Hemoptysis is the act of coughing up blood, or blood-stained mucus from the bronchi, larynx, trachea, or lungs.

Patient information

Hemoptysis, how can I remember it is related to coughing up blood?
How about ptyyy. Isn't that the sound of spitting out something? Perhaps, blood ?

• Respiratory, including: → bright red, foamy blood is from the respiratory tract
  • Infections, including:
    • Bronchitis, most commonly
    • Pneumonia, commonly
    • Tuberculosis
  • Pulmonary edema
  • Pulmonary embolism
  • Lung cancer, including both non-small cell and small cell lung carcinoma → particularly in smokers, where it may be persistent
  • Foreign body aspiration → common in kids
  • Aspiration pneumonia
  • Lung abscess
  • Sarcoidosis
  • Aspergilloma
  • Histoplasmosis
  • Bronchiectasis
  • Coccidoidomycosis
  • Pneumonic plague
  • Cystic fibrosis
  • Goodpasture's syndrome
• Cardiovascular, including:
  • Anticoagulant use → Hx of use of drugs e.g. warfarin
  • CHF
  • Mitral stenosis
  • Tropical eosinophilia
  • Bleeding disorders, including:
    • Hughes-Strovin Syndrome and other variants of Behcet's disease
    • Eosinophilic granulomatosis w/ polyangitis (Churg-Strauss syndrome)
    • Granulomatosis w/ polyangiitis
• Gastrointestinal cause → dark red, coffee colored blood comes from the GI tract
• Physical trauma, that is not respiratory or cardiovascularly related
• Drug induced

• Considered massive, if there is >300mL of blood lost in the last 24 hours

• Bloody mucus from the sinus or nose, can be misidentified as hemoptysis → may indicate nasal or sinus cancer, or sinus infection

• HPC of blood:
  • Is blood coughed up or vomited → source
  • Whether color is blood-streaked, fresh blood, frothy pink, bloody gelatinous → source
• Hx of TB, bronchiectasis, chronic bronchitis, mitral stenosis, etc → recurrence
• Hx of cigaretete somking, occupational disease by exposure to silica dust, etc → risk factors
• Associated Sx, including fever, chest pain, coughing, purulent sputum, mucocutaneous bleeding, jaundice → cause
• CXR, CT scan, CT virtual bronchoscopy, bronchial angiography
• WBC's → infection
• Sputum cell and bacterial exam, sputum culture → source
• Broncihal fiber endoscopy

• Depends on underlying cause
• Iced saline
• Topical vasoconstrictors, e.g. adrenalin or vasopressin
• Selective bronchial intubation, can be used to collapse the lung that is bleeding
• Endobronchial tamponade
• Laser photocoagulation, to stop bleeding during bronchoscopy
• Angiography of bronchial arteries, to locate the bleeding, and it can often be embolized
• Surgery, is last resort, and can include lobectomy (removal of lung lobe) or pneumonectomy (removal of the entire lung)
• Erlotinib or gefitinib, to Tx non-small-cell lung cancer
• Cough suppressants, can increase the risk of choking

• Primary danger is from choking, rather than blood loss

• Hematemesis (vomiting blood, cf coughing up blood in hemoptysis)