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Hemoptysis
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<h2 id="diagnosis">Diagnosis</h2> <ul><li>Past history, history of present illness, family history<a class="footnote-ref" id="fnref:2" href="#fn:2"><sup>2</sup></a> <ul><li>history of tuberculosis, bronchiectasis, chronic bronchitis, mitral stenosis, etc.</li> <li>history of <a href="/facts/Cigarette_smoking/obI4MYne">cigarette smoking</a>, occupational diseases by exposure to silica dust, etc.</li></ul></li> <li>Blood <ul><li>duration, frequency, amount</li> <li>Amounts of blood: large amounts of blood, or there is blood-streaked sputum</li> <li>Probable source of bleeding: Is the blood coughed up, or vomited?</li></ul></li> <li>Bloody <a href="/facts/Sputum/gduT4NG3">sputum</a> <ul><li>color, characters: blood-streaked, fresh blood, frothy pink, bloody gelatinous.</li></ul></li> <li>Accompanying symptoms <ul><li>fever, chest pain, coughing, purulent sputum, mucocutaneous bleeding, jaundice.</li></ul></li> <li>Imaging examination <ul><li>chest X-ray, CT scan and 3D reconstruction images or CT virtual bronchoscopy, bronchial angiography.</li></ul></li> <li>Laboratory tests <ul><li>blood test: WBC</li> <li>Sputum: cells and bacterial examinations, sputum culture</li></ul></li> <li>Bronchial fiber endoscopy<a class="footnote-ref" id="fnref:3" href="#fn:3"><sup>3</sup></a></li></ul> <h2 id="differential-diagnosis">Differential diagnosis</h2> <p>The most common causes for hemoptysis in adults are chest infections such as <a href="/facts/Bronchitis/IATP1XWJ">bronchitis</a> or <a href="/facts/Pneumonia/Jw0KquTA">pneumonia</a>.<a class="footnote-ref" id="fnref:4" href="#fn:4"><sup>4</sup></a> In children, hemoptysis is commonly caused by the presence of a <a href="/facts/Foreign_body/T1u8fIwH">foreign body</a> in the <a href="/facts/Respiratory_tract/nnG9UEmr">airway</a>. Other common causes include <a href="/facts/Lung_cancer/LHLdR454">lung cancers</a> and <a href="/facts/Tuberculosis/ggPyovAl">tuberculosis</a>. Less common causes include <a href="/facts/Aspergilloma/WqWX27wx">aspergilloma</a>, <a href="/facts/Bronchiectasis/14qT98Q5">bronchiectasis</a>, <a href="/facts/Coccidioidomycosis/WBBD9nMk">coccidioidomycosis</a>, <a href="/facts/Pulmonary_embolism/LPjKCPba">pulmonary embolism</a>, <a href="/facts/Pneumonic_plague/qLKr0Xsq">pneumonic plague</a>, and <a href="/facts/Cystic_fibrosis/tlNK5BAH">cystic fibrosis</a>. Rarer causes include <a href="/facts/Hereditary_hemorrhagic_telangiectasia/nHrVMLBu">hereditary hemorrhagic telangiectasia</a> (HHT or Rendu-Osler-Weber syndrome), <a href="/facts/Goodpasture%27s_syndrome/31UPe0pr">Goodpasture's syndrome</a>, and <a href="/facts/Granulomatosis_with_polyangiitis/TPu4mHpD">granulomatosis with polyangiitis</a>. A rare cause of hemoptysis in women is <a href="/facts/Endometriosis/wKS0I8mc">endometriosis</a>, which leads to intermittent hemoptysis coinciding with menstrual periods in 7% of women with thoracic endometriosis syndrome.