1. Core Clinical Problems
Haemoptysis

2. Mrs Reddy coughed up blood
What would you like to know?

3. Haemoptysis
Source?
Onset?
Duration?
Character?
Amount?

4. Haemoptysis Source? Onset? Duration? Character? Amount? Nose? GI?
Vomit?
“Coffee Ground”
Haematemesis
Dark and acidotic
Melaena (also swallowed blood)
Bronchial

5. Haemoptysis
Source?
Onset?
Duration?
Character?
Amount?

6. Haemoptysis
Source?
Onset?
Duration?
Character?
Amount?

7. Haemoptysis Source? Onset? Duration? Character? Amount? Frothy Old
Rusty
Streaks
Mixed with sputum?
If not consider infarction and trauma

8. Haemoptysis Source? Onset? Duration? Character? Amount? Massive Major
≥ 500 mls in 24h
Admission
May need emergency treatment
Major
mls in 24h
Non Major < ml OP Inv

9. What could be causing Mrs Reddy’s haemoptysis?

10. Causes
Trauma
Infective
Neoplastic
Vascular
Parenchymal
Non pulmonary

11. Causes Trauma Infective Neoplastic Vascular Parenchymal Non pulmonary
Wounds
Post intubation
Foreign Body

12. Causes Trauma Infective Neoplastic Vascular Parenchymal Non pulmonary
Pneumonia
Abscess
Acute Bronchitis
Tuberculosis
Bronchiectasis
Fungi

13. Causes Trauma Infective Neoplastic Vascular Parenchymal Non pulmonary
Primary
Secondary
Lung
Breast
Brain
Prostate
Colon
Other

14. Causes Trauma Infective Neoplastic Vascular Parenchymal Non pulmonary
Pulmonary Embolism
Vasculitis
SLE
Wegener’s RA
Osler-Weber-Rendu
Arteriovenous malformation (AVM)

15. Causes Trauma Infective Neoplastic Vascular Parenchymal Non pulmonary
Interstitial Lung Disease (ILD)
Sarcoid
Haemosiderosis
Goodpasture’s syndrome
Cystic Fibrosis

16. Causes Trauma Infective Neoplastic Vascular Parenchymal Non pulmonary
CVS
Pulmonary oedema
Mitral stenosis
Aortic aneurysm
Eisenmenger’s Syndrome
Bleeding Diathesis
Including Drug induced

17. Mrs Reddy is 42. She presents with haemoptysis, weight loss of 10 kg over 2 months and night sweats. She has never smoked

18. Her CXR shows cavitation in the right upper zone.

19. What are the possible diagnoses?
Tumour TB
Pneumonia
Mycobateria other than TB (MOTT)
Any of them

20. What would you like to do next?
Sputum MC+S
Induced sputum x3 for AFB
CT Chest
Commence Antibiotics
Blood Cultures

21. Bronchiio-Alveolar Lavage (BAL) CT biopsy Mantoux test
Sputum samples are negative for AFB. You still have high index of suspicion. What next?
Bronchial Biopsy
Bronchiio-Alveolar Lavage (BAL)
CT biopsy
Mantoux test
Repeat CXR in 2 months

22. Peter is 31. He is a non smoker , suffers from heartburn and works in a job centre. He presents with coughing up a small cup full of fresh blood over 24 hours. He normally keeps well and his mother has had problems with “DVT” in the past.

23. His CXR is normal and you note that his RR is 24/min, HR 96/min and BP 121/63. His pO2 on room air is 8.3 kPa

24. You put him on oxygen and start him on...
Warfarin
Low Molecular Weight Heparin
Aspirin
Streptokinase
Traneximic acid

25. What investigation would you arrange?
CTPA
CT chest
HRCT
PFTs + DLCO
V/Q scan

26. If Peter was 30 years older,smoked all his life and had emphysema on his CXR

27. Which test would you choose?
CTPA
CT chest
HRCT
PFTs + DLCO
V/Q scan

28. George is 73. He presents acutely with breathlessness and coughing up frothy pink sputum. He has been suffering from orthopnoea, PND and ankle oedema over several days.

29. He has fine inspiratory crackles at the bases and midzones, raised jugular venous pressure and has a heart rate of 110

30. This is his ECG

32. What does this show? Normal sinus rhythm
Left Bundle Branch Block (LBBB)
Right Bundle Branch Block (RBBB)
ST elevation myocardial infarction
Ventricular tachycardia

33. !

34. Which of the following is likely to be present on his CXR?
Cardiomegaly
Upper lobe venous diversion
Pleural effusion
Kerley B Lines
Perhilar patchy opacification (Bat’s wing)

35. What has caused his deterioration?
Acute Bronchitis
Cryptogenic organising pneumonia
Pulmonary embolism
Acute pulmonary oedema
Aspiration pneumonia

36. End!