Hemoptysis — DDX

(Main differentiating signs/symptoms)

  • Pneumonia → fever, productive cough, focal infiltrate on CXR

  • Bronchitis → recent URI, diffuse wheezing/rhonchi, mild blood-streaked sputum

  • Pulmonary embolism → pleuritic chest pain, tachycardia, hypoxia, unilateral leg swelling

  • Lung cancer → weight loss, smoking history, persistent cough/mass on imaging

  • Tuberculosis → night sweats, cavitary lesions, chronic cough, weight loss

  • Bronchiectasis → chronic large-volume sputum production, recurrent infections

  • COPD exacerbation → wheezing, smoking history, increased sputum/dyspnea

  • CHF/pulmonary edema → orthopnea, edema, pink frothy sputum, elevated BNP

  • Diffuse alveolar hemorrhage → hypoxia + falling Hgb + diffuse bilateral infiltrates

  • GPA/vasculitis → sinus symptoms, AKI/hematuria, constitutional symptoms

  • Goodpasture syndrome → hemoptysis + rapidly worsening renal failure

  • Fungal infection → immunocompromised patient, cavitary lesion/fungal ball

  • Mitral stenosis → AFib, diastolic murmur, pulmonary vascular congestion

  • AV malformation → recurrent unexplained hemoptysis/hypoxia

  • Coagulopathy/anticoagulation → elevated INR/thrombocytopenia, diffuse bleeding history

  • Foreign body aspiration → sudden onset cough/wheeze, focal decreased breath sounds

Risk Factors

  • Smoking/tobacco use

  • COPD/chronic lung disease

  • Prior TB exposure or incarceration/shelter exposure

  • Immunosuppression/HIV/steroid use

  • Malignancy history

  • Recent surgery/immobility

  • Anticoagulation use

  • Autoimmune disease

  • IV drug use

  • Occupational exposure (silica/asbestos)

Initial DATA

  • CBC → anemia, leukocytosis

  • CMP/BMP → renal/hepatic function

  • PT/INR/PTT → coagulopathy

  • Type & screen if moderate/severe bleed

  • VBG/ABG if hypoxic

  • Lactate if septic concern

  • BNP/troponin if CHF/cardiac concern

  • CXR first-line

  • CTA chest if PE/malignancy/active bleed concern

  • EKG

  • Pulse ox/telemetry

Pending DATA

  • Sputum culture/respiratory culture

  • AFB smear/culture + TB PCR

  • Blood cultures

  • Bronchoscopy results

  • Cytology if malignancy concern

  • Autoimmune workup: ANCA, ANA, anti-GBM

  • CTA chest final read

  • Echo if cardiac etiology suspected

  • Fungal studies if immunocompromised