Tuesday, April 21, 2020

hemoptysis - physical exam

Q: In a patient with hemoptysis, auscultation of chest should be performed as it may easily determine the side of bleeding lung? 

A) True
B) False

Answer: B

 Although physical exam universally remains an integral part of any patient's management, it can not be solely relied upon in hemoptysis. Additional investigations should be performed including chest-x-ray, CT scan or bronchoscopy. Protection of the airway remains the first priority.

Determination of bleeding lung helps to protect the preserved (good) lung. Patient should be placed in the dependent position of the suspected (bleeding) lung. Putting bleeding lung at a dependent position protects the non-bleeding lung just by a gravitational pool of blood. Once the bleeding site is confirmed, one-lung ventilation should be considered. Unfortunately, just relying on physical exam and auscultation of lung does not help since an unknown amount of blood may already have been spilled into the good lung.




1. Hirshberg B, Biran I, Glazer M, Kramer MR. Hemoptysis: etiology, evaluation, and outcome in a tertiary referral hospital. Chest 1997; 112:440. 

2. Knott-Craig CJ, Oostuizen JG, Rossouw G, et al. Management and prognosis of massive hemoptysis. Recent experience with 120 patients. J Thorac Cardiovasc Surg 1993; 105:394.

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