Correct!
4. 1 + 3
Hemoptysis is coughing up of blood that originates from the lungs. Upper airway bleeding is a common cause of spitting up blood and a source can often be identified by a careful history and physical exam. A chest x-ray is an important diagnostic test in patients with hemoptysis. A normal chest x-ray indicates there is less than a 5% chance of an endobronchial lesion on bronchoscopy. An abnormal chest x-ray often indicates the source of the bleeding. Most patients with lung cancer have symptoms including hemoptysis but most commonly include cough, weight loss, dyspnea, chest pain, bone pain, or hoarseness. About 27-29% of patients with lung cancer present with hemoptysis. Most children with hemoptysis have infection or a foreign body as their cause of hemoptysis.
Our patient’s chest x-ray was interpreted as normal. She was seen by ENT but no source of bleeding was identified on rhinolaryngoscopy. However, she returned three months later with persistent hemoptysis and now had dyspnea on exertion and mild fatigue.
A chest x-ray was interpreted as abnormal showing multiple pulmonary nodules and a CT scan was performed (Figure 2).
Figure 2. Represent images from the thoracic CT scan showing multiple pulmonary nodules. (Click here for a movie of the CT scan)
Which of the following are causes of multiple pulmonary nodules?
