Case of the Month #21 - pulmonary haemorrhage

Published 01/02/2022

What are the causes of pulmonary haemorrhage?

Pulmonary haemorrhage is a relatively uncommon condition that can present as an isolated finding or as a feature of a multi-systemic disorder. It can be divided into Diffuse Alveolar Haemorrhage or Focal Haemorrhage. The initial distinction between the two may be unclear however alveolar haemorrhage is less likely to cause massive haemopytysis1,2.

Diffuse Alveolar Haemorrhage (originating from pulmonary microvasculature)

  • Immune disorders (vasculitis, pulmonary renal syndromes, connective tissue diseases)
  • Infection bacterial/ viral/ fungal
  • Congestive cardiac failure
  • Bleeding disorders including thrombocytopenia, DIC
  • Various drugs including cocaine
  • Idiopathic

Focal Haemorrhage (originating from the bronchial circulation or lung parenchyma)

  • Vascular erosion
  • AV malformation  
  • Malignancy primary bronchial or metastatic disease
  • Local trauma iatrogenic injuries from PA catheter, aortic graft or stent insertion, post bronchoscopic procedures, penetrating chest injuries
  • Suppurative lung disease bronchiectasis including cystic fibrosis
  • Pulmonary embolism/ septic embolus/ abscess