EMQ practice - Haemoptysis

Haemoptysis

• 65 year old smoker, shortness of breath, gallop rhythm, production of pink frothy sputum
• Pulmonary oedema
• Increased JVP, gallop rhythm, pink frothy sputum
• Could be underlying myocardial infarction
• 24 year old male, cough and intermittent haemoptysis, few weeks later with haematuria, biopsy confirms crescentic glomerulonephritis, renal biopsy shows linear pattern deposition on immunofluorescence
• Goodpasture's syndrome
• Pulmonary renal syndrome (Wegener's granulomatosis, microscopic polyangiitis, and Goodpasture's disease (GD))
• cANCA for Wegener's
• Anti-GBM for GD (classic linear staining)
• Binding to lung alveolar membrane and kidney glomerular membrane (type II hypersensitivity)
• HLA-DR2 association
• In smokers, and should avoid smoking
• Treatment: plasmapheresis and corticosteroids
• 34 year old woman, complaining of nasal obstruction develops cough, haemoptysis, and pleuritic chest pain, chest radiograph shows multiple nodular masses
• Wegener's granulomatosis
• Small artery vasculitis
• Lesions in upper respiratory tract, lung and kidneys
• Eye signs up to 50% (scleritis, uveitis, retinitis)
• Vasculitis and granuloma deposition can affect any organ so less common associated symptoms and signs are legion
• Treatment: high-dose corticosteroids with cyclophosphamide
• 22 year old male, fever, nightsweats, weight loss and cough productive of cupfuls of blood. Ziehl-Neelsen stain positive for acid-fast bacilli
• Tuberculosis (TB)
• Miliary TB describes widespread TB through haematological dissemination
• 35 year old businessman, returns from trip abroad, collapses at airport with haemoptysis and pleuritic chest pain, sinus tachycardia, ECG shows right axis deviation
• Pulmonary embolus
• Ventilation perfusion scanning and pulmonary angiography performed using spiral computed tomography
• PE also increased by previous thromboembolic events, oral contraceptive pill and surgery (especially pelvic surgery immobility and associated thrombophilias)