View source for Hemoptysis

{{Distinguish|Hematemesis}}
{{short description|Medical symptom consisting of bloody mucus from coughing}}
{{Infobox medical condition
| name            = Hemoptysis
| synonyms        = Haemoptysis, coughing up of blood
| pronounce       = {{IPAc-en|h|ᵻ|ˈ|m|ɒ|p|t|ᵻ|s|ᵻ|s}}
| field           = [[Pulmonology]]
| image           = Bronchitis Normal vs Affected Airway.jpg
| caption         = Lower left: [[Inflammation]] of the [[bronchus]] can bring about bloody mucus.
| symptoms        = Spitting blood or bloody sputum
| complications   = [[Pulmonary aspiration]], [[choking]]
| onset           =
| duration        =
| types           =
| causes         = [[bronchitis]], [[lung cancer]], certain [[infections]], [[pulmonary embolism]]
| risks           =
| diagnosis       =
| differential    = [[epistaxis]] (combined with [[post-nasal drip]])
| prevention      =
| treatment       =
| medication      =
| prognosis       =
| frequency       =
| deaths          =
}}

'''Hemoptysis''' or '''haemoptysis''' is the discharge of [[blood]] or blood-stained [[sputum|mucus]] through the mouth coming from the [[bronchi]], [[larynx]], [[vertebrate trachea|trachea]], or [[lung]]s. It does not necessarily involve coughing. In other words, it is the airway bleeding. This can occur with [[lung cancer]], infections such as [[tuberculosis]], [[bronchitis]], or [[pneumonia]], and certain cardiovascular conditions. Hemoptysis is considered massive at {{convert|300|mL|floz|abbr=on}}.  In such cases, there are always severe injuries. The primary danger comes from [[choking]], rather than [[bleeding|blood loss]].<ref name="Pocket medicine">{{cite book| vauthors = Sabatine MS |title=Pocket medicine|date=2014|publisher=Aspen Publishers, Inc|location=[S.l.]|isbn=978-1-4511-9378-7|edition=Fifth}}</ref>

==Diagnosis==
[[File:hemoptysis.svg|thumb|300px|Diagnostic approach to solving the puzzle of hemoptysis.]]
* Past history, history of present illness, family history<ref>{{cite web |url=https://www.lecturio.com/concepts/hemoptysis/| title=Hemoptysis|website=The Lecturio Medical Concept Library |access-date= 24 July 2021}}</ref>
** history of tuberculosis, bronchiectasis, chronic bronchitis, mitral stenosis, etc.
** history of [[cigarette smoking]], occupational diseases by exposure to silica dust, etc.
* Blood
** duration, frequency, amount
** Amounts of blood: large amounts of blood, or there is 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<ref>{{Cite book | author = Richard F.LeBlond | title = Diagnostics | location = US | publisher = McGraw-Hill Companies, Inc. |isbn =978-0-07-140923-0 | year = 2004 }}</ref>

==Differential diagnosis==

The most common causes for hemoptysis in adults are chest infections such as [[bronchitis]] or [[pneumonia]].<ref name="Pocket medicine" />  In children, hemoptysis is commonly caused by the presence of a [[foreign body]] in the [[respiratory tract|airway]]. Other common causes include [[lung cancer]]s and [[tuberculosis]]. Less common causes include [[aspergilloma]], [[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 [[granulomatosis with polyangiitis]]. A rare cause of hemoptysis in women is [[endometriosis]], which leads to intermittent hemoptysis coinciding with menstrual periods in 7% of women with thoracic endometriosis syndrome.<ref name=McCann2020p1419>{{cite journal | vauthors = McCann MR, Schenk WB, Nassar A, Maimone S | title = Thoracic endometriosis presenting as a catamenial hemothorax with discordant video-assisted thoracoscopic surgery | journal = Radiology Case Reports | volume = 15 | issue = 9 | pages = 1419–1422 | date = September 2020 | pmid = 32642009 | pmc = 7334551 | doi = 10.1016/j.radcr.2020.05.064 }}</ref> Hemoptysis may be exacerbated or even caused by overtreatment with [[anticoagulant]] drugs such as [[warfarin]].{{cn|date=June 2021}}

