Hemoptysis

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

 * 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

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

 * 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

 * Treat underling etiologies for minor hemoptysis
 * Special attention to airway, breathing and circulation
 * Administration of supplemental O2
 * Stablize hemodynamics
 * Cough suppression
 * Intubation

Acute Pharmacotherapies

 * IV estrogen

Surgery and Device Based Therapy

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