HAEMOPTYSIS

Massive – 200 ml/ 24 h

· Source

90 % from systemic arteries

10 % from pulmonary arteries

- from developed pulmonary artery aneurysms (TB)

· Bronchial disease

Carcinoma *

Bronchiectasis *

Acute bronchitis *

Bronchial adenoma

Foreign body

 

 

 

· Parenchymal disease

Tuberculosis *

Suppurative pneumonia *

Lung abscess

Parasites (e.g. hydatid disease, flukes)

Trauma

Actinomycosis

Aspergilloma

· Lung vascular disease

Pulmonary infarction *

Arteriovenous malformation

Hereditary hemorrhagic teleangiectasia

Polyarteritis nodosa

Goodpasture`s syndrome

M. Wegener

Idiopathic pulmonary haemosiderosis

· Cardiovascular disease

Acute left ventricular failure *

Mitral stenosis *

Aortic aneurysm

· Blood disorders

Leukaemia

Haemophilia

Anticoagulants

 

 

· Diff. dg.

hematemesis

nasopharyngeal bleeding

· Diagnostic procedures

blood count

arterial blood gases

chest X-ray

(bronchoscopy)

sputum: bacteriology (incl. BK), cytology

CT

bronchial arteriography

perfusion (ventilation) scan

echocardiography

· Treatment

· Goals of treatment
  1. prevent asphyxiation
  2. stop the bleeding
  3. treat the primary disease

· Treatment

Of hemoptysis of small amount (< 15-20 ml)

-cough suppression

-(ATB)

-diagnostic evaluation

Of hemoptysis > few teaspoons/24 h

-bed rest, sedation

-position with the bleeding side down

Of massive (> 200 ml/day) haemoptysis

-position, ice

-placing a Fogarty ballon

-placing an ET into mainstem bronchus of nonbleeding lung

hemostyptics, plasma, transfusions, oxygen