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.{{citation needed|date=November 2020}}
* [[Lung cancer]], including both non-small cell lung carcinoma and small cell lung carcinoma.<ref>[https://health.google.com/health/ref/Lung+cancer+-+small+cell Google Health – Google<!-- Bot generated title -->]</ref><ref>[https://health.google.com/health/ref/Lung+cancer+-+non-small+cell Google Health – Google<!-- Bot generated title -->]</ref>
* [[Sarcoidosis]]<ref>{{Cite web |url=http://www.pulmonologychannel.com/sarcoidosis/symptoms.shtml |title=Sarcoidosis Signs & Symptoms – Sarcoidosis – HealthCommunities.com<!-- Bot generated title --> |access-date=2010-02-05 |archive-url=https://web.archive.org/web/20090221145513/http://www.pulmonologychannel.com/sarcoidosis/symptoms.shtml |archive-date=2009-02-21 }}</ref>
* [[Aspergilloma]]<ref>{{MedlinePlusEncyclopedia|000127|Pulmonary aspergilloma}}</ref>
* [[Tuberculosis]]<ref>[https://health.google.com/health/ref/Pulmonary+tuberculosis Google Health – Google<!-- Bot generated title -->]</ref>
* [[Histoplasmosis]]<ref>{{Cite web |url=http://www.mayoclinic.com/health/histoplasmosis/DS00517/DSECTION=symptoms |title=Histoplasmosis Symptoms – Diseases and Conditions – Mayo Clinic<!-- Bot generated title --> |access-date=2010-02-05 |archive-url=https://web.archive.org/web/20130531010442/http://www.mayoclinic.com/health/histoplasmosis/DS00517/DSECTION=symptoms |archive-date=2013-05-31 |url-status=live }}</ref>
* [[Pneumonia]]<ref>{{cite web |url=https://www.lecturio.com/concepts/pneumonia/| title=Pneumonia|website=The Lecturio Medical Concept Library | date=27 August 2020|access-date= 1 July 2021}}</ref>
* [[Pulmonary edema]]<ref>{{cite book |title=Dorland's illustrated medical dictionary |date=2 May 2011 |publisher=Saunders/Elsevier |isbn=978-1-4160-6257-8 |page=593 |edition=32nd}}</ref><ref>{{cite journal |vauthors=Ware LB, Matthay MA |title=Clinical practice. Acute pulmonary edema |journal=N. Engl. J. Med. |volume=353 |issue=26 |pages=2788–96 |date=December 2005 |pmid=16382065 |doi=10.1056/NEJMcp052699}}</ref>
* [[Endometriosis#Localization|Endometriosis]] and [[Hemothorax#Nontraumatic|thoracic endometriosis syndrome]]<ref>{{cite web |url=https://www.lecturio.com/concepts/endometriosis/| title=Endometriosis
|website=The Lecturio Medical Concept Library |access-date= 25 July 2021}}</ref>
* [[Foreign body aspiration]] and [[aspiration pneumonia]]<ref>{{cite web |url=https://www.lecturio.com/concepts/foreign-body-aspiration/| title=Foreign Body Aspiration
|website=The Lecturio Medical Concept Library |access-date= 25 July 2021}}</ref>
* [[Goodpasture's syndrome]]<ref>{{EMedicine|article|1001872|Pediatric Goodpasture Syndrome }}</ref>
* [[Microscopic polyangiitis]]<ref>{{cite journal |vauthors=Altaie R, Ditizio F, Fahy GT |title=Microscopic polyangitis presenting with sub-acute reversible optic neuropathy |journal=Eye (Lond) |volume=19 |issue=3 |pages=363–5 |date=March 2005 |pmid=15272290 |doi=10.1038/sj.eye.6701479 |doi-access=free |hdl=10379/8830 |hdl-access=free }}</ref>
