Also, we get into haemoptysis. So, we’re
gonna continue coughing, but this isn’t
just rusty color, we have actual blood tinged
or blood filled. It is important to distinguish
blood mixed with sputum, that’s more like
bronchitis from gross blood without the sputum
which is a lot more ominous. Is that clear?
So, the description of, well, rusty sputum
and tinged is more along the lines of infection,
so maybe there’s a better chance of managing
your patient. Where if it’s haemoptysis
and you see blood without the sputum, this
is extremely concerning.
Also, you need to distinguish blood from the
lungs, foamy, mixed with mucus versus blood
that’s from the upper airway or perhaps
even the GI tract. Think of haematemesis,
okay? Haematemesis and this will be the blood
that is pure red, there is no foam, there
is no mucus here per se. It’s important
that you understand the anatomical
histology that we talked about.
Massive haemoptysis is defined as more than
100 millilitres in a 24 hour period, that’s
quite a bit of blood. Now, this definition
could vary, but in general, it's blood without
the sputum and if you find that blood being
a little foamy, maybe mucus-filled, then you
know that it’s probably a cough or a blood
haemoptysis originating from your
respiratory tree. Common causes? Bronchitis,
lung cancer and bronchiectasis. These would
be common causes of haemoptysis, if it’s
Uncommon causes, aspergilloma, what does that
mean? If aspergillus which has now taken advantage
of maybe perhaps a TB cavity resulting in
a haemoptysis. CHF, especially mitral stenosis,
isn’t it? With mitral stenosis, there could
be enough of left atrial enlargement and pressure
in which, my goodness gracious, not only are
you pushing out your transudate, but they
might actually be completely filled with blood.
Goodpasture, obviously, would be haemoptysis.
Pulmonary AV malformations; AVM stands for
AV malformations. Remember our concept of
tachypnoea which means that your patient is
going to feel dyspnoea even when standing
up because you’re losing your capillaries.
We have PE or infarction. Other uncommon causes,
tuberculosis. You’re looking for these areas
in which, remember these are microaerophilic
type of organisms. So therefore, may then
create that caseous type of granulomas and
Wagner, formerly known, currently known,
as granulomatosis with polyangiitis. Along
with this, keep in mind with Goodpasture.
Both of these may result in not only haemoptysis,
but then also haematuria. While granulomatosis
with polyangiitis may also present with recurrent sinusitis
and the fact that you have complete
necrotization of that nasal septum.