Differential diagnosis of hemoptysis

The method of identifying hemoptysis is through X-ray examination. First, the lungs and bronchi must be checked for tuberculosis or bronchitis, and it is also necessary to determine whether there are symptoms of tumors. Therefore, when patients have hemoptysis, they must pay special attention to it, as it may affect their life safety at any time. In many cases, hemoptysis is caused by lung disease due to excessive smoking, and we need to perform repeated chest examinations.

examine

1. Medical history

Bleeding is first or multiple. If it happens multiple times, is there any difference from the past? Tuberculosis should be considered in young and middle-aged people who cough, spit blood and have low fever. People over middle age, especially male smokers, should be aware of the possibility of lung cancer. They should carefully inquire and observe the color of hemoptysis and the presence of sputum. When inquiring about personal history, they should pay attention to the history of contact with tuberculosis, years of smoking history, menstrual history, history of occupational dust exposure, and eating raw crabs.

Hemoptysis accompanied by chest pain is often seen in pulmonary infarction and pneumococcal pneumonia; hemoptysis accompanied by choking cough is often seen in bronchial lung cancer, and bloody sputum is seen in lung abscess; massive hemoptysis is often seen in cavitary tuberculosis, ruptured bronchial aneurysm, etc. Anicteric leptospirosis can also cause massive hemoptysis.

2. Physical examination

All patients with hemoptysis should undergo careful and repeated chest examinations. Some chronic heart and lung diseases may be accompanied by clubbing of fingers and toes. Patients with progressive tuberculosis and lung cancer often have significant weight loss. Some blood disorders cause systemic bleeding tendency.

3. Laboratory examination

Sputum examination helps to detect tuberculosis bacteria, fungi, bacteria, cancer cells, parasite eggs, heart failure cells, etc.; bleeding time, coagulation time, prothrombin time, platelet count and other tests help to diagnose bleeding diseases; red blood cell count and prohemoglobin determination help to infer the degree of bleeding, and eosinophilia suggests the possibility of parasitic disease.

4. Equipment inspection

(1) X-ray examination: All patients with hemoptysis should undergo X-ray examination, chest fluoroscopy, chest tomography, and, if necessary, bronchography to assist in diagnosis.

(2) CT examination helps to detect small bleeding lesions.

(3) Bronchoscopy should be considered for patients with unexplained hemoptysis or bronchial obstruction and atelectasis, such as tumors, tuberculosis foreign bodies, etc., and biopsy should be taken for pathological examination.

(4) Radionuclide gallium examination helps in the differential diagnosis of lung cancer and other lung masses.

diagnosis

The diagnosis can be confirmed based on medical history, clinical manifestations and relevant examinations.

Differential Diagnosis

It needs to be differentiated from hematemesis.