Info
🌱 來自: Huppert’s Notes
Alveolar Hemorrhage🚧 施工中
Alveolar Hemorrhage
• Definition: Bleeding into the alveolar space due to disruption of the alveolar–capillary basement membrane
• Etiologies: See Table 2.5
TABLE 2.5 • Etiologies of Alveolar Hemorrhage Based on Mechanism
• Clinical presentation:
- Cough, fever, hemoptysis, or diffuse GGOs + other concerning features (e.g., extrapulmonary signs of vasculitis, known condition associated with DAH, declining hemoglobin without clear reason)
- Pearl: Hemoptysis is only present in 50% of cases and absence does not predict hemorrhage severity
- Also consider alveolar hemorrhage in a patient with GGOs who is failing to progress as expected (e.g., patient with suspected cardiogenic pulmonary edema who is not improving with diuresis)
• Diagnostics:
- Labs: CBC, BUN/Cr, UA, ESR, CRP. Consider rheumatologic w/u, which may include ANA, dsDNA, RNP, C3, C4, RF, CCP, ANCA, MPO, PR3, cryoglobulins, anti-GBM, RVVT, cardiolipin, B2-glycoprotein Ab
- Imaging: Noncontrast chest CT (consider contrast if suspect other causes of hemoptysis): Imaging shows patchy or diffuse GGOs
- Bronchoscopy: 1) Serial lavage – gets progressively more hemorrhagic; 2) Rule out infection; 3) Check CBC with differential to evaluate for eosinophilia
• Management:
- Capillaritis: Immunosuppression
• For ANCA-associated vasculitis, typically give pulse-dose steroids first and then adjunctive therapies like cyclophosphamide, rituximab, etc. if lack of response
- Bland hemorrhage or diffuse alveolar damage:
• Treat underlying cause, supportive care