* [[Granulomatosis with polyangiitis]]<ref>{{cite web|title=Granulomatosis with Polyangiitis|url=https://www.mayoclinic.org/diseases-conditions/granulomatosis-with-polyangiitis/symptoms-causes/syc-20351088|website=www.mayoclinic.org|publisher=Mayo Foundation for Medical Education and Research|access-date=3 March 2018|archive-url=https://web.archive.org/web/20171222133353/https://www.mayoclinic.org/diseases-conditions/granulomatosis-with-polyangiitis/symptoms-causes/syc-20351088|archive-date=22 December 2017|url-status=live}}</ref>
* [[Eosinophilic granulomatosis with polyangiitis]]{{sfn|Adu|Emery|Madaio|2012|p=125}}<ref name="VillaForte2022">{{cite web |last1=Villa-Forte |first1=Alexandra |title=Eosinophilic Granulomatosis with Polyangiitis (EGPA) |url=https://www.msdmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/vasculitis/eosinophilic-granulomatosis-with-polyangiitis-egpa |website=www.msdmanuals.com |publisher=Merck & Co |access-date=7 September 2024}}</ref>
* [[Bronchitis]]<ref name="pulmonologychannel.com">{{Cite web |url=http://www.pulmonologychannel.com/hemoptysis/causes.shtml |title=Hemoptysis Causes – Hemoptysis – HealthCommunities.com<!-- Bot generated title --> |access-date=2010-02-05 |archive-url=https://web.archive.org/web/20090123040911/http://www.pulmonologychannel.com/hemoptysis/causes.shtml |archive-date=2009-01-23 }}</ref>
* [[Bronchiectasis]]<ref name="pulmonologychannel.com"/>
* [[Pulmonary embolism]]<ref name="pulmonologychannel">{{Cite web |url=http://www.pulmonologychannel.com/hemoptysis/other-causes.shtml |title=Other Causes of Hemoptysis – Hemoptysis – HealthCommunities.com<!-- Bot generated title --> |access-date=2010-02-05 |archive-url=https://web.archive.org/web/20090608070815/http://www.pulmonologychannel.com/hemoptysis/other-causes.shtml |archive-date=2009-06-08 }}</ref>
* [[Anticoagulant|Anticoagulant use]]<ref name="pulmonologychannel" />
* [[Physical trauma|Trauma]]<ref name="pulmonologychannel" />
* [[Lung abscess]]<ref name="pulmonologychannel" />
* [[Mitral stenosis]]<ref>{{cite web |url=https://www.lecturio.com/concepts/mitral-stenosis/| title=Mitral Stenosis
|website=The Lecturio Medical Concept Library |access-date= 24 July 2021}}</ref>
* [[Tropical pulmonary eosinophilia]]<ref>{{Citation|last1=Jha|first1=Suman K.|title=Tropical Pulmonary Eosinophilia|date=2020|url=https://www.ncbi.nlm.nih.gov/books/NBK557524/|work=StatPearls|place=Treasure Island (FL)|publisher=StatPearls Publishing|pmid=32491456|access-date=2020-12-01|last2=Karna|first2=Bibek|last3=Mahajan|first3=Kunal}}</ref>
* [[Bleeding disorders]]<ref>{{cite journal|last1=Hunt|first1=Beverley J.|title=Bleeding and Coagulopathies in Critical Care|journal=New England Journal of Medicine|volume=370|issue=9|year=2014|pages=847–859|issn=0028-4793|doi=10.1056/NEJMra1208626|pmid=24571757}}</ref>
* [[Hughes-Stovin syndrome]] and other variants of [[Behçet's disease]]<ref>{{cite journal |last1=Hughes |first1=JP |last2=Stovin |first2=PG |title=Segmental pulmonary artery aneurysms with peripheral venous thrombosis. |journal=British Journal of Diseases of the Chest |date=January 1959 |volume=53 |issue=1 |pages=19–27 |doi=10.1016/S0007-0971(59)80106-6 |pmid=13618502}}</ref>
* Pulmonary [[arteriovenous malformations]]

