GI? Vomit? “Coffee Ground” Haematemesis Dark and acidotic Melaena (also swallowed blood) Bronchial Haemoptysis

5. Source? Onset? Duration? Character? Amount? Haemoptysis

6. Source? Onset? Duration? Character? Amount? Haemoptysis

7. Source? Onset? Duration? Character? Amount? Frothy Old Rusty Streaks Mixed with sputum? If not consider infarction and trauma Haemoptysis

8. Source? Onset? Duration? Character? Amount? Massive ≥ 600 mls in 24h Admission May need emergency treatment Non massive < 600 mls in 24h Usually Ix as OP Haemoptysis

9. What could be causing Mrs Reddy’s haemoptysis?

10. Trauma Infective Neoplastic Vascular Parenchymal Non pulmonary Causes

11. Trauma Infective Neoplastic Vascular Parenchymal Non pulmonary Wounds Post intubation Foreign Body Causes

12. Trauma Infective Neoplastic Vascular Parenchymal Non pulmonary Pneumonia Abscess Acute Bronchitis Tuberculosis Bronchiectasis Fungi Causes

13. Trauma Infective Neoplastic Vascular Parenchymal Non pulmonary Primary Secondary Lung Breast Brain Prostate Colon Other Causes

14. Trauma Infective Neoplastic Vascular Parenchymal Non pulmonary Pulmonary Embolism Vasculitis SLE Wegener’s RA Osler-Weber-Rendu Arteriovenous malformation (AVM) Causes

15. Trauma Infective Neoplastic Vascular Parenchymal Non pulmonary Interstitial Lung Disease (ILD) Sarcoid Haemosiderosis Goodpasture’s syndrome Cystic Fibrosis Causes

16. Trauma Infective Neoplastic Vascular Parenchymal Non pulmonary CVS Pulmonary oedema Mitral stenosis Aortic aneurysm Eisenmenger’s Syndrome Bleeding Diathesis Including Drug induced Causes

17. Mrs Reddy is 42. She presents with haemoptysis, weight loss of 10 kg over 2 months and night sweats.She has never smoked

18. Her CXR shows cavitation in the right upper zone.

19. What are the possible diagnoses? • Tumour • TB • Pneumonia • Mycobateria other than TB (MOTT) • Any of them

20. What are the possible diagnoses? • Tumour • TB • Pneumonia • Mycobateria other than TB (MOTT) • Any of them

21. What would you like to do next? • Sputum MC+S • Induced sputum x3 for AFB • CT Chest • Commence Antibiotics • Blood Cultures

22. What would you like to do next? • Sputum MC+S • Induced sputum x3 for AFB • CT Chest • Commence Antibiotics • 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

24. 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.

26. 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

27. You put him on oxygen and start him on… • Warfarin • Low Molecular Weight Heparin • Aspirin • Streptokinase • Traneximic acid

28. You put him on oxygen and start him on… • Warfarin • Low Molecular Weight Heparin • Aspirin • Streptokinase • Traneximic acid

29. Which investigation would you arrange? • CTPA • CT chest • HRCT • PFTs + DLCO • V/Q scan

30. Which investigation would you arrange? • CTPA • CT chest • HRCT • PFTs + DLCO • V/Q scan

31. If Peter was 30 years older,smoked all his life and had emphysema on his CXR

32. 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.

35. He has fine inspiratory crackles at the bases and midzones,raised jugular venous pressure and has a heart rate of 110

36. This is his ECG

37. www.med.umich.edu/lrc/baliga/case01/LBBB.html

38. What does this show? • Normal sinus rhythm • Left Bundle Branch Block (LBBB) • Right Bundle Branch Block (RBBB) • ST elevation myocardial infarction • Ventricular tachycardia

39. What does this show? • Normal sinus rhythm • Left Bundle Branch Block (LBBB) • Right Bundle Branch Block (RBBB) • ST elevation myocardial infarction • Ventricular tachycardia

40. ! www.med.umich.edu/lrc/baliga/case01/LBBB.html

41. 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 (Bat’s 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 (Bat’s wing)

43. What has caused his deterioration? • Acute Bronchitis • Cryptogenic organising pneumonia • Pulmonary embolism • Acute pulmonary oedema • Aspiration pneumonia

44. What has caused his deterioration? • Acute Bronchitis • Cryptogenic organising pneumonia • Pulmonary embolism • Acute pulmonary oedema • Aspiration pneumonia

45. End!