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Haemoptysis Haemoptysis Mudher Al-khairalla Mudher Al-khairalla
HaemoptysisHaemoptysis
Mudher Al-khairallaMudher Al-khairalla
Mrs Reddy coughed up Mrs Reddy coughed up bloodblood
What would you like to know?What would you like to know?
HaemoptysisHaemoptysis Source?Source? Onset?Onset? Duration?Duration? Character?Character? Amount?Amount?
HaemoptysisHaemoptysis Source?Source? Onset?Onset? Duration?Duration? Character?Character? Amount?Amount?
Nose?Nose? GI?GI?
Vomit?Vomit? ““Coffee Ground”Coffee Ground” HaematemesisHaematemesis
Dark and acidoticDark and acidoticMelaena (also Melaena (also
swallowed blood)swallowed blood) BronchialBronchial
HaemoptysisHaemoptysis Source?Source? Onset?Onset? Duration?Duration? Character?Character? Amount?Amount?
HaemoptysisHaemoptysis Source?Source? Onset?Onset? Duration?Duration? Character?Character? Amount?Amount?
HaemoptysisHaemoptysis Source?Source? Onset?Onset? Duration?Duration? Character?Character? Amount?Amount?
FrothyFrothy OldOld RustyRusty StreaksStreaks Mixed with Mixed with
sputum?sputum? If not consider If not consider
infarction and infarction and traumatrauma
HaemoptysisHaemoptysis Source?Source? Onset?Onset? Duration?Duration? Character?Character? Amount?Amount?
MassiveMassive ≥ ≥ 600 mls in 24h600 mls in 24h AdmissionAdmission May need May need
emergency emergency treatmenttreatment
Non massiveNon massive < 600 mls in 24h< 600 mls in 24h Usually Ix as OPUsually Ix as OP
What could be causing What could be causing Mrs Reddy’s Mrs Reddy’s
haemoptysis?haemoptysis?
CausesCauses TraumaTrauma InfectiveInfective NeoplasticNeoplastic VascularVascular ParenchymalParenchymal Non pulmonaryNon pulmonary
CausesCauses TraumaTrauma InfectiveInfective NeoplasticNeoplastic VascularVascular ParenchymalParenchymal Non pulmonaryNon pulmonary
WoundsWounds Post intubationPost intubation Foreign BodyForeign Body
CausesCauses TraumaTrauma InfectiveInfective NeoplasticNeoplastic VascularVascular ParenchymalParenchymal Non pulmonaryNon pulmonary
PneumoniaPneumonia AbscessAbscess Acute BronchitisAcute Bronchitis TuberculosisTuberculosis BronchiectasisBronchiectasis FungiFungi
CausesCauses TraumaTrauma InfectiveInfective NeoplasticNeoplastic VascularVascular ParenchymalParenchymal Non pulmonaryNon pulmonary
PrimaryPrimary SecondarySecondary
LungLung BreastBreast BrainBrain ProstateProstate ColonColon OtherOther
CausesCauses TraumaTrauma InfectiveInfective NeoplasticNeoplastic VascularVascular ParenchymalParenchymal Non pulmonaryNon pulmonary
Pulmonary Pulmonary Embolism Embolism
VasculitisVasculitis SLESLE Wegener’sWegener’s RARA Osler-Weber-RenduOsler-Weber-Rendu
Arteriovenous Arteriovenous malformation (AVM)malformation (AVM)
CausesCauses TraumaTrauma InfectiveInfective NeoplasticNeoplastic VascularVascular ParenchymalParenchymal Non pulmonaryNon pulmonary
Interstitial Lung Interstitial Lung Disease (ILD)Disease (ILD)
SarcoidSarcoid HaemosiderosisHaemosiderosis Goodpasture’s Goodpasture’s
syndromesyndrome Cystic FibrosisCystic Fibrosis
CausesCauses TraumaTrauma InfectiveInfective NeoplasticNeoplastic VascularVascular ParenchymalParenchymal Non pulmonaryNon pulmonary
CVSCVS Pulmonary oedemaPulmonary oedema Mitral stenosisMitral stenosis Aortic aneurysmAortic aneurysm Eisenmenger’s Eisenmenger’s
SyndromeSyndrome Bleeding DiathesisBleeding Diathesis
Including Drug Including Drug inducedinduced
Mrs Reddy is 42. Mrs Reddy is 42. She presents with She presents with haemoptysis, weight loss haemoptysis, weight loss of 10 kg over 2 months of 10 kg over 2 months and night sweats.and night sweats.She has never smokedShe has never smoked
Her CXR shows Her CXR shows cavitation in the right cavitation in the right upper zone.upper zone.
