Hemoptysis or haemoptysis (icon) is the expectoration (cough

Cough

A cough is a sudden and often repetitively occurring reflex which helps to clear the large breathing passages from secretions, irritants, foreign particles and microbes...

ing up) of blood

Blood

Blood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....

 or of blood-stained sputum

Sputum

Sputum is mucus that is coughed up from the lower airways. It is usually used for microbiological investigations of respiratory infections....

 from the bronchi, larynx

Larynx

The larynx , commonly called the voice box, is an organ in the neck of amphibians, reptiles and mammals involved in breathing, sound production, and protecting the trachea against food aspiration. It manipulates pitch and volume...

, trachea

Vertebrate trachea

In tetrapod anatomy the trachea, or windpipe, is a tube that connects the pharynx or larynx to the lungs, allowing the passage of air. It is lined with pseudostratified ciliated columnar epithelium cells with goblet cells that produce mucus...

, or lungs (e.g. in tuberculosis or other respiratory infections or cardiovascular pathologies).

Differential diagnosis

There are many conditions involving Hemoptysis, including bronchitis

Bronchitis

Acute bronchitis is an inflammation of the large bronchi in the lungs that is usually caused by viruses or bacteria and may last several days or weeks. Characteristic symptoms include cough, sputum production, and shortness of breath and wheezing related to the obstruction of the inflamed airways...

 and pneumonia

Pneumonia

Pneumonia is an inflammatory condition of the lung—especially affecting the microscopic air sacs —associated with fever, chest symptoms, and a lack of air space on a chest X-ray. Pneumonia is typically caused by an infection but there are a number of other causes...

 most commonly, but also lung neoplasm

Lung cancer

Lung cancer is a disease characterized by uncontrolled cell growth in tissues of the lung. If left untreated, this growth can spread beyond the lung in a process called metastasis into nearby tissue and, eventually, into other parts of the body. Most cancers that start in lung, known as primary...

 (in smokers, hemoptysis is often persistent), aspergilloma

Aspergilloma

An aspergilloma, also known as a mycetoma or fungus ball, is a clump of fungus which exists in a body cavity such as the lung. It is associated with the Aspergillus species, but Zygomycota and Fusarium may also form similar structures....

, tuberculosis

Tuberculosis

Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...

, bronchiectasis

Bronchiectasis

Bronchiectasis is a disease state defined by localized, irreversible dilation of part of the bronchial tree caused by destruction of the muscle and elastic tissue. It is classified as an obstructive lung disease, along with emphysema, bronchitis, asthma, and cystic fibrosis...

, coccidioidomycosis

Coccidioidomycosis

Coccidioidomycosis is a fungal disease caused by Coccidioides immitis or C. posadasii. It is endemic in certain parts of Arizona, California, Nevada, New Mexico, Texas, Utah and northwestern Mexico.C...

, pulmonary embolism

Pulmonary embolism

Pulmonary embolism is a blockage of the main artery of the lung or one of its branches by a substance that has travelled from elsewhere in the body through the bloodstream . Usually this is due to embolism of a thrombus from the deep veins in the legs, a process termed venous thromboembolism...

, pneumonic plague

Pneumonic plague

Pneumonic plague, a severe type of lung infection, is one of three main forms of plague, all of which are caused by the bacterium Yersinia pestis. It is more virulent and rare than bubonic plague...

, and Cystic Fibrosis

Cystic fibrosis

Cystic fibrosis is a recessive genetic disease affecting most critically the lungs, and also the pancreas, liver, and intestine...

. Rarer causes include hereditary hemorrhagic telangiectasia

Hereditary hemorrhagic telangiectasia

Hereditary hemorrhagic telangiectasia , also known as Osler-Weber-Rendu disease and Osler-Weber-Rendu syndrome, is a genetic disorder that leads to abnormal blood vessel formation in the skin, mucous membranes, and often in organs such as the lungs, liver and brain.It may lead to nosebleeds, acute...

 (HHT or Rendu-Osler-Weber syndrome), or Goodpasture's syndrome

Goodpasture's syndrome

Goodpasture’s syndrome is a rare disease characterized by glomerulonephritis and hemorrhaging of the lungs...

 and Wegener's granulomatosis

Wegener's granulomatosis

Wegener's granulomatosis , more recently granulomatosis with polyangiitis , is an incurable form of vasculitis that affects the nose, lungs, kidneys and other organs. Due to its end-organ damage, it is life-threatening and requires long-term immunosuppression...

