Been spitting blood with no cough. Bronchoscope showed nothing. Why is it getting thicker? Why is she fatigued and dizzy?
Thank you for writing in. I am cardiologist and try to answer your questions to the best of my knowledge.
Hemoptysis is the technical term for spitting of blood either from lungs or bronchi. You can correct me in the follow up question if there is any wrong presumption I make.
I assume that cardiac and pulmonary system examination before these 3 weeks were normal; yet the blood is dark red colored with clots not frothy(mixed with air) and we have excluded pseudohemoptysis and hematemesis (blood spitting out but originating from stomach).
Frequency of the hemoptysis is more however the quantity is less; therefore emergency room did not consider it an emergency. I hope a chest x-ray has been done and it did not give any clue. Fiberoptic bronchoscopy has been normal.
The commonest causes of hemoptysis in children are Foreign Body, Airway Trauma. Primary Pulmonary Source would include Lung Abscess, Tuberculosis, and Tumor of lung, Lupus and similar disorders. Primary causes related to vascular system include AV fistula, pulmonary embolism, mitral stenosis, pulmonary endometriosis, systemic clotting disorders.
We have normal bronchoscopy and normal clinical examination of chest. A normal Computerized Tomography would have excluded most of the lung related causes.
A cardiac examination with contrast echocardiography will exclude most of cardiovascular causes. If your cardiologist then feels, a pulmonary angiography can be done (a procedure which is not only diagnostic but therapeutic for some conditions).
The goals of management are three fold: bleeding cessation, aspiration prevention, and treatment of the underlying cause.
I do not blame the patient for being fatigued, confused and dizzy. Can you take her to a hospital where there is a cardiologist, pulmonologist, radiologist and gastroenterologist under one roof? She will get well.
With Best wishes. (Do write follow up questions if I have assumed anything wrong).
Dr Anil Grover
Thank you once again Dr. XXXXXXX and many blessings to you : )
Thank you for your kind words.
But that reminds me the child is sick and justifiably complaining. Please get her admitted if you can. Not necessarily in emergency but in pediatric ward.
Establishing a diagnosis will not take long, some investigations will be decided by treating doctors and visiting consultants. Within a matter of hours treatment will be started.
I appreciate blessings sent to me; your sick daughter is my prayers to Almighty.
Knowing the system there you will be able to find a solution but keep your cool.
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