Hemoptysis or haemoptysis is the expectoration of blood or of blood-stained sputum from the
bronchi, larynx, trachea, or lungs.
Differential diagnosis There are many conditions involving hemoptysis,
including but not limited to bronchitis and pneumonia most commonly, but also lung neoplasm,
aspergilloma, tuberculosis, bronchiectasis, coccidioidomycosis, pulmonary embolism, pneumonic
plague, and cystic fibrosis.
Rarer causes include hereditary hemorrhagic telangiectasia, Goodpasture's syndrome and
Wegener's granulomatosis.
In children, hemoptysis is commonly caused by the presence of a foreign body in the respiratory
tract.
The condition can also result from over-anticoagulation from treatment by drugs such as warfarin.
Blood-laced mucus from the sinus or nose area can sometimes be misidentified as symptomatic
of hemoptysis.
Extensive non-respiratory injury can also cause one to cough up blood.
Cardiac causes like congestive heart failure and mitral stenosis should be ruled out.
The origin of blood can be identified by observing its color.
Bright-red, foamy blood comes from the respiratory tract, whereas dark-red, coffee-colored blood
comes from the gastrointestinal tract.
Sometimes hemoptysis may be rust-colored.
Lung cancer, including both non-small cell lung carcinoma and small cell lung carcinoma.
Sarcoidosis Aspergilloma
Tuberculosis Histoplasmosis
Pneumonia Pulmonary edema
Foreign body aspiration and aspiration pneumonia Goodpasture's syndrome
Wegener's granulomatosis Bronchitis
Bronchiectasis Pulmonary embolism
Anticoagulant use Trauma
Lung abscess Mitral stenosis
Tropical eosinophilia Drug induced
Bleeding disorders Hughes-Stovin Syndrome and other variants
of Behçet's disease Diagnostic approach
Past history, history of present illness, family history
history of tuberculosis, bronchiectasis, chronic bronchitis, mitral stenosis, etc.
history of smoking, occupational diseases by exposure to silica dust, etc.
Blood duration, frequency, amount
Amounts of blood: large amounts of blood, or is there blood-streaked sputum
Probable source of bleeding: Is the blood coughed up, or vomited?
Bloody sputum color, characters: blood-streaked, fresh blood,
frothy pink, bloody gelatinous.
Accompanying symptoms fever, chest pain, coughing, purulent sputum,
mucocutaneous bleeding, jaundice.
Imaging examination chest X-ray, CT scan and 3D reconstruction
images or CT virtual bronchoscopy, bronchial angiography.
Laboratory tests blood test: WBC
Sputum: cells and bacterial examinations, sputum culture
Bronchial fiber endoscopy Treatment
Treatment depends largely upon the underlying cause.
Many modalities of treatment can be used, like, iced saline, or topical vasoconstrictors,
such as adrenalin or vasopressin can be used.
Selective bronchial intubation can be used to collapse lung in which the hemorrhage is
occurring, also endobronchial tamponade can be used.
Laser photocoagulation can be used to stop bleeding during bronchoscopy.
Angiography of bronchial arteries can be performed to locate the bleeding, and it can often be
embolized.
Surgical option is usually the last resort, and can involve, lobectomy or pneumonectomy.
Non–small-cell lung cancer can also be treated with erlotinib or gefitinib.
References
External links Haemoptysis at GPnotebook