TAILIEUCHUNG - Chapter 034. Cough and Hemoptysis (Part 5)

Approach to the Patient: Hemoptysis The history is extremely valuable. Hemoptysis that is described as bloodstreaking of mucopurulent or purulent sputum often suggests bronchitis. Chronic production of sputum with a recent change in quantity or appearance favors an acute exacerbation of chronic bronchitis. Fever or chills accompanying bloodstreaked purulent sputum suggests pneumonia, whereas a putrid smell to the sputum raises the possibility of lung abscess. When sputum production has been chronic and copious, the diagnosis of bronchiectasis should be considered. Hemoptysis following the acute onset of pleuritic chest pain and dyspnea is suggestive of pulmonary embolism. . | Chapter 034. Cough and Hemoptysis Part 5 Approach to the Patient Hemoptysis The history is extremely valuable. Hemoptysis that is described as bloodstreaking of mucopurulent or purulent sputum often suggests bronchitis. Chronic production of sputum with a recent change in quantity or appearance favors an acute exacerbation of chronic bronchitis. Fever or chills accompanying blood-streaked purulent sputum suggests pneumonia whereas a putrid smell to the sputum raises the possibility of lung abscess. When sputum production has been chronic and copious the diagnosis of bronchiectasis should be considered. Hemoptysis following the acute onset of pleuritic chest pain and dyspnea is suggestive of pulmonary embolism. A history of previous or coexisting disorders should be sought such as renal disease seen with Goodpasture s syndrome or Wegener s granulomatosis lupus erythematosus with associated pulmonary hemorrhage from lupus pneumonitis or a previous malignancy either recurrent lung cancer or endobronchial metastasis from a nonpulmonary primary tumor or treatment for malignancy with recent chemotherapy or a bone marrow transplant . In a patient with AIDS endobronchial or pulmonary parenchymal Kaposi s sarcoma should be considered. Risk factors for bronchogenic carcinoma particularly smoking and asbestos exposure should be sought. Patients should be questioned about previous bleeding disorders treatment with anticoagulants or use of drugs that can be associated with thrombocytopenia. The physical examination may also provide helpful clues to the diagnosis. For example examination of the lungs may demonstrate a pleural friction rub pulmonary embolism localized or diffuse crackles parenchymal bleeding or an underlying parenchymal process associated with bleeding evidence of airflow obstruction chronic bronchitis or prominent rhonchi with or without wheezing or crackles bronchiectasis . Cardiac examination may demonstrate findings of pulmonary arterial hypertension mitral .

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