HEMOPTYSIS

Allen Widysanto
 DEFINITION
Hemoptysis is defined as the spitting of
blood derived from the lungs or bronchial
tubes as a result of pulmonary or
bronchial hemorrhage
 CLASSIFICATION
HEMOPTYSIS

MASSIVE NONMASSIVE

Blood loss 200-1000 ml/24 hours Blood loss less than 200 ml

NO DEFINITE CRITERIA
 Massive hemoptysis
Pulmonology and Respiratory Department
at FKUI /Persahabatan Hospital has own
criteria.
Blood loss 600 ml/24 hours and it doesnt stop on observation

Blood loss 250 ml but 600 ml/24 hours, Hb level 10 g%, hemoptysis
still occured

Blood loss > 250 ml but 600 ml/24 hours, hb level > 10 g%,
observation during 48 hours + conservative treatment , hemoptysis
still occured
 Causes
idiopathic

PULMONARY EXTRA PULMONARY

Upper Respir Tract

Tuberculosis
Bronchitis GIT
Ex Tuberculosis Bronchiectasis
Fungal infection
Dental/gum
Lung cancer

PH-MS

THE MOST IMPORTANT IS THE SOURCE

OF HEMOPTYSIS Coagulopathy
 PATHOPHYSIOLOGY

Aneurysme Rasmussen

TUBERCULOSIS Lymphadenopathy

Bronchiectasis

Non specific Superficial mucosa inflammation may lead

Rupture of Superficial blood vessel
infection

bacterial virus fungi

 Superficial mucosal invasion
LUNG CANCER
Erosion into blood vessel

Angiogenesis

Secondary infection

CARDIAC Left ventricular HF

Mitral Stenosis

IT IS DEPEND ON THE CAUSES

 Hemoptysis in children
LOWER RESPIRATORY TRACT INFECTION

FOREIGN BODY ASPIRATION

BRONCHIECTASIS

PULMONARY TB .. Very rare

 Hemoptysis vs Hematemesis
Absence of nausea and vomiting Presence of nausea and vomiting
Lung disease Gastric or hepatic disease
Asphyxia possible Asphyxia unusual
Sputum examination
Frothy Rarely frothy
Liquid or clotted appearance Coffee ground appearance
Bright red or pink Brown to black
Laboratory
Alkaline pH Acidic pH
Mixed with macrophages and neutrophils Mixed with food particles
 DIAGNOSTIC
history taking
CLINICAL CLUES SUGGESTED DIAGNOSIS
Anticoaulant use Medication effect, coagulation disorder
Association with menses Catamenial hemoptysis
Dyspnea on exertion, fatigue, orthopnea, paroxysmal Mitral valve stenosis
nocturnal dyspnea, frothy sputum
Fever, productive cough Upper Respiratory infection, acute sinusitis, bronchitis,
pneumonia, lung abscess
History of breast,colon or renal cancer Metastatic disease of lungs
History of chronic lung disease, recurrent LRTI, cough with
copius sputum
Bronchiectasis
???
HV, immunosuppresion Neoplasia, tuberculosis, Kaposis sarcoma
Nausea, vomiting, melena, alcoholism, chronic use of NSAID Gastritis, gastric or peptic ulcer, esophageal varices
Pleuritic chest pain, calf tenderness Pulmonary embolism or infarction
Tobacco use Acute bronchitis, chronic bronchitis, lung cancer,
pneumonia
Travel history Tuberculosis, parasites, biologic agents
Weight loss Emphysema, lung cancer, tuberculosis,bronchiectasis,
lung abscess, HIV
 DIAGNOSTIC
Physical Examination
Cachexia, clubbing, hoarseness, hyperpigmentation, Lung cancer
Horners syndrome
Clubbing Primary lung cancer, bronchiectasis, severe lung
metastasis
Dullness to percussion, fever, unilateral rales Pneumonia

Facial tenderness, fever, mucopurulent nasal discharge, Acute URTI, acute sinusitis
postnasal drainage ????
Fever, tachypnea, hypoxia, barrel chest, ICS retraction, pursed lip AECB
breathing

Heart murmur, pectus excavatum Mitral valve stenosis

Tahypnea, tachycardia, dyspnea, unilateral leg pain, Pulmonary thromboembolic disease

edema
 DIAGNOSTIC EVALUATION
Historytaking
Physical examination
Supportive:
chest X ray
Sputum evaluation
Blood gas analysis
CT scan
Bronchoscopy
Harrison 15th,ed.
 MANAGEMENT OF MASSIVE
HAEMOPTYSIS
Airway protection and resuscitation
Identifying the site and cause of
bleeding
Bronchoscopic treatment
Bronchial artery embolization (BAE)
Surgical treatment
SURGICAL MANAGEMENT