Hemoptysis differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Karina Zavaleta, MD [2], Anmol Pitliya, M.B.B.S. M.D.[3]

Cough with hemopotysis differential diagnosis

Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Onset Duration Productive cough Hemoptysis Weight lost Fever Dyspnea Ascultation Lab findings Imaging PFT Gold standard
Respiratory Lower airway Bronchiectasis[1] Chronic
  • Months to years
+ Mucopurulent sputum + +
  • CT of chest
Foreing body aspiration[2][3][4] Acute
  • Variable
+ + + +
  • No specific tests
  • Not specific
  • In children <1 year and adults >75 years
  • Organic materials in children
  • Inorganic materials in adults
Parenchyma Lung cancer[5][6] Chronic
  • Years
+ + + +/− + The following investigations may be helpful:
  • Not specific
Interstitial lung disease[7][8] Chronic
  • Variable
+ + + The following investigations may be helpful:
  • Lung biopsy when lab, imaging, and PFT has indeterminate result
Tuberculosis (TB)[9][10] Chronic
  • More than 2 or 3 weeks
+ + + + +
Organ system Diseases Onset Duration Productive cough Hemoptysis Weight lost Fever Dyspnea Ascultation Lab findings Imaging PFT Gold standard Other features
Cardiac Mitral Stenosis[11][12] Chronic
  • Variable
+ Pink frothy + +
  • Not specifc
Pulmonary hypertension[13][14] Chronic
  • More than 2 years
+ + + The following investigations may be helpful:
Autoimmune Goodpasture syndrome[15][16] Chronic
  • Variable
+ + The following investigations may be helpful:
  • Pulmonary infiltratation in chest X−Ray
  • CT scan for parenchymal involvement
Wegener's disease (GPA) [17][18] Chronic
  • Months
+ + + + + The following investigations may be helpful:
Microscopic polyangitis (MPA)[19] Chronic
  • Variable
+ + + + + The following investigations may be helpful:
Churg−Strauss[20][21] Chronic
  • Variable
+ + + + +
  • Infiltrates in chest X−Ray
  • Ground glass opacities, tree−in−bud sign and small nodules in chest CT

