Diffuse alveolar hemorrhage: Difference between revisions
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==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 | ||
** [[Systemic lupus erythematosus]] | |||
Secondary vasculitis | ** [[Rheumatoid arthritis]] | ||
* [[Systemic lupus erythematosus]] | ** Mixed connective tissue disease | ||
* [[Rheumatoid arthritis]] | ** [[Polymyositis]]/[[Dermatomyositis]] | ||
* Mixed connective tissue disease | *Acute [[lung transplant]] rejection | ||
* [[Polymyositis]]/[[Dermatomyositis]] | *Drug induced (ie. chemotherapy, [[amiodarone]], propylthiouracil) | ||
*[[ARDS]] | |||
Acute [[lung transplant]] rejection | *Multilobar [[Pneumonia]] | ||
*[[Coagulopathy]] | |||
Drug induced (ie. chemotherapy, [[amiodarone]], propylthiouracil) | *Pulmonic veno-occlusive disease | ||
*[[Mitral stenosis]] | |||
[[ARDS]] | |||
Multilobar [[Pneumonia]] | |||
[[Coagulopathy]] | |||
Pulmonic veno-occlusive disease | |||
[[Mitral stenosis]] | |||
==Diagnosis== | ==Diagnosis== | ||
Revision as of 19:53, 13 June 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
General principles
- 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