Noninvasive diagnosis of pulmonary hemorrhage in rheumatoid arthritis

The noninvasive diagnosis of pulmonary hemorrhage usually relies upon the presence of hemoptysis or hemosiderin-laden macrophages in the sputum. Respiratory tract secretions, however, may be contaminated with blood during passage through the large airways or upper respiratory tract, and hemosiderin-laden macrophages may be found in the sputum of patients with other diseases such as pulmonary edema. In addition, pulmonary hemorrhage may occur without associated hemoptysis or significant changes in the chest roentgenogram.1 We have used serial measurements of the pulmonary uptake of carbon monoxide combined with M-mode echocardiography to monitor left atrial size in order to document pulmonary hemorrhage in an 11-year-old girl with rheumatoid arthritis.