Investigation and assessment

Urgent assessment of cardiorespiratory function and cardiorespiratory monitoring are required. Massive haemoptysis may require resuscitation and urgent intubation. The diagnosis may be suggested by the history and a CXR may identify a cavitating lesion. Lower lobe shadowing on a CXR may be the result of overspill of blood from elsewhere in the bronchial tree. Early surgical intervention should be prompted by a changing air-fluid level, persistent opacification of a previous cavity or a mobile mass. Early bronchoscopy may identify the source of haemoptysis, although only while bleeding is active. Blood in multiple bronchial orifices may be confusing but saline lavage may leave the source visible. Rigid bronchoscopy is useful in massive haemoptysis allowing oxygenation and wide bore suction.

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