What are the possible What are the possible diagnoses?diagnoses?
1.1. TumourTumour2.2. TBTB3.3. PneumoniaPneumonia4.4. Mycobateria other than TB (MOTT)Mycobateria other than TB (MOTT)5.5. Any of themAny of them
What are the possible What are the possible diagnoses?diagnoses?
1.1. TumourTumour2.2. TBTB3.3. PneumoniaPneumonia4.4. Mycobateria other than TB (MOTT)Mycobateria other than TB (MOTT)5.5. Any of themAny of them
What would you like to do What would you like to do next?next?
1.1. Sputum MC+SSputum MC+S2.2. Induced sputum x3 for AFBInduced sputum x3 for AFB3.3. CT ChestCT Chest4.4. Commence AntibioticsCommence Antibiotics5.5. Blood CulturesBlood Cultures
What would you like to do What would you like to do next?next?
1.1. Sputum MC+SSputum MC+S2.2. Induced sputum x3 for AFBInduced sputum x3 for AFB3.3. CT ChestCT Chest4.4. Commence AntibioticsCommence Antibiotics5.5. Blood CulturesBlood Cultures
Sputum samples are negative Sputum samples are negative for AFBfor AFB
You still have high index of You still have high index of suspicionsuspicion
what next?what next?1.1. Bronchial BiopsyBronchial Biopsy2.2. Bronchiio-Alveolar Lavage (BAL)Bronchiio-Alveolar Lavage (BAL)3.3. CT biopsyCT biopsy4.4. Mantoux testMantoux test5.5. Repeat CXR in 2 monthsRepeat CXR in 2 months
Sputum samples are negative Sputum samples are negative for AFBfor AFB
You still have high index of You still have high index of suspicionsuspicion
what next?what next?1.1. Bronchial BiopsyBronchial Biopsy2.2. Bronchio-Alveolar Lavage (BAL)Bronchio-Alveolar Lavage (BAL)3.3. CT biopsyCT biopsy4.4. Mantoux testMantoux test5.5. Repeat CXR in 2 monthsRepeat CXR in 2 months
Peter is 31.Peter is 31.He is a non smoker , suffers from He is a non smoker , suffers from
heartburn and works in a job heartburn and works in a job centre.centre.
He presents with coughing up 3 He presents with coughing up 3 glass-fulls of fresh blood over 24 glass-fulls of fresh blood over 24
hours.hours.He normally keeps well and his He normally keeps well and his mother has had problems with mother has had problems with
“DVT” in the past.“DVT” in the past.
His CXR is normal and you His CXR is normal and you note that his RR is 24/min, note that his RR is 24/min, HR 96/min and BP 121/63.HR 96/min and BP 121/63.His pO2 on room air is 8.3 His pO2 on room air is 8.3
kPa kPa
You put him on oxygen and start You put him on oxygen and start him on…him on…
1.1. WarfarinWarfarin2.2. Low Molecular Weight HeparinLow Molecular Weight Heparin3.3. AspirinAspirin4.4. StreptokinaseStreptokinase5.5. Traneximic acidTraneximic acid
You put him on oxygen and start You put him on oxygen and start him on…him on…
1.1. WarfarinWarfarin2.2. Low Molecular Weight HeparinLow Molecular Weight Heparin3.3. AspirinAspirin4.4. StreptokinaseStreptokinase5.5. Traneximic acidTraneximic acid
Which investigation would you Which investigation would you arrange?arrange?
