Showing posts with label DIFFUSE PULMONARY HEMORRHAGE. Show all posts
Showing posts with label DIFFUSE PULMONARY HEMORRHAGE. Show all posts


  • Rare disease characterized by necrotizing granulomas and vasculitis of upper and lower respiratory tracts; also systemic vasculitis with focal necrotizing glomerulonephritis.
  • Triad of upper respiratory tract, lung and kidney involvement is the classical mode of presentation.
  • Systemic vasculitis may be manifested by skin, eye and joint findings.
  • Limited form with long survival when the disease is predominantly restricted to lungs.
  • Etiology is unknown.
Clinical Picture Diagnosis
  • Waxing and waning lung lesions, single or multiple often with cavitation.
  • CXR: Bilateral nodules ranging from 1 to 9 cm in size; may also see diffuse interstitial disease and alveolar hemorrhage.
  • Antineutrophilic cytoplasmic antibodies (ANCA) Percutaneous renal biopsy; lung biopsy.
  • Depending on the organ involved, necrotizing nasal lesions, glomerulonephritis, CNS or skin involvement can be seen on biopsy.
  • Cytotoxic therapy (Cyclophosphamide) with steroids produce rapid reversal of disease.


Rare disease characterized by intra-alveolar hemorrhage and glomerulonephritis.
Etiology and Pathogenesis
  • A cytotoxic antibody against glomerular and alveolar basement membrane is responsible for the injury.
  • By activating complement, the antibody causes damage to glomerular and alveolar basement membrane.
  • A respiratory viral infection is believed to initiate production of the antibody.
  • Antigenic similarity between kidney and lung basement membrane accounts for the clinical picture.
Clinical Features
  • Pulmonary complaints consist of hemoptysis and dyspnea.
  • Hematuria, proteinuria, red cell casts and renal failure are results of glomerulonephritis.
  • Iron deficiency anemia results from pulmonary hemorrhage.
  • Diffuse bilateral alveolar infiltrates in chest x-ray.
  • Hypoxemia and restrictive defect of PFT's.
  • Leniar deposition of IgG and complement along glomerular and alveolocapillary basement membranes, characteristic of type II reaction in lung and kidney biopsies.
  • EM
  • Antiglomerular basement membrane antibody can be detected in serum.

  • Steroid in high doses controls pulmonary hemorrhage.
  • Nephrectomy with dialysis is necessary in some patients.
  • Combination of plasmapheresis and immunosuppressive therapy provides the best results.


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.
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
Alveolar spaces are filled with blood. Lung is heavy and feels consolidated. rest of the findings will depend on the etiology.
  • 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.

  • Supportive care.
  • Appropriate therapy based on the etiology.