There was a nice article over at Consultant360.com by Drs. Laren Tan and Samuel Louie on hemoptysis pearls. Learned quite a few things.
200 mls of blood (about a cupful) is enough to fill the dead space in the lungs and is therefore generally considered the minimum amount of blood to make the diagnosis of “massive” hemoptysis.
Hemoptysis with chest pain – think pneumonia/pleurisy, PE with pleurisy, pulmonary edema from an MI, or lung cancer
Hemoptysis with dyspnea – think either exacerbation of patient’s underlying medical problem or a precursor to respiratory failure
Hemoptysis with fever – think infection, autoimmune disease, vasculitis, or even PE with lung infarction
Chest xray, CBC, and coags are the initial diagnostic tests. CT scan is indicated for suspected masses, recurrent hemoptysis, or high suspicion of cancer. Although not mentioned in the article, PE evaluation would also be an indication, depending on symptoms and pre-test probability scoring. CT alone has a diagnostic yield of about 67%.
For a differential diagnosis of hemoptysis, remember the mnemonic “BATTLECAMP”
B – Bronchitis
A – Abscess
T – Tumor
T – Tuberculosis
L – Lupus
E – Embolism
C – Coagulopathy
A – Autoimmune (eg, Goodpasture syndrome, systemic lupus erythematosus)
M – Mitral Stenosis
P – Pneumonia