October 2012 Pulmonary Case of the Month: Hemoptysis from an Uncommon Cause

Lewis J. Wesselius, MD

Department of Pulmonary Medicine

Mayo Clinic Arizona

Scottsdale, AZ

History of Present Illness

A 39 year old woman is seen with a history of cough intermittently productive of small amounts of blood or blood-tinged sputum for 4 months. She reports no other respiratory symptoms and has otherwise felt well.

PMH, FH and SH

There was no significant PMH and no prior history of lung disease. Her father has a history of Parkinson’s disease and osteosarcoma. She is a nonsmoker, does not drink alcohol, and has never abused drugs. She has 2 children and is engaged to be remarried.

Physical Examination

Her physical examination is normal.

Chest X-ray

Her chest x-ray is below (Figure 1).

Figure 1. Panel A: Frontal chest radiography. Panel B: Lateral chest radiography.

Laboratory Evaluation

Hemoglobin was 13.2 g/dL and WBC was 8400 cells/μL with a normal differential. Urinanalysis was unremarkable.

Which of the following statements regarding hemoptysis is or are true?

1. A normal chest x-ray makes a benign cause of the hemoptysis more likely
2. Most patients with lung cancer are asymptomatic
3. Hemoptysis in children is usually associated with an infection or a foreign body
4. 1 + 3
5. All of the above

Reference as: Wesselius LJ. October 2012 pulmonary case of the month: hempotypsis from an uncommon cause. Southwest J Pulm Crit Care 2012;5:169-75.  PDF