Diffuse alveolar hemorrhage: Difference between revisions
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==Background== | ==Background== | ||
* Diffuse Alveolar Hemorrhage (DAH) is a life-threatening condition. | *Diffuse Alveolar Hemorrhage (DAH) is a life-threatening condition. | ||
* It is a subset of Pulmonary hemorrhage involving the microcirculation involving alveolar microvasculature. | *It is a subset of Pulmonary hemorrhage involving the microcirculation involving alveolar microvasculature. | ||
* Most commonly the result of systemic vasculitis. <ref>Park M. Diffuse Alveolar Hemorrhage. Tuberc Resp Dis (Seoul) 2013. 74(4):151-162</ref> | *Most commonly the result of systemic vasculitis. <ref>Park M. Diffuse Alveolar Hemorrhage. Tuberc Resp Dis (Seoul) 2013. 74(4):151-162</ref> | ||
==Clinical Features== | ==Clinical Features== | ||
* [[Hemoptysis]] ( may be initially absent in up 33% of DAH presentations <ref>Lara A, Schwarz M. Diffuse Alveolar Hemorrhage. Chest 2010. 137(5):1164-1171</ref> | *[[Hemoptysis]] ( may be initially absent in up 33% of DAH presentations <ref>Lara A, Schwarz M. Diffuse Alveolar Hemorrhage. Chest 2010. 137(5):1164-1171</ref> | ||
* [[Anemia]] | *[[Anemia]] | ||
* Diffuse lung infiltrates | *Diffuse lung infiltrates | ||
* Acute hypoxemic respiratory failure | *Acute hypoxemic respiratory failure | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Idiopathic small vessel vasculitis | *Idiopathic small vessel vasculitis | ||
** [[Wegener's granulomatosis]] | **[[Wegener's granulomatosis]] | ||
** Churg-Straus syndrome | **Churg-Straus syndrome | ||
** Microscopic polyangitis | **Microscopic polyangitis | ||
*Primary immune complex-mediated vasculitis | *Primary immune complex-mediated vasculitis | ||
** Goodpasture's syndrome | **Goodpasture's syndrome | ||
** [[Henoch-Schonlein purpura]] | **[[Henoch-Schonlein purpura]] | ||
*Secondary vasculitis | *Secondary vasculitis | ||
** [[Systemic lupus erythematosus]] | **[[Systemic lupus erythematosus]] | ||
** [[Rheumatoid arthritis]] | **[[Rheumatoid arthritis]] | ||
** Mixed connective tissue disease | **Mixed connective tissue disease | ||
** [[Polymyositis]]/[[Dermatomyositis]] | **[[Polymyositis]]/[[Dermatomyositis]] | ||
*Acute [[lung transplant]] rejection | *Acute [[lung transplant]] rejection | ||
*Drug induced (ie. chemotherapy, [[amiodarone]], propylthiouracil) | *Drug induced (ie. chemotherapy, [[amiodarone]], propylthiouracil) | ||
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==Management== | ==Management== | ||
* Airway stabilization if large volume hemoptysis or problems with oxygenation/ventilation (>8.0 ETT preferable) | *Airway stabilization if large volume hemoptysis or problems with oxygenation/ventilation (>8.0 ETT preferable) | ||
* IV corticosteroids - high dose [[Corticosteroids|Methylprednisolone]] Q6H<ref>Park M. Diffuse Alveolar Hemorrhage. Tuberc Resp Dis (Seoul) 2013. 74(4):151-162</ref> | *IV corticosteroids - high dose [[Corticosteroids|Methylprednisolone]] Q6H<ref>Park M. Diffuse Alveolar Hemorrhage. Tuberc Resp Dis (Seoul) 2013. 74(4):151-162</ref> | ||
* Bronchoscopy to obtain BAL and localize source of bleeding if localizable | *Bronchoscopy to obtain BAL and localize source of bleeding if localizable | ||
* [[Hemoptysis|Management of Hemoptysis]] | *[[Hemoptysis|Management of Hemoptysis]] | ||
==Disposition== | ==Disposition== | ||
Revision as of 15:27, 5 July 2016
Background
- Diffuse Alveolar Hemorrhage (DAH) is a life-threatening condition.
- It is a subset of Pulmonary hemorrhage involving the microcirculation involving alveolar microvasculature.
- Most commonly the result of systemic vasculitis. [1]
Clinical Features
- Hemoptysis ( may be initially absent in up 33% of DAH presentations [2]
- Anemia
- Diffuse lung infiltrates
- Acute hypoxemic respiratory failure
Differential Diagnosis
- Idiopathic small vessel vasculitis
- Wegener's granulomatosis
- Churg-Straus syndrome
- Microscopic polyangitis
- Primary immune complex-mediated vasculitis
- Goodpasture's syndrome
- Henoch-Schonlein purpura
- Secondary vasculitis
- Systemic lupus erythematosus
- Rheumatoid arthritis
- Mixed connective tissue disease
- Polymyositis/Dermatomyositis
- Acute lung transplant rejection
- Drug induced (ie. chemotherapy, amiodarone, propylthiouracil)
- ARDS
- Multilobar Pneumonia
- Coagulopathy
- Pulmonic veno-occlusive disease
- Mitral stenosis
Diagnosis
- Clinical suspicion with falling hematocrit
- Radiographic imaging consistent with bilateral infiltration (CXR, CT) - can be patchy, focal or diffuse
- Bronchoscopy with BAL showing sequentially increasing RBC counts
Management
- Airway stabilization if large volume hemoptysis or problems with oxygenation/ventilation (>8.0 ETT preferable)
- IV corticosteroids - high dose Methylprednisolone Q6H[3]
- Bronchoscopy to obtain BAL and localize source of bleeding if localizable
- Management of Hemoptysis