<a class="footnote-ref" id="fnref:5" href="#fn:5"><sup>5</sup></a> Hemoptysis may be exacerbated or even caused by overtreatment with <a href="/facts/Anticoagulant/cARpjm0G">anticoagulant</a> drugs such as <a href="/facts/Warfarin/kMnH6tb0">warfarin</a>. </p><p>Blood-laced mucus from the sinus or nose area can sometimes be misidentified as symptomatic of hemoptysis (such secretions can be a sign of nasal or <a href="/facts/Sinus_cancer/ybG3rkBB">sinus cancer</a>, but also a <a href="/facts/Sinus_infection/czg09cPT">sinus infection</a>). Extensive non-respiratory injury can also cause one to cough up blood. Cardiac causes like <a href="/facts/Congestive_heart_failure/7fckX3Jm">congestive heart failure</a> and <a href="/facts/Mitral_stenosis/ctQo7BGm">mitral stenosis</a> should be ruled out. The origin of blood can be identified by observing its color. Bright-red, foamy blood comes from the respiratory tract, whereas dark-red, coffee-colored blood comes from the <a href="/facts/Gastrointestinal_tract/nK2zwqBS">gastrointestinal tract</a>. Sometimes hemoptysis may be rust-colored. </p> <ul><li><a href="/facts/Lung_cancer/LHLdR454">Lung cancer</a>, including both non-small cell lung carcinoma and small cell lung carcinoma.<a class="footnote-ref" id="fnref:6" href="#fn:6"><sup>6</sup></a><a class="footnote-ref" id="fnref:7" href="#fn:7"><sup>7</sup></a></li> <li><a href="/facts/Sarcoidosis/qgV7Uoe8">Sarcoidosis</a><a class="footnote-ref" id="fnref:8" href="#fn:8"><sup>8</sup></a></li> <li><a href="/facts/Aspergilloma/WqWX27wx">Aspergilloma</a><a class="footnote-ref" id="fnref:9" href="#fn:9"><sup>9</sup></a></li> <li><a href="/facts/Tuberculosis/ggPyovAl">Tuberculosis</a><a class="footnote-ref" id="fnref:10" href="#fn:10"><sup>10</sup></a></li> <li><a href="/facts/Histoplasmosis/FfMdb5m8">Histoplasmosis</a><a class="footnote-ref" id="fnref:11" href="#fn:11"><sup>11</sup></a></li> <li><a href="/facts/Pneumonia/Jw0KquTA">Pneumonia</a><a class="footnote-ref" id="fnref:12" href="#fn:12"><sup>12</sup></a></li> <li><a href="/facts/Pulmonary_edema/sVS5UDxl">Pulmonary edema</a><a class="footnote-ref" id="fnref:13" href="#fn:13"><sup>13</sup></a><a class="footnote-ref" id="fnref:14" href="#fn:14"><sup>14</sup></a></li> <li><a href="/facts/Endometriosis/wKS0I8mc">Endometriosis</a> and <a href="/facts/Hemothorax/HnfkhAxA">thoracic endometriosis syndrome</a><a class="footnote-ref" id="fnref:15" href="#fn:15"><sup>15</sup></a></li> <li><a href="/facts/Foreign_body_aspiration/ALL0HNEM">Foreign body aspiration</a> and <a href="/facts/Aspiration_pneumonia/c92nqX66">aspiration pneumonia</a><a class="footnote-ref" id="fnref:16" href="#fn:16"><sup>16</sup></a></li> <li><a href="/facts/Goodpasture%27s_syndrome/31UPe0pr">Goodpasture's syndrome</a><a class="footnote-ref" id="fnref:17" href="#fn:17"><sup>17</sup></a></li> <li><a href="/facts/Microscopic_polyangiitis/bE1WLbax">Microscopic polyangiitis</a><a class="footnote-ref" id="fnref:18" href="#fn:18"><sup>18</sup></a></li> <li><a href="/facts/Granulomatosis_with_polyangiitis/TPu4mHpD">Granulomatosis with polyangiitis</a><a class="footnote-ref" id="fnref:19" href="#fn:19"><sup>19</sup></a></li> <li><a href="/facts/Eosinophilic_granulomatosis_with_polyangiitis/3FDUbbpT">Eosinophilic granulomatosis with polyangiitis</a><a class="footnote-ref" id="fnref:20" href="#fn:20"><sup>20</sup></a><a class="footnote-ref" id="fnref:21" href="#fn:21"><sup>21</sup></a></li> <li><a href="/facts/Bronchitis/IATP1XWJ">Bronchitis</a><a class="footnote-ref" id="fnref:22" href="#fn:22"><sup>22</sup></a></li> <li><a href="/facts/Bronchiectasis/14qT98Q5">Bronchiectasis</a><a