Hemoptysis overview

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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

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MRI

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Other Diagnostic Studies

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

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Hereditary pancreatitis from Other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications, and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Patients with hemoptysis may have a positive history of upper respiratory tract infectiongastrointestinal disease, exposure to patients with tuberculosisbleeding disordersmedications (anticoagulants), and cigarette smoking. Common symptoms of hemoptysis include bloody sputum, chronic coughshortness of breathpleuritic chest pain, and wheezing. Less common symptoms of hemoptysis depends on the etiology include weight loss, change in coughfatigue.

Physical Examination

Physical examination of patients with hemoptysis might be normal. However, patients might show different findings depend on underlying causes. Patients with hemoptysis usually appear anxious and depend on the severity of bleeding they might be critically ill. Patients with hemoptysis usually have abnormal vital signs indicating dehydration, other signs of mucosal bleeding, purulent bloody sputum, and abnormal lung exam indicating underlying pulmonary causes.

Laboratory Findings

Electrocardiogram

There are no electrocardiogram findings associated with hemoptysis. However, electrocardiogram might be abnormal with some of the underlying causes of hemoptysis.

X-ray

Chest x-ray is the first diagnostic modality that is used in a patient with hemoptysis. Chest x-ray might differentiate underlying causes of hemoptysis. Chest x-ray is usually used to compare with previous or later imagings in order to evaluate the progression and resolution of the underlying cause. However, chest x-ray might be completely normal in patients with hemoptysis.

Echocardiography and Ultrasound

There are no echocardiography/ultrasound findings associated with hemoptysis. However, echocardiography or ultrasound might be abnormal with some of the underlying causes of hemoptysis.

CT scan

MRI

Chest MRI may be helpful in the diagnosis of underlying causes of hemoptysis.

Other Imaging Findings

Other imaging findings may be helpful in the diagnosis of underlying causes of hemoptysis.

Other Diagnostic Studies

Treatment

Medical Therapy

Hemoptysis is a symptom that indicates an underlying pulmonary or extrapulmonary cause. Pharmacologic medical therapy depends on an underlying cause. However, the mainstay of treatment for massive hemoptysis is supportive and surgical therapy.

Surgery

Massive hemoptysis is a life-threatening condition and requires prompt intensive care. Surgery is indicated in patients with hemoptysis who are resistant to embolization. Interventional techniques are used to stop bleeding which include bronchial arterial embolization, different bronchoscopic strategies such as cold saline lavage, topical vasoconstrictor agents, balloon tamponade, endobronchial stent placement, endobronchial spigot, oxidized regenerated celluloseN-Butyl cyanoacrylate gluefibrinogenthrombintranexamic acidlaser photocoagulationargon plasma coagulation, and electrocautery. Surgical techniques that are used for management of hemoptysis include pulmonary resectionlobectomy, and bilobectomy. Surgical techniques are definitely curative, effective for localized lesions. However, surgery has a mortality rate of 10-30%. Currently, bronchial arterial embolization considered as a first line therapy for both new and recurrent hemoptysis.

Primary Prevention

Effective measures for the primary prevention of hemoptysis include smoking cessation, avoiding air pollutants, and use of physical barriers such as masks and gown.

Secondary Prevention

There are no established measures for the secondary prevention of hemoptysis.

References