Hemoptysis

Etiology

• Source other than the lower respiratory tract
  • Upper airway (nasopharyngeal) bleeding
  • Gastrointestinal bleeding
• Tracheobronchial source
  • Neoplasm
    • Bronchogenic carcinoma
    • Endobronchial metastatic tumor
    • Kaposi sarcoma
    • Bronchial carcinoid
  • Bronchitis (acute or chronic)
  • Bronchiectasis
  • Broncholithiasis
  • Airway trauma
  • Foreign body
• Pulmonary parenchymal source
  • Infection
    • Lung abscess
    • Pneumonia
    • Tuberculosis
    • Mycetoma ("fungus ball")
  • Autoimmune/vasculitides
    • Goodpasture syndrome
    • Granulomatosis with polyangiitis
    • Lupus pneumonitis
  • Idiopathic pulmonary hemosiderosis
  • Lung contusion
• Primary vascular source
  • Arteriovenous malformation
  • Pulmonary embolism
  • Elevated pulmonary venous pressure (especially mitral stenosis)
  • Pulmonary artery rupture secondary to balloon-tip pulmonary artery catheter manipulation
• Miscellaneous and rare causes
  • Pulmonary endometriosis
  • Systemic coagulopathy or use of anticoagulants or thrombolytic agents

Differential Diagnosis

• Bronchitis (20%-40%)
• Lung cancer (15-30%)
• Bronchiectasis (10-20%)
• Cryptogenic (10-20%)
• Pneumonia (5-10%)
• Tuberculosis (5-15%)
• Other serious causes:
  • Lung abscess
  • Invasive fungal infection
  • ANCA-associated vasculitis

Clinical Manifestations

• History
  • Bright red blood or clots (quantify amount)
• Signs & Symptoms

Investigations

• CXR
• CT chest +/- CTPE
• CBC, lytes, creatinine
• Sputum culture
• Bronchoscopy

Management

Acute

• Vitamin K, if indicated
• Tranexamic acid
• Transfer to ICU if massive hemoptysis