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Clinical Review Lesson of the week

Rare causes of haemoptysis in suspected pulmonary embolism

BMJ 2004; 329 doi: (Published 02 September 2004) Cite this as: BMJ 2004;329:557
  1. M S Warburton, senior house officer (,
  2. M A Jackson, consultant physician in general, renal, and metabolic medicine1,
  3. R Norton, consultant cardiothoracic surgeon2,
  4. M Bhabra, consultant cardiothoracic surgeon2
  1. 1 Department of General Medicine, New Cross Hospital, Wolverhampton WV6 7OQ
  2. 2 Walsgrave Hospital
  1. Correspondence to: M Warburton


    When a patient presents with haemoptysis and pleuritic chest pain, a pulmonary embolism is an important and common diagnosis to consider. There is a tendency in busy medical admissions units to start treatment of certain conditions without thorough investigation, with the intention of reducing delays in starting treatment. Patients are usually treated for suspected pulmonary embolism with heparin early to reduce mortality and morbidity. It is important, however, to remember other less common causes of haemoptysis.

    Case report

    A 59 year old woman was admitted to our medical assessment unit with chest pain and haemoptysis. She had experienced pleuritic left sided, chest wall pain intermittently for the previous week, with gradually increasing intensity. On the day of admission she had also produced about a cupful of bright red blood while coughing. She had no medical history of note, except that she was a smoker.

    On admission the patient was in distress but not objectively dyspnoeic—her respiratory rate was not raised and her oxygen saturations on air were 97%. She did not show any signs of shock; she had no tachycardia and her …

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