class="footnote-ref" id="fnref:23" href="#fn:23"><sup>23</sup></a></li> <li><a href="/facts/Pulmonary_embolism/LPjKCPba">Pulmonary embolism</a><a class="footnote-ref" id="fnref:24" href="#fn:24"><sup>24</sup></a></li> <li><a href="/facts/Anticoagulant/cARpjm0G">Anticoagulant use</a><a class="footnote-ref" id="fnref:25" href="#fn:25"><sup>25</sup></a></li> <li><a href="/facts/Physical_trauma/PJ7CbnMQ">Trauma</a><a class="footnote-ref" id="fnref:26" href="#fn:26"><sup>26</sup></a></li> <li><a href="/facts/Lung_abscess/BtcGrSpn">Lung abscess</a><a class="footnote-ref" id="fnref:27" href="#fn:27"><sup>27</sup></a></li> <li><a href="/facts/Mitral_stenosis/ctQo7BGm">Mitral stenosis</a><a class="footnote-ref" id="fnref:28" href="#fn:28"><sup>28</sup></a></li> <li><a href="/facts/Tropical_pulmonary_eosinophilia/QVR7j0Jv">Tropical pulmonary eosinophilia</a><a class="footnote-ref" id="fnref:29" href="#fn:29"><sup>29</sup></a></li> <li><a href="/facts/Bleeding_disorders/1qchdP31">Bleeding disorders</a><a class="footnote-ref" id="fnref:30" href="#fn:30"><sup>30</sup></a></li> <li><a href="/facts/Hughes-Stovin_syndrome/xUQNlIyF">Hughes-Stovin syndrome</a> and other variants of <a href="/facts/Beh%C3%A7et%27s_disease/oah5LIcL">Behçet's disease</a><a class="footnote-ref" id="fnref:31" href="#fn:31"><sup>31</sup></a></li> <li>Pulmonary <a href="/facts/Arteriovenous_malformations/4yIVzsBR">arteriovenous malformations</a></li></ul> <h2 id="massive-hemoptysis-and-mortality">Massive hemoptysis and mortality</h2> <p>Although there are reports that the fatality rate is as high as 80%, the mortality rate for hospitalized hemoptysis patients is 9.4% (with <a href="/facts/Sample_size/sf8dAFzq">n</a>=28539), calculated from the data in the article by Kinoshita et al.<a class="footnote-ref" id="fnref:32" href="#fn:32"><sup>32</sup></a> This is probably the most reasonable figure considering the overwhelming number of cases. </p><p>The general definition of massive hemoptysis is more than 200 ml within 24 hours, but there is a wide range in the literature (100–600 ml). Considering that the total volume of the tracheal and bronchial lumen is about 150 cc,<a class="footnote-ref" id="fnref:33" href="#fn:33"><sup>33</sup></a><a class="footnote-ref" id="fnref:34" href="#fn:34"><sup>34</sup></a> it may be reasonable to define massive hemoptysis as 200 ml, which is a little more than 150 ml, in terms of setting the threshold for fatal hemoptysis. More than 400ml/day is not adequate for screening purposes. </p> <h2 id="treatment">Treatment</h2> <p>Treatment depends on the underlying cause. Treatments include iced <a href="/facts/Saline_(medicine)/wNMLPtho">saline</a>, and topical <a href="/facts/Vasoconstrictors/9hdY0aR2">vasoconstrictors</a> such as <a href="/facts/Epinephrine_(medication)/4kTu0y6V">adrenaline</a> or <a href="/facts/Vasopressin/B1EksWWY">vasopressin</a>. <a href="/facts/Tranexamic_acid/gzN6y7mK">Tranexamic acid</a> was proved to improve in-hospital mortality.<a class="footnote-ref" id="fnref:35" href="#fn:35"><sup>35</sup></a> Selective <a href="/facts/Tracheal_intubation/5kw0TNxc">bronchial intubation</a> can be used to collapse the lung that is bleeding. Also, endobronchial tamponade can be used.