Page 7 / March 07
Fresh blood and bloody secretions are seen coating the entire airway opening. The blood washed away easily with 2 cc of 2% lidocaine. Normal mucosa was seen underneath. Although the blood was easily removed on suctioning it reappeared as quickly more distally. No abnormal vessels or airway lesions were seen.
It is worth bearing in mind that although it remains important to review carefully the accuracy of hemoptysis as opposed to hemetemesis, young children freuqently swallow their expectorations leading to subsequent vomiting and also melena.
In summary this boy has a history of intermittent hemoptysis over 6 months with an acute episode that continued in hospital. He appeared systemically well without any oxygen requirement or respiratory distress. He has no raised inflammatory markers and no infectious organisms have been identified. The CXR showed a nodulo-reticular pattern and the CT micro-nodular lesions with ground glass changes that was distributed peripherally. His bronchoscopy was strikingly hemorraghic.
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ANSWER:
Fresh blood and bloody secretions are seen coating the entire airway opening. The blood washed away easily with 2 cc of 2% lidocaine. Normal mucosa was seen underneath. Although the blood was easily removed on suctioning it reappeared as quickly more distally. No abnormal vessels or airway lesions were seen.
It is worth bearing in mind that although it remains important to review carefully the accuracy of hemoptysis as opposed to hemetemesis, young children freuqently swallow their expectorations leading to subsequent vomiting and also melena.
In summary this boy has a history of intermittent hemoptysis over 6 months with an acute episode that continued in hospital. He appeared systemically well without any oxygen requirement or respiratory distress. He has no raised inflammatory markers and no infectious organisms have been identified. The CXR showed a nodulo-reticular pattern and the CT micro-nodular lesions with ground glass changes that was distributed peripherally. His bronchoscopy was strikingly hemorraghic.
What are the differential diagnoses and your immediate management plan?
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