Pulmonary Hemorrhage

Chapter 76


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Pulmonary Hemorrhage


Karen Z. Voter, MD, FAAP, and Clement L. Ren, MD, MS


Introduction/Etiology/Epidemiology


Hemoptysis in children is uncommon and is frequently related to a known underlying condition.


Reports of “coughing up blood” can be related to bleeding from the nasopharynx, esophagus, lower airways, or lung parenchyma.


Underlying conditions associated with pulmonary bleeding include


Tracheostomy


Cystic fibrosis (CF)


Pulmonary hypertension, usually associated with congenital heart disease


Autoimmune diseases, including granulomatosis with polyangiitis (formerly known as Wegener granulomatosis), systemic lupus erythematosus, microscopic polyangiitis, and Goodpasture syndrome


Infection, usually tuberculous or fungal, though it can be bacterial


Endobronchial mass


Foreign body


Pathophysiology


Mucosal irritation from dry secretions or trauma


Mucosal trauma, especially with a tracheostomy or foreign body


Pulmonary hypertension from congenital heart disease or arteriovenous malformation


Pulmonary embolism


Autoimmune vasculitis


Erosion through pulmonary tissue into bronchial vessels


Can be massive if a bronchial artery is eroded


Occurs in CF


Idiopathic pulmonary hemosiderosis (IPH)


Thought to be immune mediated, but without detectable autoantibodies


Heiner syndrome is a subform of IPH associated with allergy to milk protein


Clinical Features


Coughing or suctioning up blood is the most common presentation.


Anemia (iron deficiency) may be present.


There may be opacities on chest radiographs that are typically more transient than those of pneumonia.


The patient may have multiple episodes of bleeding.


Especially with massive bleeding, patients can often localize the site.


Signs of infection include fever and leukocytosis.


Signs of pulmonary embolism may be present.


Risk factors include therapy with oral contraceptives.


The presence of renal disease or rash suggests an autoimmune disorder.


Differential Diagnosis


Nonpulmonary source of bleeding


Nose


Upper airway


Gastrointestinal


Pneumonia


Complication of an underlying diagnosis


Congenital heart disease


IPH

Aug 8, 2019 | Posted by in PEDIATRICS | Comments Off on Pulmonary Hemorrhage
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