Hemoptysis

Hemoptysis or haemoptysis /hɨˈmɒptɨsɪs/ 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 or cardiovascular pathologies).

Differential diagnosis

There are many conditions involving hemoptysis, including but not limited to bronchitis and pneumonia most commonly, but also lung neoplasm (in smokers, hemoptysis is often persistent), aspergilloma, tuberculosis, bronchiectasis, coccidioidomycosis, pulmonary embolism, pneumonic plague, and cystic fibrosis. Rarer causes include hereditary hemorrhagic telangiectasia (HHT or Rendu-Osler-Weber syndrome), Goodpasture's syndrome and Wegener's granulomatosis. In children, hemoptysis is commonly caused by the presence of a foreign body in the respiratory tract. The condition can also result from over-anticoagulation from treatment by drugs such as warfarin.

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 sinus cancer, but also a sinus infection). Extensive non-respiratory injury can also cause one to cough up blood. Cardiac causes like congestive heart failure and mitral stenosis 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 gastrointestinal tract. Sometimes hemoptysis may be rust-colored.

• Lung cancer, including both non-small cell lung carcinoma and small cell lung carcinoma.^[1][2]
• Sarcoidosis^[3]
• Aspergilloma^[4]
• Tuberculosis^[5]
• Histoplasmosis^[6]
• Pneumonia
• Foreign body aspiration and aspiration pneumonia
• Goodpasture's syndrome^[7]
• Wegener's granulomatosis^[8]
• Bronchitis^[9]
• Bronchiectasis^[9]
• Pulmonary embolism^[10]
• Anticoagulant use^[10]
• Trauma^[10]
• Lung abscess^[10]
• Mitral stenosis
• Tropical eosinophilia
• Drug induced
• Bleeding disorders
• Hughes-Stovin Syndrome and other variants of Behçet's disease

Diagnostic approach

Diagnostic approach to solving the puzzle of hemoptysis.

• Past history, history of present illness, family history
  • history of tuberculosis, bronchiectasis, chronic bronchitis, mitral stenosis, etc.
  • history of smoking, occupational diseases by exposure to silica dust, etc.
• Blood
  • duration, frequency, amount
  • Amounts of blood: large amounts of blood, or is there blood-streaked sputum
  • Probable source of bleeding: Is the blood coughed up, or vomited?
• Bloody sputum
  • color, characters: blood-streaked, fresh blood, frothy pink, bloody gelatinous.
• Accompanying symptoms
  • fever, chest pain, coughing, purulent sputum, mucocutaneous bleeding, jaundice.
• Imaging examination
  • chest X-ray, CT scan and 3D reconstruction images or CT virtual bronchoscopy, bronchial angiography.
• Laboratory tests
  • blood test: WBC
  • Sputum: cells and bacterial examinations, sputum culture
• Bronchial fiber endoscopy^[11]

Treatment

Treatment depends largely upon the underlying cause. Many modalities of treatment can be used, like, iced saline, or topical vasoconstrictors, such as adrenalin or vasopressin can be used. Selective bronchial intubation can be used to collapse lung in which the hemorrhage is occurring, also endobronchial tamponade can be used. Laser photocoagulation can be used to stop bleeding during bronchoscopy. Angiography of bronchial arteries can be performed to locate the bleeding, and it can often be embolized.^[12] Surgical option is usually the last resort, and can involve, lobectomy or pneumonectomy. Non–small-cell lung cancer can also be treated with erlotinib or gefitinib.^[13]

References

External links

• Haemoptysis at GPnotebook