== Massive hemoptysis and mortality ==
[[File:Raetchon å sonk.jpg|thumb|right|228px|{{center|Hemoptysis }}]]
Although there are reports that the fatality rate is as high as 80%, the mortality rate for hospitalized hemoptysis patients is 9.4% (with [[Sample size|n]]=28539), calculated from the data in the article by Kinoshita et al.<ref name=":0">{{cite journal | vauthors = Kinoshita T, Ohbe H, Matsui H, Fushimi K, Ogura H, Yasunaga H | title = Effect of tranexamic acid on mortality in patients with haemoptysis: a nationwide study | journal = Critical Care | volume = 23 | issue = 1 | page = 347 | date = November 2019 | pmid = 31694697 | pmc = 6836388 | doi = 10.1186/s13054-019-2620-5 | url =  | doi-access = free }}</ref> This is probably the most reasonable figure considering the overwhelming number of cases.{{cn|date=June 2021}}

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,<ref>{{cite journal | vauthors = Patwa A, Shah A | title = Anatomy and physiology of respiratory system relevant to anaesthesia | journal = Indian Journal of Anaesthesia | volume = 59 | issue = 9 | pages = 533–41 | date = September 2015 | pmid = 26556911 | pmc = 4613399 | doi = 10.4103/0019-5049.165849 | url = http://www.ijaweb.org/text.asp?2015/59/9/533/165849 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Davidson K, Shojaee S | title = Managing Massive Hemoptysis | journal = Chest | volume = 157 | issue = 1 | pages = 77–88 | date = January 2020 | pmid = 31374211 | doi = 10.1016/j.chest.2019.07.012 | s2cid = 199388328 | doi-access =  }}</ref> 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.{{cn|date=June 2021}}

