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HEMOPTYSIS DIAGNOSIS |
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The diagnosis of hemoptysis is
complicated by the number of possible causes. Patient history It is important for the doctor to distinguish between blood from the lungs and blood coming from the nose, mouth, or digestive tract. Patients may aspirate, or breathe, blood from the nose or stomach into their lungs and cough it up. They may also swallow blood from the chest area and then vomit. The doctor will ask about stomach ulcers, repeated vomiting, liver disease, alcoholism, smoking, tuberculosis, mitral valve disease, or treatment with anticoagulant medications. Physical examination The doctor will examine the patient's nose, throat, mouth, and chest for bleeding from these areas and for signs of chest trauma. The doctor also listens to the patient's breathing and heartbeat for indications of heart abnormalities or lung disease. Laboratory tests Laboratory tests include blood tests to rule out clotting disorders, and to look for food particles or other evidence of blood from the stomach. Sputum can be tested for fungi, bacteria, or parasites. X-ray and bronchoscopy Chest x-rays and bronchoscopy are the most important studies for evaluating hemoptysis. They are used to evaluate the cause, location, and extent of the bleeding. The bronchoscope is a long, flexible tube used to identify tumors or remove foreign objects. Imaging and other tests Computed tomography scans (CT scans) are used to detect aneurysms and to confirm x-ray results. Ventilation-perfusion scanning is used to rule out pulmonary embolism. The doctor may also order an angiogram to rule out pulmonary embolism, or to locate a source of bleeding that could not be seen with the bronchoscope. In spite of the number of diagnostic tests, the cause of hemoptysis cannot be determined in 20–30% of cases. |
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