Pulmonary Hemorrhage in Children

Abstract

Pulmonary hemorrhage (PH), defined as extravasation of blood into airways and/or lung parenchyma, is uncommon in children. Hemoptysis, a characteristic feature of PH is rare as children tend to swallow the blood; on the other hand bleeding from upper respiratory tract and gastrointestinal bleeding (hematemesis) may mimic hemoptysis. The etiology is variable and their relative frequencies vary according to the studied population but infections, bronchiectasis, artificial airway and foreign body inhalation are the commonest. The presentation is variable depending on its origin within the respiratory tract (focal or diffuse), type of bleeding (acute or chronic/ recurrent), amount of bleeding, and presence of pre-existing lung disease. After establishing a pulmonary source of bleeding, the goals of management are to stop further bleeding and establish an etiological diagnosis. A systematic approach starting with history, clinical examination supported with laboratory tests, bronchoscopy and radiology is able to give the diagnosis in most of the cases; lung biopsy being required in only a few. Apart from the emergency measures, supportive and symptomatic management, specific therapy is dependent upon the etiology. Local causes of massive/ recurrent bleeding may be amenable to therapeutic bronchoscopy, angiography with selective embolization and surgical intervention such as resection or revascularization. In milder cases with infectious etiology, treatment of the primary disease generally suffices. Diffuse pulmonary hemorrhage associated with capillaritis requires immunosuppression and also tend to carry a poorer prognosis. Apart from the immediate complications of cardio-respiratory compromise and anemia, recurrent PH in the long term may lead to chronic respiratory insufficiency.