1.1. CTPACTPA2.2. CT chestCT chest3.3. HRCTHRCT4.4. PFTs + DLCOPFTs + DLCO5.5. V/Q scanV/Q scan
Which investigation would you Which investigation would you arrange?arrange?
1.1. CTPACTPA2.2. CT chestCT chest3.3. HRCTHRCT4.4. PFTs + DLCOPFTs + DLCO5.5. V/Q scanV/Q scan
If Peter was 30 years If Peter was 30 years older,smoked all his life older,smoked all his life and had emphysema on and had emphysema on
his CXRhis CXR
Which test would you Which test would you choose?choose?
1.1. CTPACTPA2.2. CT chestCT chest3.3. HRCTHRCT4.4. PFTs + DLCOPFTs + DLCO5.5. V/Q scanV/Q scan
Which test would you Which test would you choose?choose?
1.1. CTPACTPA2.2. CT chestCT chest3.3. HRCTHRCT4.4. PFTs + DLCOPFTs + DLCO5.5. V/Q scanV/Q scan
George is 73. He presents acutely with George is 73. He presents acutely with breathlessness and coughing up frothy breathlessness and coughing up frothy
pink sputum. He has been suffering from pink sputum. He has been suffering from orthopnoea, PND and ankle oedema over orthopnoea, PND and ankle oedema over
several days.several days.
He has fine inspiratory crackles at the He has fine inspiratory crackles at the bases and midzones,raised jugular venous bases and midzones,raised jugular venous
pressure and has a heart rate of 110pressure and has a heart rate of 110
This is his ECGThis is his ECG
What does this show?What does this show?1.1. Normal sinus rhythmNormal sinus rhythm2.2. Left Bundle Branch Block (LBBB)Left Bundle Branch Block (LBBB)3.3. Right Bundle Branch Block (RBBB)Right Bundle Branch Block (RBBB)4.4. ST elevation myocardial infarctionST elevation myocardial infarction5.5. Ventricular tachycardiaVentricular tachycardia
What does this show?What does this show?1.1. Normal sinus rhythmNormal sinus rhythm2.2. Left Bundle Branch Block Left Bundle Branch Block
(LBBB)(LBBB)3.3. Right Bundle Branch Block (RBBB)Right Bundle Branch Block (RBBB)4.4. ST elevation myocardial infarctionST elevation myocardial infarction5.5. Ventricular tachycardiaVentricular tachycardia
www.med.umich.edu/lrc/baliga/case01/LBBB.html
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Which of the following is likely to Which of the following is likely to be present on his CXR?be present on his CXR?
1.1. CardiomegalyCardiomegaly2.2. Upper lobe venous diversionUpper lobe venous diversion3.3. Pleural effusionPleural effusion4.4. Kerley B LinesKerley B Lines5.5. Perhilar patchy opacification (Bat’s Perhilar patchy opacification (Bat’s
wing)wing)
Which of the following is likely to Which of the following is likely to be present on his CXR?be present on his CXR?
1.1. CardiomegalyCardiomegaly2.2. Upper lobe venous diversionUpper lobe venous diversion3.3. Pleural effusionPleural effusion4.4. Kerley B LinesKerley B Lines5.5. Perhilar patchy opacification Perhilar patchy opacification
(Bat’s wing)(Bat’s wing)
What has caused his What has caused his deterioration?deterioration?
1.1. Acute BronchitisAcute Bronchitis2.2. Cryptogenic organising pneumoniaCryptogenic organising pneumonia3.3. Pulmonary embolismPulmonary embolism4.4. Acute pulmonary oedemaAcute pulmonary oedema5.5. Aspiration pneumoniaAspiration pneumonia
What has caused his What has caused his deterioration?deterioration?
1.1. Acute BronchitisAcute Bronchitis2.2. Cryptogenic organising pneumoniaCryptogenic organising pneumonia3.3. Pulmonary embolismPulmonary embolism4.4. Acute pulmonary oedemaAcute pulmonary oedema5.5. Aspiration pneumoniaAspiration pneumonia
End!End!
