Hemoptysis

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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]

Overview

Hemoptysis or haemoptysis (see American and British spelling differences) is the expectoration (coughing up) of blood or of blood-stained sputum from a source below the vocal cords such as 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.

Pathophysiology

In most cases of hemoptysis, bleeding comes from the bronchial arteries as opposed to the pulmonary arteries.

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.

20% of the cases of hemoptysis are idiopathic in nature.

Natural Hisotry, Compilcations and Prognosis

Although uncommon, massive hemoptysis may be fatal.

Complete List of Differential Diagnoses

Diagnostic workup

Laboratory Findings

Electrolyte and Biomarker Studies

Chest X Ray

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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