DDx

Infectious

Bronchitis

TB

Mycetoma (e.g. aspergilloma)

Parasitic (echinococcus, schisto etc)

Neoplastic

Bronchogenic carcinoma

Bronchial adenoma

Cardiovascular

PE with pulmonary infarction

Pulmonary hypertension (mitral stenosis, L-heart endocarditis, CHF)

Structural

Bronchiectasis (CF, organizing PNA, chronic bronchitis)

Hypersensitivity PNA

Tracheo-innominate fistula

Aortobronchial fistula

Vasculitides

Goodpasture’s (anti-GBM)

Granulomatosis w/ polyangiitis

SLE

Behcets

Traumatic

Pulmonary contusion

Ruptured bronchus d/t deccel injury

Penetrating

Iatrogenic

Bronchoscopy

PA catheter

Miscellaneous

Nitrogen dioxide inhalation (ice rinks)

Cocaine inhalation

Workup

History

• Differentiate b/t hemoptysis vs GIB vs epistaxis
• Ask about urinary sxs, epistaxis, other bleeding history
• Connective tissue disease history
• Ask about exposures including TB rfs, occupational
• Smoking history
• Cyclic timing (e.g. pulmonary endometrioma)

Minor Hemoptysis

H&P -> CXR

• If normal CXR and suspect bronchitis, can f/u w/ PCP
• If abnormal CXR or suspect other etiology, CBC, chemistry, coags, UA and pulmonology f/u

Massive Hemoptysis

• Airway control
• Affected lung dependent
• CXR vs CT vs Bronch
• Selectively intubate the good lung, can pass fogarty catheter alongside ETT to tamponade the bleeding bronchus