Pocket Pediatrics: The Massachusetts General Hospital for Children Handbook of Pediatrics (Pocket Notebook Series), 2 Ed.

HEMOPTYSIS

• Expectoration of blood that originated in the lungs or bronchial tubes

• Differential

• Extrapulmonary: Oral, GI, epistaxis

• Airways: Tracheobronchitis (most common cause), bronchiectasis (esp with CF), foreign body, tracheostomy related

• Pulmonary parenchyma: PNA, cavitary lesions, tumor (often metastatic), trauma, TB

• Pulmonary vasculature: IPH, Heiner syndrome (assoc w/ cow’s milk), vasculitis (Wegener, Goodpasture, HSP, SLE), pulm HTN (arterial or venous), pulm infarction/PE, AVMs, coagulopathies

• Diagnostic studies

• Labs: CBC, ANA, anti-GBM, ANCA, U/A (eval for hematuria), BUN/Cr, PT/PTT, PPD

• pH analysis of sample (hematemesis: ↓ pH vs. hemoptysis: ↑ pH)

• Radiographic studies: CXR (patchy or diffuse alveolar opacities in DAH)

• Consider helical chest CT

• Consider echocardiography to r/o heart disease

• Diagnostic procedures

• Flex bronch/BAL: Hemosiderin-laden macrophages present from 3 d–wk after bleed

• Open lung biopsy

• Management

• Treat underlying cause once identified

• Mild hemoptysis: No immediate treatment required

• Massive hemoptysis: Provide O₂, decubitus position (w/ bleeding side down to

promote oxygenation), selective intubation or main stem bronchus on nonbleeding side, bronchial artery embolization, rigid bronchoscopy, surgical resection