HEMOPTYSIS / 47
Table 3–4. Causes, characteristics, and evaluation of hemoptysis (continued) Cause
Source and pathophysiology
Vasculitides and alveolar hemorrhagic syndromes Systemic lupus erythematosus
Alveolar hemorrhage, small-vessel vasculitis with capillaritis, granular IgG deposition along granular wall Goodpasture’s Alveolar hemorrhage syndrome with chronic inflammation, no vasculitis Wegener’s Necrotizing vasculitis granulomatosis with granulomatous inflammation
Nonspecific vasculitis
Small-vessel arteritis and capillaritis
Idiopathic pulmonary hemorrhage
Alveolar hemorrhage with interstitial fibrosis and hemosiderin-laden macrophages
Chest x-ray
Specific diagnostic tests
Diffuse acinal filling Glomerular nephritis, positive ANA Diffuse densities
Positive serum ABMA positive linear IgG in glomeruli Nodular/cavitary Positive cANCA, parenchymal lesion necrotizing glomerular nephritis, upper airway involvement Nonspecific pANCA variable, necrotizing crescentic glomerular nephritis Diffuse alveolar Negative IgG deposits, diagnosis of exclusion
Note: ABMA, antibasement membrane antibody; ANA, antinuclear antibody; AVMs, arteriovenous malformations; cANCA, cytoplasmic antineutrophilic cytoplasmic antibody; CT, computed tomography; FOB, fiber optic bronchoscopy; HRCT, high-resolution computed tomography; IgG, immunoglobulin G; pANCA, perinuclear antineutrophilic cytoplasmic antibody; PFTs, pulmonary function tests.
chest may be diagnostic in pulmonary embolism or infarction but is not useful in localizing the source of bleeding when multiple abnormalities are present.
Other Specific Tests Pulmonary function tests are helpful in distinguishing restrictive from obstructive lung disease and may help in identifying the pathophysiology of the underlying cause but do not directly aid in diagnosis. Bronchoscopy is indicated to assess the airways and to obtain histologic confirmation of specific diagnoses. The choice of rigid versus fiber optic bronchoscopy (FOB) or the use of both depends on the degree of bleeding, the location of the lesion, and the importance of maintaining a patent airway. The suction channel and suction capacity of most flexible fiber optic