الرحيم الرحمن الله بسم

Clinical picture & examination

Hemoptysis

Complaint

History

Examination

D.D

4

• Rare < 6Y.

• Older children…………… with a focal hemorrhage warmth or “bubbling”

sensation in the chest wall. This can occasionally aid the clinician in locating the area involved.

Complaint

Rapid and large-volume blood loss manifests as symptoms of cyanosis, respiratory distress, and shock.

Chronic, subclinical blood loss may manifest as anemia, fatigue, dyspnea, or altered activity tolerance.

Less commonly, patients present with symptoms of chronic illness such as failure to thrive.

•History of Chief Complaint: Seek information regarding the timing and amount

of blood. Find out about associated symptoms:

Fever, a recent history of infection or cold symptoms (fatigue, runny nose, sore throat, coughing).

Recent choking episodes, recent trauma or the possibility of aspiration.

Recent weight loss or appetite changes. Inquire about any medications that the child

has or may have taken.

HISTORY

•Past Medical History Does the child have any known underlying

diseases (eg. Cystic Fibrosis, congenital diseases, rheumatic heart disease).

Is there a history of symptoms that may suggest chronic lung disease (eg. long-term coughing, wheezing, or stridor).

Are there any surgeries that the child has undergone?

Is the child’s growth and development progressing normally?

•Other important details Are there any familial disorders? Are there any allergies the child

has? Are the child’s vaccinations up to

date? What do they think is the cause of

hemoptysis?

• Hemoptysis is first differentiated from other

common sources of bleeding, including the

upper airway and the gastrointestinal tract.

Examination

Features Hemoptysis Hematemesis

Sputum features -bright red or pink-frothy

-pH: alkaline

-consistency: liquid with clotted look

-content: mixed in with sputum

-dark red or brown if lower in GI tract, bright red if higher up-usually not frothy

-pH: acidic

-consistency: ground coffee, stale blood appearance

-content: may have food particles

History -no nausea or vomiting-may have history of lung disease

-may be associated with coughing or gurgling

-presence of nausea or vomiting

-may have history of gastrointestinal or hepatic disease

Table 1: Comparison between hemoptysis and hematemesis

• Special attention is given to the oral cavity and nasopharynx as potential sources of bleeding.

• Fiberoptic laryngoscopy is performed in cooperative children to evaluate the pharynx and larynx.

•A complete general physical exam that includes vitals and growth parameters must be carried out.

inspection

Mass

MVT chest wall expansion

blunt trauma

palpation

tenderness

masses

lymph nodes

percussion

consolidation collapse effusion

auscultation

Localized wheezing

Pleural rub

murmurs

• PsudohemoptysisHematemesis (GIT bleeding).

Bleeding from upper air ways.

Factitious hemoptysis.

Differential diagosis

•Factitious hemoptysis is considered in the differential diagnosis if no etiology is discernible after a thorough evaluation, especially when the medical history or the patient's behavior is unusual

Thanks

mounira mahmoudmedical student