What is the initial diagnostic investigation for pulmonary haemorrhage?
The investigation of choice is an urgent CT Thorax angiogram to diagnose and differentiate diffuse alveolar haemorrhage from focal haemorrhage via identification of a focal bleeding point. This can then be used to guide endovascular embolization by interventional radiology if appropriate5,6.
Flexible bronchoscopy can be used to locate an endobronchial lesion but can also differentiate a diagnosis of diffuse alveolar hemorrhage vs focal bleeding using serial bronchoalveolar lavage (BAL). Three 30ml syringes are flushed into a bronchus then aspirated. If blood clears with repeated flushing this suggests bleeding from a bronchial source. If on flushing BAL becomes progressively more hemorrhagic this is suggestive alveolar haemorrhage. This technique is time consuming, operator dependent and does not always give a definitive diagnosis. BAL can also be sent for culture to identify infective cause.