References

  1. King PT, Holdsworth SR, Freezer NJ, Villanueva E, Holmes PW (2006). "Characterisation of the onset and presenting clinical features of adult bronchiectasis". Respir Med. 100 (12): 2183–9. doi:10.1016/j.rmed.2006.03.012. PMID 16650970.
  2. Hewlett JC, Rickman OB, Lentz RJ, Prakash UB, Maldonado F (2017). "Foreign body aspiration in adult airways: therapeutic approach". J Thorac Dis. 9 (9): 3398–3409. doi:10.21037/jtd.2017.06.137. PMC 5708401. PMID 29221325.
  3. Rafanan AL, Mehta AC (2001). "Adult airway foreign body removal. What's new?". Clin. Chest Med. 22 (2): 319–30. PMID 11444115.
  4. Haddadi S, Marzban S, Nemati S, Ranjbar Kiakelayeh S, Parvizi A, Heidarzadeh A (2015). "Tracheobronchial Foreign-Bodies in Children; A 7 Year Retrospective Study". Iran J Otorhinolaryngol. 27 (82): 377–85. PMC 4639691. PMID 26568942.
  5. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D (2011). "Global cancer statistics". CA Cancer J Clin. 61 (2): 69–90. doi:10.3322/caac.20107. PMID 21296855.
  6. Ost DE, Jim Yeung SC, Tanoue LT, Gould MK (2013). "Clinical and organizational factors in the initial evaluation of patients with lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines". Chest. 143 (5 Suppl): e121S–e141S. doi:10.1378/chest.12-2352. PMC 4694609. PMID 23649435.
  7. Lama VN, Martinez FJ (2004). "Resting and exercise physiology in interstitial lung diseases". Clin. Chest Med. 25 (3): 435–53, v. doi:10.1016/j.ccm.2004.05.005. PMID 15331185.
  8. Chetta A, Marangio E, Olivieri D (2004). "Pulmonary function testing in interstitial lung diseases". Respiration. 71 (3): 209–13. doi:10.1159/000077416. PMID 15133338.
  9. Perlman DC, el-Sadr WM, Nelson ET, Matts JP, Telzak EE, Salomon N, Chirgwin K, Hafner R (1997). "Variation of chest radiographic patterns in pulmonary tuberculosis by degree of human immunodeficiency virus-related immunosuppression. The Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA). The AIDS Clinical Trials Group (ACTG)". Clin. Infect. Dis. 25 (2): 242–6. PMID 9332519.
  10. Barnes PF, Verdegem TD, Vachon LA, Leedom JM, Overturf GD (1988). "Chest roentgenogram in pulmonary tuberculosis. New data on an old test". Chest. 94 (2): 316–20. PMID 2456183.
  11. MUNROE DS, RALLY CR (1963). "The diagnosis of mitral stenosis". Can Med Assoc J. 88: 611–22. PMC 1921207. PMID 13936649.
  12. Chandrashekhar Y, Westaby S, Narula J (2009). "Mitral stenosis". Lancet. 374 (9697): 1271–83. doi:10.1016/S0140-6736(09)60994-6. PMID 19747723.
  13. Brown LM, Chen H, Halpern S, Taichman D, McGoon MD, Farber HW, Frost AE, Liou TG, Turner M, Feldkircher K, Miller DP, Elliott CG (2011). "Delay in recognition of pulmonary arterial hypertension: factors identified from the REVEAL Registry". Chest. 140 (1): 19–26. doi:10.1378/chest.10-1166. PMC 3198486. PMID 21393391.
  14. Sun XG, Hansen JE, Oudiz RJ, Wasserman K (2003). "Pulmonary function in primary pulmonary hypertension". J Am Coll Cardiol. 41 (6): 1028–35. PMID 12651053.
  15. Boyce NW, Holdsworth SR (1986). "Pulmonary manifestations of the clinical syndrome of acute glomerulonephritis and lung hemorrhage". Am. J. Kidney Dis. 8 (1): 31–6. PMID 3728460.
  16. Foster MH (2017). "Basement membranes and autoimmune diseases". Matrix Biol. 57-58: 149–168. doi:10.1016/j.matbio.2016.07.008. PMC 5290253. PMID 27496347.
  17. Hoffman GS, Kerr GS, Leavitt RY, Hallahan CW, Lebovics RS, Travis WD, Rottem M, Fauci AS (1992). "Wegener granulomatosis: an analysis of 158 patients". Ann. Intern. Med. 116 (6): 488–98. PMID 1739240.
  18. Falk RJ, Gross WL, Guillevin L, Hoffman GS, Jayne DR, Jennette JC, Kallenberg CG, Luqmani R, Mahr AD, Matteson EL, Merkel PA, Specks U, Watts RA (2011). "Granulomatosis with polyangiitis (Wegener's): an alternative name for Wegener's granulomatosis". Arthritis Rheum. 63 (4): 863–4. doi:10.1002/art.30286. PMID 21374588.
  19. Jennette, J. Charles; Falk, Ronald J. (1997). "Small-Vessel Vasculitis". New England Journal of Medicine. 337 (21): 1512–1523. doi:10.1056/NEJM199711203372106. ISSN 0028-4793.
  20. Vaglio A, Buzio C, Zwerina J (2013). "Eosinophilic granulomatosis with polyangiitis (Churg-Strauss): state of the art". Allergy. 68 (3): 261–73. doi:10.1111/all.12088. PMID 23330816.
  21. Lanham JG, Elkon KB, Pusey CD, Hughes GR (1984). "Systemic vasculitis with asthma and eosinophilia: a clinical approach to the Churg-Strauss syndrome". Medicine (Baltimore). 63 (2): 65–81. PMID 6366453.

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