Hemoptysis
Hemoptysis is the medical term for coughing up blood or blood-stained sputum that arises from the respiratory tract, including the bronchi, lungs, and trachea. This condition can indicate various underlying health issues, with Mycobacterium tuberculosis being the most prevalent cause globally. In industrialized nations, common causes include bronchitis, bronchiectasis, and lung cancer, particularly bronchogenic carcinoma. Hemoptysis may also stem from other pulmonary conditions such as aspergilloma, pneumonia, and pulmonary embolism, as well as from foreign objects in the respiratory tract, particularly in children.
The symptoms are characterized by bright red, foamy blood in sputum, suggesting respiratory origin, as opposed to dark red blood that indicates gastrointestinal sources. Diagnosis typically involves a physical examination to identify the source of the bleeding, often supported by imaging tests. Treatment focuses on halting the bleeding, clearing the airways, and addressing the underlying condition. In cases of massive hemoptysis, defined by significant blood loss or risk of asphyxiation, urgent medical intervention is required. Overall, the prognosis varies according to the underlying cause of hemoptysis.
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Subject Terms
Hemoptysis
ALSO KNOWN AS: Coughing up of blood or blood-stained sputum
RELATED CONDITIONS: Tuberculosis, bronchitis, bronchiectasis, aspergilloma, coccidioidomycosis, pulmonary embolism, pneumonia, pneumonic plague, lung cancer (especially bronchogenic carcinoma)
DEFINITION: Hemoptysis is the coughing up of blood or blood-stained sputum that originates in the bronchi, lungs, trachea, or some other part of the respiratory tract.
Etiology and the disease process: Hemoptysis has many potential causes, but an underlying condition is most common. The most common cause of hemoptysis is Mycobacterium tuberculosis infection. The most common causes of hemoptysis in industrialized nations are bronchitis, bronchiectasis, and bronchogenic carcinoma. Other pulmonary conditions, such as aspergilloma, coccidioidomycosis, pulmonary embolism, pneumonia, and pneumonic plague, may also cause hemoptysis. Hemoptysis can also be caused by the presence of a foreign object in the respiratory tract, although this is much more common in children than adults.
Incidence: Some 30 to 60 percent of individuals with lung cancers experience hemoptysis—patients with bronchogenic carcinoma account for up to 44 percent of cancer-related cases.
Symptoms: Hemoptysis, itself a symptom of an underlying disorder, is marked by the color of the blood in sputum, normally bright red and foamy rather than dark red.
Screening and diagnosis: Hemoptysis is usually diagnosed with a physical examination. One of the most important things in the examination is determining if the blood being coughed up is hemoptysis. Coughed-up blood can also originate from the gastrointestinal tract. The blood’s origin can be determined by its color. Bright red, foamy blood originates from the respiratory tract, while dark red blood originates from the gastrointestinal tract.
Sometimes, a chest radiograph is used to diagnose hemoptysis. In more complicated cases, advanced tests may be employed. The most common set of advanced tests includes fiber-optic bronchoscopy and high-resolution computed tomography. This set of tests is often used when the cause of hemoptysis is suspected to be malignant cancer.
Treatment and therapy: Treating hemoptysis involves stopping the bleeding, clearing the airways, and treating the underlying condition. Patients at low risk with normal chest radiographs may be treated as outpatients with close monitoring and antibiotics to treat any underlying infection causing the hemoptysis.
If the patient is diagnosed with life-threatening, massive hemoptysis, the situation becomes much more urgent. Massive hemoptysis is defined by the rate of bleeding rather than the volume of blood coughed up. The risk of death from massive hemoptysis is not from the loss of blood but from possible asphyxiation from blockage of the airways. Massive hemoptysis is defined as more than 200 milliliters of blood coughed up per day. Massive hemoptysis is a medical emergency and requires immediate medical attention. The most common treatments for massive hemoptysis are bronchial angiography with embolization or surgical removal of the bleeding site.
Prognosis, prevention, and outcomes: Outcomes depend on the type of cancer or other disorder for which hemoptysis is a symptom.
Bibliography
"Coughing Up Blood." Cleveland Clinic, 10 Oct. 2022, my.clevelandclinic.org/health/symptoms/17696-coughing-up-blood. Accessed 20 June 2024.
"Coughing Up Blood." Mayo Clinic, 7 Apr. 2018, www.mayoclinic.org/symptoms/coughing-up-blood/basics/definition/sym-20050934. Accessed 20 June 2024.
"Coughing Up Blood." MedlinePlus, medlineplus.gov/ency/article/003073.htm. Accessed 20 June 2024.
Ghigna, Maria R., et al. "A Quite Exceptional Case of Recurrent Hemoptysis." Chest, vol. 144, no. 5, 2013, pp. 1724–28.
"Hemoptysis." The Merck Manual. Merck, www.msdmanuals.com/professional/pulmonary-disorders/symptoms-of-pulmonary-disorders/hemoptysis. Accessed 20 June 2024.
Lilly, Craig M. Irwin & Rippe’s Intensive Care Medicine. 9th ed., Wolters Kluwer, 2024.
Singer, Emad D., et al. "Hemoptysis in Cancer Patients." Cancers, vol. 15, no. 19, 2023, p. 4765. doi.org/10.3390/cancers15194765,