Vasculitis/Diffuse Alveolar Hemorrhage - Diagnosis

Name: Insights in ILD
Keywords: Insights in ILD

DIAGNOSIS

Highly variable¹
Patients commonly present with nonspecific symptoms that can develop acutely or over time^1,2
- Dyspnea
- Cough
- Fever
- Chest pain
A majority of patients (~67%) experience a variable degree of hemoptysis¹
Anemia — acute or chronic (lasting several weeks) — is common²
Patients will often have signs and symptoms of a related systemic disorder¹
Patient presentation can range from being asymptomatic with radiographic abnormalities to severe respiratory failure resulting from impaired oxygen uptake from the alveoli^1,2

Decreased hemoglobin and/or hematocrit levels without external bleeding in addition to increasing pulmonary alveolar opacities is characteristic of DAH²
Identification of the underlying systemic disease causing DAH is crucial¹
- Review of systems including exposure history
- Past medical history  
- Comprehensive physical exam

Transbronchial Lung Biopsy

Diagnostic gold standard to show alveolar hemorrhage as well as the inflamed capillaries²
Histologic confirmation of vascular inflammation is required¹

Imaging – Chest X-ray (CXR) and High-Resolution Computed Tomography (HRCT):

Nonspecific, varies through disease course^1,2
Alveolar opacities - focal or diffuse areas of ground glass and/or consolidation^1,2
Opacities are bilateral, patchy or diffuse, dominant in mid and lower zones of the lungs²
Pleural effusion is not a feature of DAH; if present, suspect heart or renal failure²

Bronchoscopy with Bronchoalveolar Lavage (BAL):

Laboratory studies:

Because of nonspecific presentation, comprehensive panels should be done including complete blood count (CBC), coagulation, serum creatinine, and antineutrophil cytoplasmic antibody (ANCA) testing¹