What is hemoptysis?

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: There are many potential causes for hemoptysis, but it is most often caused by an underlying condition. The most common worldwide 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 in adults.

Incidence: Some form of lung cancer causes hemoptysis in 23 percent of cases in the United States. One form in particular, bronchogenic carcinoma, causes hemoptysis in 5 to 44 percent of cancer-related cases.

Symptoms: Hemoptysis, itself the symptom of an underlying disorder, is marked by the color of the blood in sputum, normally bright red and foamy as opposed to dark red.

Screening and diagnosis: In most cases, hemoptysis is diagnosed with a physical examination. One of the most important things in the examination is determining if the blood being coughed up is really hemoptysis. Blood that is coughed up can also originate from the gastrointestinal tract. The origin of blood 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 will be 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 a malignant cancer.

Treatment and therapy: Goals in treating hemoptysis are stopping the bleeding, clearing the airways, and treating the underlying condition. Patients who are not high risk and have chest radiographs that appear to be normal may be treated as outpatients with close monitoring and antibiotics to treat any underlying infection that could be 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 hemoptyis is defined as more than 200 milliliters of blood coughed up per day. Massive hemoptysis is a medical emergency and must be treated immediately. 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.

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Mucha, Susan M., et al. "Separating Fact from Factitious Hemoptysis: A Case Report." Critical Care Nurse 34.4 (2014): 36–42. Print.