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Hemoptysis
ICD-10 R04.2
ICD-9 786.3
DiseasesDB 5578
MedlinePlus 003073
MeSH D006469

Hemoptysis or haemoptysis (pronounced /hɨˈmɒptɨsɪs/) is the expectoration (coughing up) of blood or of blood-stained sputum from the bronchi, larynx, trachea, or lungs (e.g. in tuberculosis or other respiratory infections).

Contents

Differential diagnosis

This can be due to bronchitis or pneumonia most commonly, but also to lung neoplasm (in smokers, when hemoptysis is persistent), aspergilloma, tuberculosis, bronchiectasis, coccidioidomycosis, pulmonary embolism, or pneumonic plague.

Rarer causes include hereditary hemorrhagic telangiectasia (HHT or Rendu-Osler-Weber syndrome), or Goodpasture's syndrome and Wegener's granulomatosis. In children it is commonly due to a foreign body in the respiratory tract. It can result from over-anticoagulation from treatment by drugs such as warfarin. Cardiac causes like congestive heart failure and mitral stenosis should be ruled out. It can be sometimes be confused with mucus from the sinus or nose area, which can be a sign of nasal or sinus cancer, but also a sinus infection. Extensive injury can cause one to cough up blood.

The origin of blood can be known by observing its color. Bright red, foamy blood comes from the respiratory tract while dark red, coffee-colored blood comes from the gastrointestinal tract. Sometimes hemoptysis may be rust colored.

Diagnostic approach

Hemoptysis.png

In general, hemoptysis requires a systematic and thorough evaluation to discover its cause. (Hemoptysis in a patient with chronic bronchitis during an acute exacerbation is a possible exception because it is usually mild and self-limited.) However, if the hemoptysis is massive, recurrent, or won't go away, then further evaluation is indicated.

Is it really hemoptysis? The history in most cases will suggest that blood is actually being coughed up from the lungs, but it may be difficult at times to distinguish hemoptysis from bleeding in the upper respiratory tract (such as the nasopharynx or sinuses), or blood from the gastrointestinal tract that was regurgitated or vomited.

Is the bleeding massive[15] (i.e. life-threatening)? This is important not only for necessitating a different approach to management, but will often alter the differential diagnosis, or list of possible causes. Massive or life-threatening hemoptysis is more than 200 ml (or a little under a half pint) total in one day. Any amount of bleeding at a high rate, even over a short period of time, should be managed as being potentially life-threatening because blood will flood the airways and cause asphyxiation.

What does the medical evaluation consist of? Generally, the initial evaluation will consist of a careful history and thorough physical examination. The doctor will ask about any acute or chronic pulmonary symptoms, including cough, shortness of breath, wheezing, or if you have had any previous lung disease. The history or physical may uncover findings suggesting a certain cause, such as underlying heart disease, vasculitis, or pulmonary thromboembolism. Systemic symptoms, such as fever, night sweats, weight loss, and malaise may be present in chronic infection, cancer, or inflammatory diseases. Depending upon the situation, the initial evaluation often occurs in the Emergency Department of a hospital[16]

What tests might be done? Generally, the first test will be a two-view (front and side) chest x-ray. The chest x-ray can be unrevealing, however, despite the presence of an important disease as the cause for the hemoptysis. Blood tests, including complete blood count (CBC) and coagulation studies (PT/PTT) are commonly ordered tests for patients with hemoptysis. Depending on the patient age and clinical circumstances, sputum testing for infection and/or cancer may be obtained. Chest CT scanning (contrast, high-resolution, or spiral) is a non-invasive and sensitive x-ray technique that can help the doctor determine the cause of hemoptysis[17]. Ventilation-Perfusion (V/Q) scan is useful in evaluating for thromboembolic disease. The decision whether to perform fiberoptic bronchoscopy should be made in consultation with a lung specialist (pulmonologist). An echocardiogram can help examine the functioning of the heart and heart valves. On rare occasions, more invasive testing is required, including surgery (such as thoracoscopy, mediastinoscopy, or thoracotomy).

Treatment

Treatment depends largely upon the underlying cause.

Angiography of bronchial arteries can be performed to locate the bleeding, and it can often be embolized.[18]

References

  1. ^ https://health.google.com/health/ref/Lung+cancer+-+small+cell
  2. ^ https://health.google.com/health/ref/Lung+cancer+-+non-small+cell
  3. ^ http://www.pulmonologychannel.com/sarcoidosis/symptoms.shtml
  4. ^ http://www.nlm.nih.gov/medlineplus/ency/article/000127.htm
  5. ^ https://health.google.com/health/ref/Pulmonary+tuberculosis
  6. ^ http://www.mayoclinic.com/health/histoplasmosis/DS00517/DSECTION=symptoms
  7. ^ http://emedicine.medscape.com/article/1001872-overview
  8. ^ http://www.mayoclinic.com/health/wegeners-granulomatosis/DS00833/DSECTION=symptoms
  9. ^ http://www.pulmonologychannel.com/hemoptysis/causes.shtml
  10. ^ http://www.pulmonologychannel.com/hemoptysis/causes.shtml
  11. ^ http://www.pulmonologychannel.com/hemoptysis/other-causes.shtml
  12. ^ http://www.pulmonologychannel.com/hemoptysis/other-causes.shtml
  13. ^ http://www.pulmonologychannel.com/hemoptysis/other-causes.shtml
  14. ^ http://www.pulmonologychannel.com/hemoptysis/other-causes.shtml
  15. ^ Cahill BC, Ingbar DH. Massive hemoptysis: Assessment and management. Clin Chest Med 1994; 15:147-167.
  16. ^ Goldman JM. Hemoptysis: Emergency assessment and management. Emerg Med Clin N Amer 1989; 7:325-339.
  17. ^ Marshall TJ, Flower CDR, Jackson JE. The role of radiology in the investigation and management of patients with haemoptysis. Clinical Radiol 1996; 51:391-400.
  18. ^ Uppsala Academic Hospital > Guidelines for treatment of acute lung diseases. August 2004. Authors: Christer Hanson, Carl-Axel Karlsson, Mary Kämpe, Kristina Lamberg, Eva Lindberg, Lavinia Machado Boman, Gunnemar Stålenheim

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