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

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [2] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.

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

Diagnostic workup

Laboratory Findings

Electrolyte and Biomarker Studies

Chest X Ray

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

Surgery and Device Based Therapy

  • Bronchoscopic balloon tamponade
  • Arteriography and embolization
  • Emergent thoracic surgery

External links

References

  1. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

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