Diffuse pulmonary hemorrhage (DPH) is a subtype of pulmonary hemorrhage where bleeding into the lung is diffuse. If the bleeding is into the alveolar spaces this can be further subclassified as diffuse alveolar hemorrhage (DAH).
While the exact presentation can vary is has been classically associated with dyspnea in the setting of hemoptysis +/- an iron deficiency anemia 7.
- pulmonary vasculitides: especially small vessel vasculitides: alveolar hemorrhage secondary to extensive parenchymal small-vessel vasculitis is typically more diffuse and initially causes more widespread lobular ground-glass opacification with gravity-dependent density gradients through to air-space consolidation, often with interspersed areas of ground-glass opacity; these include
- post bone marrow transplantation 3
- all-trans-retinoic acid (ATRA) syndrome 11
- Goodpasture syndrome 10
- pulmonary hemosiderosis: idiopathic pulmonary hemosiderosis 7
- coagulative disorders: often require another precipitating source such as an infection to cause DPH 7
- widespread metastatic lung disease: has been described as a very rare cause of DPH 5
While chest radiographic appearances are nonspecific, there may be evidence of bilateral air-space consolidation with relative apical sparing 7.
May show areas of widespread ground glass opacification +/- crazy paving pattern 8 +/- areas of consolidation. In the subacute phase HRCT may show fine diffuse nodular densities 9-10. In later stage there may also be evidence of interlobular septal thickening due to intralymphatic accumulation of hemosiderin.
For radiographic (plain radiograph and CT) in the acute phase of DPH appearances consider:
- multiple localized pulmonary hemorrhages from diffuse aspiration of blood 7
- pulmonary edema 1
- diffuse pulmonary infection / diffuse pneumonia 1
For HRCT appearances in the subacute phase (i.e. fine nodules) consider:
- 1. Albelda SM, Gefter WB, Epstein DM et-al. Diffuse pulmonary hemorrhage: a review and classification. Radiology. 1985;154 (2): 289-97. Radiology (abstract) - Pubmed citation
- 2. Marten K, Schnyder P, Schirg E et-al. Pattern-based differential diagnosis in pulmonary vasculitis using volumetric CT. AJR Am J Roentgenol. 2005;184 (3): 720-33. AJR Am J Roentgenol (full text) - Pubmed citation
- 3. Witte RJ, Gurney JW, Robbins RA et-al. Diffuse pulmonary alveolar hemorrhage after bone marrow transplantation: radiographic findings in 39 patients. AJR Am J Roentgenol. 1991;157 (3): 461-4. AJR Am J Roentgenol (abstract) - Pubmed citation
- 4. Santos-ocampo AS, Mandell BF, Fessler BJ. Alveolar hemorrhage in systemic lupus erythematosus: presentation and management. Chest. 2000;118 (4): 1083-90. doi:10.1378/chest.118.4.1083 - Pubmed citation
- 5. Nara M, Sasaki T, Shimura S et-al. Diffuse alveolar hemorrhage caused by lung metastasis of ovarian angiosarcoma. Intern. Med. 1996;35 (8): 653-6. Intern. Med. (link) - Pubmed citation
- 6. Onomura K, Nakata H, Tanaka Y et-al. Pulmonary hemorrhage in patients with systemic lupus erythematosus. J Thorac Imaging. 1991;6 (2): 57-61. - Pubmed citation
- 7. Primack SL, Miller RR, Müller NL. Diffuse pulmonary hemorrhage: clinical, pathologic, and imaging features. AJR Am J Roentgenol. 1995;164 (2): 295-300. AJR Am J Roentgenol (abstract) - Pubmed citation
- 8. Frazier AA, Franks TJ, Cooke EO et-al. From the archives of the AFIP: pulmonary alveolar proteinosis. Radiographics. 28 (3): 883-99. doi:10.1148/rg.283075219 - Pubmed citation
- 9. Lynch DA, Newell JD, Lee J. Imaging of diffuse lung disease. Pmph Bc Decker. (2000) ISBN:1550090925. Read it at Google Books - Find it at Amazon
- 10. Reiser MF. Multislice CT. Springer Verlag. (2010) ISBN:3642069681. Read it at Google Books - Find it at Amazon
- 11. Jung JI, Choi JE, Hahn ST et-al. Radiologic features of all-trans-retinoic acid syndrome. AJR Am J Roentgenol. 2002;178 (2): 475-80. AJR Am J Roentgenol (full text) - Pubmed citation