Diffuse pulmonary hemorrhage is one of the conditions in the differential of acute diffuse alveolar pattern on CXR.

Clinical Picture

• Patients present with acute onset of shortness of breath and cough.
• Hemoptysis may or may not be present.
• Chest x-ray shows diffuse alveolar pulmonary infiltrates.
• tachypnea with bilateral crackles can be heard on physical exam.
• Blood gases show hypoxia with widened A-a gradient and alveolar hyperventilation.

Etiology

Multiple etiologies can give rise to pulmonary hemorrhage. Following are the common.

• Thrombocytopenia
• Goodpasture's syndrome
• Wegener's granulomatosis
• Systemic lupus erythematosis
• Idiopathic pulmonary hemorrhage

Pathology

Alveolar spaces are filled with blood. Lung is heavy and feels consolidated. rest of the findings will depend on the etiology.

Diagnosis

• Constellation of hemoptysis, diffuse alveolar infiltrates on CXR, unexplained drop in hemoglobin usually raises suspicion for pulmonary hemorrhage.
• If PFT can be done, increase in diffusion capacity can be seen due to sequestration of blood in lungs.
• Bronchoalveolar alveolar lavage will show RBC's and Iron stain is positive in macrophages.

Treatment

• Supportive care.
• Appropriate therapy based on the etiology.