HEMOPTYSIS

Ask the Following Questions:

1. Is there chest pain? If there is chest pain along with the hemoptysis, one should suspect a pulmonary embolism.
2. Is there fever and/or purulent sputum? The presence of fever and purulent sputum suggests pneumonia, lung abscess, tuberculosis, and bronchiectasis. However, bronchiectasis does not usually occur with fever.
3. Is there dyspnea, cardiomegaly, or a heart murmur? These findings suggest congestive heart failure or mitral stenosis.
4. Is there copious sputum? The presence of copious sputum should suggest bronchiectasis or lung abscess. If there is fever along with it, lung abscess is more likely. Copious foamy sputum suggests congestive heart failure.

DIAGNOSTIC WORKUP

Routine diagnostic tests include a CBC, sedimentation rate, chemistry panel, coagulation profile, sputum smear, culture and sensitivity, a chest x-ray, and an EKG.

If a pulmonary embolism or infarction is suspected, arterial blood gases and a ventilation-perfusion scan should be ordered. In some cases, a pulmonary angiogram may be necessary. Objective testing for deep vein thrombosis with ultrasonography or impedance plethysmography may help confirm suspicion of a pulmonary embolism.

If tuberculosis is suspected, one should order a sputum or gastric washings for AFB smear, culture, and guinea pig inoculation. A tuberculin test should also be done. Apical lordotic views of the lung as well as lateral and oblique views may help identify a tuberculous cavity. There are serologic tests for antibodies against specific mycobacterial antigens.

Sputum cultures for fungi and skin tests for the various fungi may need to be done. If congestive heart failure is suspected, venous pressure and circulation time should be measured, and a pulmonary function test should be done. Echocardiography will help diagnose mitral stenosis.

A consultation with a pulmonologist and bronchoscopy need to be done if bronchogenic carcinoma or bronchiectasis is suspected. Other studies that are helpful in diagnosing bronchogenic carcinoma are sputa for Pap smear, transbronchial needle biopsy, and CT. MRI may confirm vascular etiologies for the bleeding such as pulmonary aneurysm. Serologic studies [ANA, antineutrophil cytoplasmic antibody (C-ANCA), etc.] may be useful in detecting collagen diseases. A bronchogram will be helpful in diagnosing bronchiectasis and foreign bodies.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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