<a class="footnote-ref" id="fnref:36" href="#fn:36"><sup>36</sup></a> <a href="/facts/Laser_photocoagulation/Iot9ygPR">Laser photocoagulation</a> can be used to stop bleeding during <a href="/facts/Bronchoscopy/n1WHpAbP">bronchoscopy</a>. <a href="/facts/Angiography/4onftT3X">Angiography</a> of <a href="/facts/Bronchial_arteries/PPkX4rRt">bronchial arteries</a> can be performed to locate the bleeding, and it can often be <a href="/facts/Embolization/zPNry9cY">embolized</a>.<a class="footnote-ref" id="fnref:37" href="#fn:37"><sup>37</sup></a> <a href="/facts/Bronchial_artery_embolization/bnEXoJQF">Bronchial artery embolization</a> (BAE) is the first line treatment nowadays.<a class="footnote-ref" id="fnref:38" href="#fn:38"><sup>38</sup></a><a class="footnote-ref" id="fnref:39" href="#fn:39"><sup>39</sup></a><a class="footnote-ref" id="fnref:40" href="#fn:40"><sup>40</sup></a><a class="footnote-ref" id="fnref:41" href="#fn:41"><sup>41</sup></a><a class="footnote-ref" id="fnref:42" href="#fn:42"><sup>42</sup></a> Surgical option is usually the last resort and can involve <a href="/facts/Lobectomy/ajoIeSDs">removal of a lung lobe</a> or <a href="/facts/Pneumonectomy/1pA8opIs">removal of the entire lung</a>. Cough suppressants can increase the risk of choking.<a class="footnote-ref" id="fnref:43" href="#fn:43"><sup>43</sup></a> </p> <h2 id="further-reading">Further reading</h2> <ul><li>Adu D, Emery P, Madaio M (2012). <i>Rheumatology and the Kidney</i> (2, illustrated ed.). Oxford University Press. <a href="/facts/ISBN_(identifier)/15AdSPa9">ISBN</a> 9780199579655.</li> <li>Corey R (1990). <a href="https://www.ncbi.nlm.nih.gov/books/NBK360/">"Chapter 39: Hemoptysis"</a>. In Walker HK, Hall WD, Hurst JW (eds.). <i>Clinical Methods: The History, Physical, and Laboratory Examinations</i>. Boston: Butterworths. <a href="/facts/ISBN_(identifier)/15AdSPa9">ISBN</a> 978-0-409-90077-4. <a href="/facts/PMID_(identifier)/JlHAvMHt">PMID</a> <a href="https://pubmed.ncbi.nlm.nih.gov/21250201">21250201</a>.</li></ul> <h2 id="external-links">External links</h2> <h2 id="references">References</h2> <ol> <li id="fn:1"><p>Sabatine MS (2014). Pocket medicine (Fifth ed.). [S.l.]: Aspen Publishers, Inc. ISBN 978-1451193787. <a href="978-1451193787" target="_blank">978-1451193787</a> <a href="#fnref:1" class="footnote-back-ref">↩</a></p></li> <li id="fn:2"><p>"Hemoptysis". The Lecturio Medical Concept Library. Retrieved 24 July 2021. <a href="https://www.lecturio.com/concepts/hemoptysis/" target="_blank">https://www.lecturio.com/concepts/hemoptysis/</a> <a href="#fnref:2" class="footnote-back-ref">↩</a></p></li> <li id="fn:3"><p>Richard F.LeBlond (2004). Diagnostics. US: McGraw-Hill Companies, Inc. ISBN 978-0-07-140923-0. <a href="978-0-07-140923-0" target="_blank">978-0-07-140923-0</a> <a href="#fnref:3" class="footnote-back-ref">↩</a></p></li> <li id="fn:4"><p>Sabatine MS (2014). Pocket medicine (Fifth ed.). [S.l.]: Aspen Publishers, Inc. ISBN 978-1451193787. <a href="978-1451193787" target="_blank">978-1451193787</a> <a href="#fnref:4" class="footnote-back-ref">↩</a></p></li> <li id="fn:5"><p>McCann MR, Schenk WB, Nassar A, Maimone S (September 2020). "Thoracic endometriosis presenting as a catamenial hemothorax with discordant video-assisted thoracoscopic surgery". Radiology Case Reports. 15 (9): 1419–1422. doi:10.1016/j.radcr.2020.05.064. PMC 7334551. 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