Case of the Month #21 - pulmonary haemorrhage

Published 01/02/2022

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.