Hemoptysis
- think cystic fibrosis
- most common cause - lower respiratory tract infxn
- other common causes - FB aspiration, also chest trauma
- less common causes - neoplasm, vascular dz, AVM, congenital heart disease
- Do CBC, coags, CXR. Consider bronchoscopy, bleeding scan
Hemoptysis is rare in healthy
children, although it can be seen
with relative frequency in children who have cystic fibrosis. The
single most common cause is acute lower
respiratory tract infection. Another common cause is foreign
body aspiration, particularly in children younger than 4 years of age.
Chest trauma that involves a contusion
also can cause hemoptysis. Much less
common causes include neoplasms,
vascular diseases, and
arteriovenous malformation.
In countries in which corrective cardiac surgery is widely available, the
incidence of hemoptysis
due to congenital heart disease has declined significantly.
Initial laboratory tests for a child in whom hemoptysis is suspected include
complete blood count and coagulation
studies. Chest radiography then
should be performed to localize the site
of bleeding and to aid in diagnosis, although in
one third of cases the results are
normal. If the radiographic
findings are normal but significant bleeding continues,
bronchoscopy
or the administration of
radiolabeled
red blood cells may be warranted. Sputum culture may be helpful in
defining the specific bacterial cause of an infectious process, but it rarely is
useful for diagnostic purposes. A sweat
chloride test may be considered if there is a history of recurrent
bleeding or if other information from the history or physical examination
suggests cystic fibrosis.
In most children,
hemoptysis
is mild and self-limited; most cases do not require invasive measures.
Specific therapy is directed toward the underlying cause. In
life-threatening or massive bleeding, aggressive measures must be started
immediately. Mechanical ventilation, blood transfusions, fluid resuscitation,
and oxygen may be required.
Bronchoscopy may be necessary for
both diagnosis and therapy.
References:
Pianosi P, al-Sadoon H. Hemoptysis in children. Pediatr Rev. 1996;17:344-348
Thompson JW, Nguyen CD, Lazar RH, et al. Evaluation and management of
hemoptysis in infants and children. A report of nine cases. Ann Otol
Rhinol Laryngol. 1996;105:516-520