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 | *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== | ||
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*[[Mitral stenosis]] | *[[Mitral stenosis]] | ||
== | ==Evaluation== | ||
*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== | ==Management== | ||
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==Disposition== | ==Disposition== | ||
*Typically requires upper level of care | |||
==See Also== | ==See Also== | ||
*[[Hemoptysis]] | |||
==Exteernal Links== | |||
[http://lifeinthefastlane.com/ccc/diffuse-alveolar-haemorrhage/ Life in the Fast Lane: Diffuse Alveolar Hemorrhage] | |||
==References== | ==References== | ||
Revision as of 11:30, 23 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
- Granulomatosis with polyangiitis (Wegener's)
- 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
Evaluation
- 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
Disposition
- Typically requires upper level of care
See Also
Exteernal Links
Life in the Fast Lane: Diffuse Alveolar Hemorrhage