DIFFUSE ALVEOLAR HEMORRHAGE

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DIFFUSE ALVEOLAR HEMORRHAGE

Diffuse pulmonary hemorrhage is one of the conditions in the
differential of acute diffuse alveolar pattern on CXR.
Clinical Picture
Patients present with acute onset of shortness of
breath and cough.
Hemoptysis may or may not be present.
Chest x-ray shows diffuse alveolar pulmonary infiltrates.
tachypnea with bilateral crackles can be heard on physical
exam.
Blood gases show hypoxia with widened A-a gradient and
alveolar hyperventilation.
Etiology
Multiple etiologies can give rise to pulmonary hemorrhage.
Following are the common.
Thrombocytopenia
Goodpasture's syndrome
Wegener's granulomatosis
Systemic lupus erythematosis
Idiopathic pulmonary hemorrhage
Pathology
Alveolar spaces are filled with blood. Lung is heavy and feels
consolidated. rest of the findings will depend on the etiology.
Diagnosis
Constellation of hemoptysis, diffuse alveolar infiltrates on
CXR, unexplained drop in hemoglobin usually raises suspicion
for pulmonary hemorrhage.
If PFT can be done, increase in diffusion capacity can be
seen due to sequestration of blood in lungs.
Bronchoalveolar alveolar lavage will show RBC's and Iron
stain is positive in macrophages.
Treatment

Supportive care.
Appropriate therapy based on the etiology.