🫁 Hemoptysis · Pulmonary Hemorrhage · Bronchiectasis · CF · TB · Goodpasture

Schwartz Clinical Handbook — Chapter 41 · Massive vs mild hemoptysis · Cystic fibrosis · Bronchiectasis · Tuberculosis · Pulmonary hemosiderosis · Foreign body · Bronchoscopy

Select bleeding volume (streaks vs massive), chronic lung disease (CF, bronchiectasis), fever, weight loss, chest pain, renal symptoms, and smear clues → differentiate infectious (TB, pneumonia), structural (CF, bronchiectasis, foreign body), vascular (pulmonary hemosiderosis, Goodpasture), or neoplastic causes.
⚠️ Red flags: massive hemoptysis (>8 mL/kg/24h), hemodynamic instability, respiratory distress → urgent bronchoscopy, ICU, consider embolization.

📋 Step 1 — Bleeding volume & associated symptoms
📌 Diagnostic impressions
📖 Schwartz Ch 41

Select amount of hemoptysis (streaks vs massive), chronic productive cough, CF history, TB exposure, hematuria, rash, and CXR findings → differential includes cystic fibrosis, bronchiectasis, pulmonary tuberculosis, foreign body aspiration, pulmonary hemosiderosis (Goodpasture), AV malformation, and coagulopathy.

✔️ CF: chronic cough, clubbing, Pseudomonas, pancreatic insufficiency.
✔️ TB: night sweats, weight loss, exposure, PPD positive.
✔️ Goodpasture: hemoptysis + hematuria, anti‑GBM antibodies.
✔️ Foreign body: younger child, sudden onset, localized wheeze.
✔️ Massive hemoptysis: bronchial artery embolization.
📘 Schwartz pearls (Chapter 41)
• Massive hemoptysis: airway protection first, lateral decubitus position (bleeding side down).
• Rigid bronchoscopy preferred for massive bleeding.
• Pulmonary hemosiderosis: diffuse alveolar infiltrates, iron deficiency anemia, hemosiderin‑laden macrophages.
• Cystic fibrosis: sweat chloride, CFTR mutation.
• TB: respiratory isolation, RIPE therapy.