. In children hemoptysis is commonly caused by the presence of a foreign body

Foreign body

A foreign body is any object originating outside the body. In machinery, it can mean any unwanted intruding object.Most references to foreign bodies involve propulsion through natural orifices into hollow organs....

 in the respiratory tract

Respiratory tract

In humans the respiratory tract is the part of the anatomy involved with the process of respiration.The respiratory tract is divided into 3 segments:*Upper respiratory tract: nose and nasal passages, paranasal sinuses, and throat or pharynx...

. The condition can also result from over-anticoagulation from treatment by drugs such as warfarin

Warfarin

Warfarin is an anticoagulant. It is most likely to be the drug popularly referred to as a "blood thinner," yet this is a misnomer, since it does not affect the thickness or viscosity of blood...

.

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 while dark red, coffee-colored blood comes from the gastrointestinal tract

Gastrointestinal tract

The human gastrointestinal tract refers to the stomach and intestine, and sometimes to all the structures from the mouth to the anus. ....

. Sometimes hemoptysis may be rust colored.

• Lung cancer
  Lung cancer
  Lung cancer is a disease characterized by uncontrolled cell growth in tissues of the lung. If left untreated, this growth can spread beyond the lung in a process called metastasis into nearby tissue and, eventually, into other parts of the body. Most cancers that start in lung, known as primary...
  
  , including both non-small cell lung carcinoma and small cell lung carcinoma.
• Sarcoidosis
  Sarcoidosis
  Sarcoidosis , also called sarcoid, Besnier-Boeck disease or Besnier-Boeck-Schaumann disease, is a disease in which abnormal collections of chronic inflammatory cells form as nodules in multiple organs. The cause of sarcoidosis is unknown...
  
  
• Aspergilloma
  Aspergilloma
  An aspergilloma, also known as a mycetoma or fungus ball, is a clump of fungus which exists in a body cavity such as the lung. It is associated with the Aspergillus species, but Zygomycota and Fusarium may also form similar structures....
  
  
• Tuberculosis
  Tuberculosis
  Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
  
  
• Histoplasmosis
  Histoplasmosis
  Histoplasmosis is a disease caused by the fungus Histoplasma capsulatum. Symptoms of this infection vary greatly, but the disease primarily affects the lungs...
  
  
• Pneumonia
  Pneumonia
  Pneumonia is an inflammatory condition of the lung—especially affecting the microscopic air sacs —associated with fever, chest symptoms, and a lack of air space on a chest X-ray. Pneumonia is typically caused by an infection but there are a number of other causes...
  
  
• Foreign body aspiration and aspiration pneumonia
  Aspiration pneumonia
  Aspiration pneumonia is bronchopneumonia that develops due to the entrance of foreign materials into the bronchial tree, usually oral or gastric contents...
  
  
• Goodpasture's syndrome
  Goodpasture's syndrome
  Goodpasture’s syndrome is a rare disease characterized by glomerulonephritis and hemorrhaging of the lungs...
  
  
• Wegener's granulomatosis
  Wegener's granulomatosis
  Wegener's granulomatosis , more recently granulomatosis with polyangiitis , is an incurable form of vasculitis that affects the nose, lungs, kidneys and other organs. Due to its end-organ damage, it is life-threatening and requires long-term immunosuppression...
  
  
• Bronchitis
  Bronchitis
  Acute bronchitis is an inflammation of the large bronchi in the lungs that is usually caused by viruses or bacteria and may last several days or weeks. Characteristic symptoms include cough, sputum production, and shortness of breath and wheezing related to the obstruction of the inflamed airways...
  
  
• Bronchiectasis
  Bronchiectasis
  Bronchiectasis is a disease state defined by localized, irreversible dilation of part of the bronchial tree caused by destruction of the muscle and elastic tissue. It is classified as an obstructive lung disease, along with emphysema, bronchitis, asthma, and cystic fibrosis...
  
  
• Pulmonary embolism
  Pulmonary embolism
  Pulmonary embolism is a blockage of the main artery of the lung or one of its branches by a substance that has travelled from elsewhere in the body through the bloodstream . Usually this is due to embolism of a thrombus from the deep veins in the legs, a process termed venous thromboembolism...
  
  
• Anticoagulant use
  Anticoagulant
  An anticoagulant is a substance that prevents coagulation of blood. A group of pharmaceuticals called anticoagulants can be used in vivo as a medication for thrombotic disorders. Some anticoagulants are used in medical equipment, such as test tubes, blood transfusion bags, and renal dialysis...
  
