Pulmonary hemorrhage

- Hemoptysis can be from a bronchial or pulmonary artery source. 'Massive' hemoptysis is usually from an erosion into a bronchial artery, and is often seen in chronic inflammatory states (bronchiectasis, TB, aspergilloma etc.)

- Pulmonary artery hemorrhage has a broad differential. Don't miss systemic vasculitis or connective tissue disease, meds/toxins or high pulmonary pressures such as PE or mitral stenosis

- Remember to ask about drug use: cocaine can cause diffuse alveolar damage and hemorrhage within 48 hours. The treatment is primarily supportive

- Treatment? Always start with the ABCs, with a focus on airway. The patient should be placed in a lateral position with the affected lung down. This helps stop the bleeding and protect the unaffected lung from aspiration. Specific management depends on the underlying cause. For example, systemic vasculitis is treated with high dose methylprednisolone, cyclophosphamide and plasma exchange