Evaluation of massive hemoptysis with high suspicion for alveolar hemorrhage in the emergency room

Abstract

Diffuse alveolar hemorrhage is a serious life threatening condition that has to be promptly addressed during early period of presentation to emergency room. It is usually associated with some underlying causative factor. Early identification of causative factors will help in early initiation of definitive management, thereby reducing the mortality and improving the outcome. We report a case of 64-year-old male with hemoptysis who has been identified as alveolar hemorrhage in emergency room. We also evaluated its possible causative factor by clinical suspicion, laboratory investigations and contrast enhanced computed tomography imaging. Patient started showing improvement with the initiation of face mask oxygenation, empirical IV antibiotics and IV steroid which was further augmented with bronchoscopic intervention by the pulmonology team. Flexible bronchoscopy played both a diagnostic and therapeutic role in this patient. A patient presenting to emergency room with clinical triad of cough, dyspnea and massive hemoptysis has to be approached with high suspicion for diffuse alveolar hemorrhage. Rapid evaluation for its etiology and initiating empirical treatment can prevent morbidity and mortality, thereby improving survival outcome.