==Treatment==
Treatment depends on the underlying cause. Treatments include iced [[Saline (medicine)|saline]], and topical [[vasoconstrictors]] such as [[Epinephrine (medication)|adrenaline]] or [[vasopressin]]. [[Tranexamic acid]] was proved to improve in-hospital mortality.<ref name=":0" /> Selective [[tracheal intubation|bronchial intubation]] can be used to collapse the lung that is bleeding. Also, endobronchial tamponade can be used.<ref>{{cite journal | vauthors = Valipour A, Kreuzer A, Koller H, Koessler W, Burghuber OC | title = Bronchoscopy-guided topical hemostatic tamponade therapy for the management of life-threatening hemoptysis | journal = Chest | volume = 127 | issue = 6 | pages = 2113–8 | date = June 2005 | pmid = 15947328 | doi = 10.1378/chest.127.6.2113 | url = https://linkinghub.elsevier.com/retrieve/pii/S0012369215498174 | url-access = subscription }}</ref> [[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 [[embolization|embolized]].<ref name=uppsala>{{cite report | publisher = Uppsala Academic Hospital | title = Guidelines for treatment of acute lung diseases. | date = August 2004 | vauthors = Hanson C, Karlsson CA, Kämpe M, Lamberg K, Lindberg E, Boman LM, Stålenheim G }}</ref> [[Bronchial artery embolization]] (BAE) is the first line treatment nowadays.<ref>{{cite journal | vauthors = Woo S, Yoon CJ, Chung JW, Kang SG, Jae HJ, Kim HC, Seong NJ, Kim YJ, Woo YN | display-authors = 6 | title = Bronchial artery embolization to control hemoptysis: comparison of N-butyl-2-cyanoacrylate and polyvinyl alcohol particles | journal = Radiology | volume = 269 | issue = 2 | pages = 594–602 | date = November 2013 | pmid = 23801773 | doi = 10.1148/radiol.13130046 | s2cid = 21597160 | doi-access =  }}</ref><ref>{{cite journal | vauthors = Ishikawa H, Hara M, Ryuge M, Takafuji J, Youmoto M, Akira M, Nagasaka Y, Kabata D, Yamamoto K, Shintani A | display-authors = 6 | title = Efficacy and safety of super selective bronchial artery coil embolisation for haemoptysis: a single-centre retrospective observational study | journal = BMJ Open | volume = 7 | issue = 2 | article-number = e014805 | date = February 2017 | pmid = 28213604 | pmc = 5318547 | doi = 10.1136/bmjopen-2016-014805 }}</ref><ref>{{cite journal | vauthors = Ryuge M, Hara M, Hiroe T, Omachi N, Minomo S, Kitaguchi K, Youmoto M, Asakura N, Sakata Y, Ishikawa H | display-authors = 6 | title = Mechanisms of recurrent haemoptysis after super-selective bronchial artery coil embolisation: a single-centre retrospective observational study | journal = European Radiology | volume = 29 | issue = 2 | pages = 707–715 | date = February 2019 | pmid = 30054792 | pmc = 6302874 | doi = 10.1007/s00330-018-5637-2 }}</ref><ref>{{cite journal | vauthors = Panda A, Bhalla AS, Goyal A | title = Bronchial artery embolization in hemoptysis: a systematic review | journal = Diagnostic and Interventional Radiology | volume = 23 | issue = 4 | pages = 307–317 | date = 2017-07-07 | pmid = 28703105 | pmc = 5508955 | doi = 10.5152/dir.2017.16454 }}</ref><ref>{{cite journal | vauthors = Olsen KM, Manouchehr-Pour S, Donnelly EF, Henry TS, Berry MF, Boiselle PM, Colletti PM, Harrison NE, Kuzniewski CT, Laroia AT, Maldonado F, Pinchot JW, Raptis CA, Shim K, Tong BC, Wu CC, Kanne JP | display-authors = 6 | title = ACR Appropriateness Criteria® Hemoptysis | journal = Journal of the American College of Radiology | volume = 17 | issue = 5S | pages = S148–S159 | date = May 2020 | pmid = 32370959 | doi = 10.1016/j.jacr.2020.01.043 | s2cid = 218520816 | doi-access =  }}</ref> Surgical option is usually the last resort and can involve [[lobectomy|removal of a lung lobe]] or [[pneumonectomy|removal of the entire lung]]. Cough suppressants can increase the risk of choking.<ref name="Pocket medicine"/>

== References ==
{{Reflist}}

== Further reading ==
{{refbegin}}
* {{cite book |last1=Adu |first1=Dwomoa |last2=Emery |first2=Paul |last3=Madaio |first3=Michael | name-list-style = vanc |title=Rheumatology and the Kidney |year=2012 |publisher=Oxford University Press |edition=2, illustrated |isbn=978-0-19-957965-5}}
* {{cite book | vauthors = Corey R | chapter = Chapter 39: Hemoptysis | chapter-url = https://www.ncbi.nlm.nih.gov/books/NBK360/ | veditors =  Walker HK, Hall WD, Hurst JW | title = Clinical Methods: The History, Physical, and Laboratory Examinations | location = Boston |publisher=Butterworths |date=1990 |pmid=21250201 |isbn=978-0-409-90077-4 }}
{{refend}}

== External links ==
{{Medical resources
| ICD11           = {{ICD11|MD22}}
|   ICD10          = {{ICD10|R|04|2|r|00}}
|   ICD9           = {{ICD9|786.30}}
|   ICDO           =
|   OMIM           =
|   OMIM_mult      =
|   MedlinePlus    = 003073
|   eMedicineSubj  =
|   eMedicineTopic =
|   DiseasesDB     = 5578
|   MeshID         = D006469
}}

{{Circulatory and respiratory system symptoms and signs}}
{{Bleeding and clotting disorders|us=y}}
{{Authority control}}

[[Category:Bleeding]]
[[Category:Respiratory diseases]]
[[Category:Symptoms and signs: Respiratory system]]