Haemoptysis

D/D:

1. Respi
a) Infective: Bronchiectasis, TB, Pneumonia, Fungal (Aspergilloma-MASSIVE
haemoptysis), lung abscess, COPD
b) Vascular: Pulm Embolism
c) Malignancy: Pri/Secondary
d) Parenchyma: Diffuse Interstitial fibrosis, Goodpasture’s syndrome (GN +
pulm haemorrhage)
2. CVS
a) Pulm oedema (Pinkish sputum-not true haemoptysis)
b) Mitral stenosis

3. Bleeding diathesis
4. Exclude nasal, UGI bleeding!!

HT

1. Age
a) Elderly (Malignancy)

2. Onset
a) Since when?
b) After prolonged coughing?
c) Exertion? (MS)

3. Amount

4. Sputum ( blood in sputum is NOT haemoptysis)

a) Streak of blood mixed with sputum
b) Rusty: Pneumocystic Jiroveci
c) Currant jelly sputum: Klebsiella
d) Purulent (Lung abscess)
e) Pink frothy (Pulm oedema)
f) Frank blood
g) Mixed with food particles
h) Dark Red (hemetemesis)
i) Bright red (hemoptysis)
 5. Associated Sx
a) Chest pain
i. Pleuritic (worse with inspiration)
ii. Burning
iii. Radiate to throat (GERD)
b) Fever, Chills, Rigors (Pneumonia, TB)
c) Night sweat (TB)
d) SOB (HF, PE..)
e) Hoarseness, sudden weight loss (Malignancy)
f) LOA, LOW (TB, Malignancy)
g) Swollen, painful leg? Prolonged immobilization such as taking airplane,
hospitalization? Recent history of major surgery such as hip replacement
therapy? (PE)

6. Past Medical History

a) Immunocompromised state (Fungal infection)
i. DM
ii. Drug (steroid, chemotherapy)
iii. TB
iv. IVDU
v. Heart disease (MS)

7. Travel History

8. Other sites of bleeding

a) Gum bleeding
b) hemetemesis
c) Malaena
d) Petechiae/ purpura

9. Occupation

10. Social
a) Smoking
b) IVDU

Ix
1.