Page 4 / March 07
An infectious cause enters the differential right away. Bacterial pneumonias are associated with hemoptysis though it is unusual for it to be so profound and chronic. There needs to be a high index of suspicion for TB even in the absence of contact history. Other infections such as blastomycosis, histoplasmosis and strongyloides need to be kept in mind. Atypical infections such as pneumocystis carinii and diffuse viral pneumonitis are less likely causes.
The changes on the CXR are diffuse and could be consistent with interstitial and vascular pneumonitides such as Wegener's granulomatosis which can be associated with such profound and chronic hemoptysis. The diagnosis of idiopathic pulmonary hemosiderosis, though rare, should be considered.
The history and the lack of a localised pattern do not suggest; vascular malformation, chronic lung such as cystic fibrosis, congenital heart disease and he is a little old for aspirating a foreign body.
It can be helpful to draw a distinction between those diseases that lead to a localised or diffuse bleeding. Localised that often occurs in the context of pre-existing chronic or congenital lesions and diffuse bleeding associated with a systemic or pulmonary inflammatory condition.
The Emergency Doctor and General Paediatricians together formulated a differential and requested some tests.
Next page /
ANSWER:
An infectious cause enters the differential right away. Bacterial pneumonias are associated with hemoptysis though it is unusual for it to be so profound and chronic. There needs to be a high index of suspicion for TB even in the absence of contact history. Other infections such as blastomycosis, histoplasmosis and strongyloides need to be kept in mind. Atypical infections such as pneumocystis carinii and diffuse viral pneumonitis are less likely causes.
The changes on the CXR are diffuse and could be consistent with interstitial and vascular pneumonitides such as Wegener's granulomatosis which can be associated with such profound and chronic hemoptysis. The diagnosis of idiopathic pulmonary hemosiderosis, though rare, should be considered.
The history and the lack of a localised pattern do not suggest; vascular malformation, chronic lung such as cystic fibrosis, congenital heart disease and he is a little old for aspirating a foreign body.
It can be helpful to draw a distinction between those diseases that lead to a localised or diffuse bleeding. Localised that often occurs in the context of pre-existing chronic or congenital lesions and diffuse bleeding associated with a systemic or pulmonary inflammatory condition.
The Emergency Doctor and General Paediatricians together formulated a differential and requested some tests.
What tests might you request?
Next page /