Hemoptysy

The hemoptysy is a rejection of Sang resulting from the air Routes under glottic, generally during an effort of Toux. This blood red, is aired, in very variable quantity according to the causes of the hemoptysy. This Symptôme can testify to Maladie S subjacent varied but potentially serious, that it is advisable never not to neglect: any hemoptysy, whatever its abundance, must make consult a doctor as fast as possible.

Diagnosis

The suspicion of a hemoptysy must make answer the following questions:

is it indeed a hemoptysy? One will eliminate a bleeding of oral, nasal origin (épistaxis) or digestive (Hématémèse). In the case of Hemorrhage S massive, the difference can be delicate to make and require complementary examinations in urgency.
Which volume of blood was lost? A tiny hemoptysy corresponds to some spittles striated with blood, on the other hand a hemoptysy is known as massive when the losses are higher than 200 ml.
Y does it have unweaves respiratory acute? It is a crucial point of the assumption of responsibility. Signs of bad respiratory tolerance or disorders of the conscience indicate an assumption of responsibility réanimatoire in extreme urgency.
Y-a it of the signs of acute Anemia? It are seldom present, which should not however make eliminate a severe table from the start.
does the patient have respiratory antecedents? One will seek by the interrogation of the former diseases or a lifestyle (nicotinism in particular) directing towards a precise etiology.

The remainder of the examination consists of a complete physical examination, the catch of the constants and their monitoring.

Complementary examinations

Hémogramme, plate S, Hémostase, Blood group ABO + Group rhesus;
Research of the Bacillus of Koch (infectious agent responsible for the Tuberculosis) in the Expectoration S;
Radiography of the Thorax;
bronchial Fibroscopie.

The other examinations are required according to the context and of the suspectée cause of the hemoptysy in the light of the private clinic and the first examinations.

Etiologies

Traumatic causes

Traumatism open or closed thorax, generally within a framework of intra-bronchial polytraumatism
Foreign body (in the child in particular)

Nontraumatic causes

acute Bronchitis and Pneumonia S (seldom)
bronchopulmonary Cancer: it must always be evoked, in particular at the pulmonary smoker
Tuberculose activates
old Tuberculose: such an antecedent known as to make seek:

a Clerc's Office aspergillaire in a cavity séquellaire
a relapse
a cancer on scar
a dilation of the cicatricial bronchi, in general localized and surinfectée
a broncholithiase (calcified ganglion eroding a bronchial vessel

Dilation of the bronchi
mitral Contracting
pulmonary Embolism
vascular Rupture of malformation (Angioma, Disease of Returned-Osler)

Treatment

Treatment etiologic

It is obligatory in all the cases, and sufficient when the hemoptysy tiny or is moderated and tolerated well, on the condition of founding a rigorous monitoring.

Treatment of the massive hémoptysies

It is conceived only in intensive care unit. The objective is double: to maintain the functions vital (in particular respiratory) and to dry up the bleeding.

Oxygen treatment with flow adapted to the arterial gazometry in order to maintain a saturation arterial out of oxygen higher than 90%
Perfusion of macromolecules (see blood transfusion) in the event of hemodynamic failure
Intubation trachéale and mechanical Ventilation in the event of Coma

The perfusion of agents Vasoconstricteur S (apart from a formal counter-indication) generally comes to end from the bleeding. In the event of failure, a radio-interventionelle embolisation must be considered (one locates the Artère responsible for the bleeding, then one salts out there synthetic particles which will stop it and thus dry up the hemorrhage mechanically). In last end, a surgical sanction remains possible in the event of failure of the other treatments.

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