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{{Infobox_Disease |
__NOTOC__
  Name          = Hemoptysis |
{| class="infobox" style="float:right;"
  ICD10          = {{ICD10|R|04|2|r|00}} |
|-
  ICD9          = {{ICD9|786.3}} |
| [[File:Siren.gif|link=Hemoptysis resident survival guide|41x41px]] || <br> || <br>
  ICDO          = |
| [[Hemoptysis resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
  Image          = |
|}
  Caption        = |
{{Hemoptysis}}
  OMIM          = |
  OMIM_mult      = |
  MedlinePlus    = 003073 |
  eMedicineSubj  = |
  eMedicineTopic = |
  DiseasesDB    = 5578 |
}}
{{SI}}
{{CMG}}


{{EH}}
'''For hemoptysis resident survival guide, click [[Hemoptysis resident survival guide|here]].'''


'''Hemoptysis''' or '''haemoptysis''' (see [[American and British English spelling differences#Simplification of ae .28.C3.A6.29 and oe .28.C5.93.29|American and British spelling differences]]) is the expectoration ([[cough]]ing up) of [[blood]] or of blood-stained [[sputum]] from the [[bronchi]], [[larynx]], [[vertebrate trachea|trachea]], or [[lungs]] (e.g. in tuberculosis or other respiratory infections).  
'''For patient information, click [[{{PAGENAME}} (patient information)|here]].'''


It is not the same as [[hematemesis]], which refers to [[vomit]]ing up blood.
{{CMG}}; {{AE}} {{SSH}}
== 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 cancer|lung neoplasm]] (in smokers, when hemoptysis is persistent), [[aspergilloma]], [[tuberculosis]], [[bronchiectasis]], [[coccidioidomycosis]], [[pulmonary embolism]], or [[Bubonic plague|pneumonic plague]].


Rarer causes include [[hereditary hemorrhagic telangiectasia]] (HHT or Rendu-Osler-Weber syndrome), or [[Goodpasture's syndrome]] and [[Wegener's granulomatosis]].
{{SK}} Spitting up blood; bloody sputum; coughing up blood; blood in sputum; haemoptysis


In children it is commonly due to a [[foreign body]] in the [[respiratory tract]].
==[[Hemoptysis overview|Overview]]==


It can result from over-anticoagulation from treatment by drugs such as [[warfarin]].
==[[Hemoptysis historical perspective|Historical Perspective]]==


Cardiac causes like congestive heart failure and mitral stenosis should be ruled out.
== [[Hemoptysis classification|Classification]] ==


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]].
==[[Hemoptysis pathophysiology|Pathophysiology]]==
==Complete List of Differential Diagnoses==  
==[[Hemoptysis causes|Causes]]==
* [[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]] <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>


==Diagnostic workup==
==[[Hemoptysis differential diagnosis|Differentiating Hemoptysis from other Diseases]]==
[[Image:hemoptysis.png]]
== 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 ====
==[[Hemoptysis epidemiology and demographics|Epidemiology and Demographics]]==
* [[Electrolytes]]
==== 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 ===
* [[Bronchoscopy]]


== Treatment ==
==[[Hemoptysis risk factors|Risk Factors]]==
* Treat underling etiologies for minor hemoptysis
* Special attention to '''airway, breathing''' and '''circulation'''
* Administration of supplemental O2
* Stablize hemodynamics
* Cough suppression
* Intubation


=== Acute Pharmacotherapies ===
==[[Hemoptysis screening|Screening]]==
* IV [[estrogen]]


=== Surgery and Device Based Therapy ===  
==[[Hemoptysis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
* Bronchoscopic balloon tamponade
* Arteriography and embolization
* Emergent thoracic surgery


==External links==
==Diagnosis==
* {{MerckManual|6|63|g}}
[[Hemoptysis diagnostic study of choice|Diagnostic Study of Choice]] | [[Hemoptysis history and symptoms|History and Symptoms]] | [[ Hemoptysis physical examination|Physical Examination]] | [[Hemoptysis laboratory findings|Laboratory Findings]] | [[Hemoptysis electrocardiogram|Electrocardiogram]] |  [[Hemoptysis x ray|X-Ray Findings]] | [[Hemoptysis echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[Hemoptysis CT scan|CT-Scan Findings]] | [[Hemoptysis MRI|MRI Findings]] | [[Hemoptysis other imaging findings|Other Imaging Findings]] | [[Hemoptysis other diagnostic studies|Other Diagnostic Studies]]
* {{GPnotebook|-254803961}}
* [http://www.virtualcancercentre.com/symptoms.asp?sid=58 Haemoptysis] Virtual Cancer Centre
==References==
{{Reflist|2}}


{{Symptoms and signs}}
==Treatment==
{{SIB}}
[[Hemoptysis medical therapy|Medical Therapy]] | [[Hemoptysis surgery |Surgery]] | [[Hemoptysis primary prevention|Primary Prevention]] | [[Hemoptysis secondary prevention|Secondary Prevention]] | [[Hemoptysis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Hemoptysis future or investigational therapies|Future or Investigational Therapies]]


{{WH}}
==Case Studies==
{{WS}}


[[Category:Pulmonology]]
[[Hemoptysis case study one|Case #1]]


[[Category:Signs and symptoms]]
[[Category:Medicine]]
[[Category:Gastroenterology]]
[[Category:Up-To-Date]]
[[Category:Emergency medicine]]

Latest revision as of 22:02, 29 July 2020



Resident
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Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Hemoptysis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-Ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

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Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

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Risk calculators and risk factors for Hemoptysis

For hemoptysis resident survival guide, click here.

For patient information, click here.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]

Synonyms and keywords: Spitting up blood; bloody sputum; coughing up blood; blood in sputum; haemoptysis

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Hemoptysis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice | History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram |  X-Ray Findings | Echocardiography and Ultrasound | CT-Scan Findings | MRI Findings | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1