  
• Trauma
  Physical trauma
  Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...
  
  
• Lung abscess
  Lung abscess
  Lung abscess is necrosis of the pulmonary tissue and formation of cavities containing necrotic debris or fluid caused by microbial infection....
  
  
• Mitral stenosis
  Mitral stenosis
  Mitral stenosis is a valvular heart disease characterized by the narrowing of the orifice of the mitral valve of the heart.-Signs and symptoms:Symptoms of mitral stenosis include:...
  
  
• Tropical eosinophilia
  Tropical eosinophilia
  Tropical eosinophilia or TPE is characterized by cough, asthmatic attacks, and enlarged spleen, and caused by Wuchereria bancrofti a filarial infection. It occurs most frequently in India and southeast Asia. Tropical eosinophilia is considered a manifestation of a species of microfilaria...
  
  
• Drug induced
• Bleeding disorders
• Hughes-Stovin Syndrome
  Hughes-Stovin syndrome
  Hughes-Stovin syndrome is a rare autoimmune disorder of unknown cause that is characterized by the combination of multiple pulmonary artery aneurysms and deep vein thrombosis. It is named after the two British physicians, John Patterson Hughes and Peter George Ingle Stovin, who first described it...
  
   and other variants of Behçet's disease
  Behçet's disease
  Behçet's disease is a rare immune-mediated systemic vasculitis that often presents with mucous membrane ulceration and ocular involvements...
  
  

Diagnostic approach

• Past history, history of present illness, family history
  • history of tuberculosis
    Tuberculosis
    Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
    
    , bronchiectasis
    Bronchiectasis
    Bronchiectasis is a disease state defined by localized, irreversible dilation of part of the bronchial tree caused by destruction of the muscle and elastic tissue. It is classified as an obstructive lung disease, along with emphysema, bronchitis, asthma, and cystic fibrosis...
    
    , chronic bronchitis
    Chronic bronchitis
    Chronic bronchitis is a chronic inflammation of the bronchi in the lungs. It is generally considered one of the two forms of chronic obstructive pulmonary disease...
    
    , mitral stenosis
    Mitral stenosis
    Mitral stenosis is a valvular heart disease characterized by the narrowing of the orifice of the mitral valve of the heart.-Signs and symptoms:Symptoms of mitral stenosis include:...
    
    , 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;
  • Probably source of bleeding: is the blood coughed up, or vomited?
• Bloody sputum
  Sputum
  Sputum is mucus that is coughed up from the lower airways. It is usually used for microbiological investigations of respiratory infections....
  
  
  • 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

Treatment

Treatment depends largely upon the underlying cause. Many modalities of treatment can be used, like, iced saline

Saline

Saline may refer to:* Salinity, the salt content of a solution** Saline water, water containing significant concentration of salts* Soil salinity, salt content of soil* Saline , a liquid with salt content to match the human body...

, or topical vasoconstrictors, such as adrenalin or vasopressin

Vasopressin

Arginine vasopressin , also known as vasopressin, argipressin or antidiuretic hormone , is a neurohypophysial hormone found in most mammals, including humans. Vasopressin is a peptide hormone that controls the reabsorption of molecules in the tubules of the kidneys by affecting the tissue's...

 can be used. Selective bronchial intubation

Tracheal intubation

Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic or rubber tube into the trachea to maintain an open airway or to serve as a conduit through which to administer certain drugs...

 can be used to collapse lung in which the hemorrhage is occurring, also endobrachial tamponade can be used. Laser photocoagulation

Laser photocoagulation

Laser coagulation or laser photocoagulation surgery is used to treat a number of eye diseases and has become widely used in recent decades...

 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

Embolization

Embolization is a non-surgical, minimally-invasive procedure performed by an interventional radiologist and interventional neuroradiologists. It involves the selective occlusion of blood vessels by purposely introducing emboli.-Therapeutic applications:...

. Surgical option is usually the last resort, and can involve, lobectomy

Lobectomy

Lobectomy means surgical excision of a lobe. This may refer to a lobe of the lung, a lobe of the thyroid , or a lobe of the brain ....

 or pneumonectomy

Pneumonectomy

A pneumonectomy is a surgical procedure to remove a lung. Removal of just one lobe of the lung is specifically referred to as a lobectomy, and that of a segment of the lung as a wedge resection .-Indications:...

. Non–Small-Cell Lung Cancer can also be treated with Erlotinib or Gefitinib

External links

• Haemoptysis Virtual Cancer Centre