Hemoptysis
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| Hemoptysis Classification and external resources | |
| ICD-10 | R04.2 |
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| ICD-9 | 786.3 |
| DiseasesDB | 5578 |
| MedlinePlus | 003073 |
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Hemoptysis or haemoptysis (see American and British spelling differences) 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).
It is not the same as hematemesis, which refers to vomiting up blood.
Overview
- Hemoptysis is defined as coughing up blood from a source below the vocal cords.
- In most cases of hemoptysis, bleeding comes from the bronchial arteries as opposed to the pulmonary arteries.
- Massive hemoptysis may be fatal, although uncommon.
- 20% of the cases of hemoptysis are idiopathic in nature.
Causes
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.
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.
Complete List of Differential Diagnoses
- Actinomycosis
- Adult Respiratory Distress Syndrome (ARDS)
- Amyloidosis
- Aortic Aneurysm
- Arteriovenous malformation (AVM)
- Aspergilloma
- Aspiration (foreign body)
- Behcet's Syndrome
- Biopsy
- Bleeding gums
- Bronchial adenoma
- Bronchitis
- Bronchiectasis
- Bronchogenic carcinoma
- Broncholithiasis
- Bronchoscopy
- Coagulopathy
- Cocaine use
- Congestive Heart Failure
- Cystic Fibrosis
- Cytotoxic drug use
- Echinococcal cyst
- Endometriosis
- Esophageal tumors
- Fistula (between vasculature and airway)
- Goodpasture's Syndrome
- Heart failure
- Hemorrhagic diathesis
- Henoch-Schonlein Purpura
- Histiocytosis X
- Idiopathic pulmonary hemosiderosis
- Intrathoracic endometriosis
- Laryngitis
- Laryngoscopy
- Lung abscess
- Lung contusion
- Malignant lymphoma
- Mediastinal tumors
- Mediastinoscopy
- Metastases
- Mitral Stenosis
- Nosebleed
- Oral Candidiasis
- Osler-Weber-Rendu Syndrome
- Pharyngitis
- Pneumonia
- Polyarteritis Nodosa
- Primary pulmonary hypertension
- Pulmonary arteriovenous fistula
- Pulmonary congestion
- Pulmonary Embolism
- Pulmonary fibrosis
- Pulmonary hemangioma
- Pulmonary hemosiderosis
- Pulmonary Infarction
- Ruptured aortic aneurysm
- Ruptured bronchi
- Sarcoidosis
- Septic pulmonary emboli
- Shrapnel
- Spirometry
- Systemic Lupus Erythematosus
- Tonsillectomy
- Tracheitis
- Trauma
- Tuberculosis
- Violent coughing
- Wegener's Granulomatosis [1] [2]
Diagnostic workup
Laboratory Findings
- Complete blood count (CBC)
- Sputum for acid-fast stain
- Cytology
- Gram stain / culture
- Prothrombin time/partial thromboplastin time (PT / PTT)
- Pulse oximetry
- Urinalysis
- Blood urea nitrogen (BUN)/creatinine)
- Possible immunologic tests
- Arterial blood gases
Electrolyte and Biomarker Studies
Chest X Ray
- Chest X-ray for both major and minor hemoptysis
MRI and CT
- Chest CT scan to show focal bleeding
Other Diagnostic Studies
Treatment
- Treat underling etiologies for minor hemoptysis
- Special attention to airway, breathing and circulation
- Administration of supplemental O2
- Stablize hemodynamics
- Cough suppression
- Intubation
Acute Pharmacotherapies
- IV estrogen
Surgery and Device Based Therapy
- Bronchoscopic balloon tamponade
- Arteriography and embolization
- Emergent thoracic surgery
External links
- 6-63g. at Merck Manual of Diagnosis and Therapy Professional Edition
- -254803961 at GPnotebook
- Haemoptysis Virtual Cancer Centre
References
- ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
- ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
