Diffuse alveolar hemorrhage: Difference between revisions
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===Clinical Features=== | ===Clinical Features=== | ||
* [[Hemoptysis]] | * [[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 respiratory failure | * Acute hypoxemic respiratory failure | ||
===Differential Diagnosis=== | ===Differential Diagnosis=== | ||
Revision as of 16:48, 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)
Pulmonic veno-occlusive disease
Diagnosis
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