Hemoptysis is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Expectoration of blood originating from the tracheobronchial tree
  • Source of bleeding:
    • Bronchial arteries (90%), usually causes profuse bleeding
    • Pulmonary arteries (5%), usually causes small amounts of bleeding
    • Nonbronchial arteries (5%) including intercostal arteries, coronary arteries, thoracic, upper, and inferior phrenic arteries
  • Threshold of massive hemoptysis defined has been defined from 100 mL to 1 L/24 hr:
    • >8 mL/kg/day in children
    • Most common definition is >300–600 mL/24 hr
  • Mortality:
    • Massive hemoptysis (>500 mL/24 hr): 38%
    • Trivial to moderate hemoptysis (<500 mL/24 hr): 4.5%
    • Malignancy and coagulopathy increase the risk of mortality

Etiology

  • Infectious (most common cause):
    • Acute or chronic bronchitis
    • Pneumonia
    • Necrotizing pneumonia or lung abscess (Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus pneumoniae)
    • Tuberculosis
    • Viral (influenza, varicella)
    • Fungal (Aspergillus, Coccidioides, Histoplasma, Blastomyces)
    • Parasitic (Ascariasis, Amebiasis, Paragonimiasis, Echinococcus)
  • Neoplastic:
    • Squamous cell, small cell, carcinoid
    • Bronchogenic carcinoma
    • Metastatic disease
  • Pulmonary:
    • Bronchiectasis
    • Pulmonary embolism/infarction
    • Cystic fibrosis
    • Bronchopleural fistula
    • Sarcoidosis
  • Cardiac:
    • Mitral stenosis
    • Tricuspid endocarditis
    • Heart failure
  • Systemic disease:
    • Goodpasture syndrome
    • Systemic lupus erythematosus
    • Vasculitis (Wegener granulomatosis, Henoch–Schönlein purpura, Behçet disease)
  • Hematologic:
    • Coagulopathy
    • Thrombocytopenia
    • Platelet dysfunction
    • DIC
  • Vascular:
    • Pulmonary HTN
    • Arteriovenous malformation
    • Aortic aneurysm
    • Pulmonary artery aneurysm (Rasmussen aneurysm, mycotic, arteritis)
    • Aortobronchial fistula
  • Drugs/toxins:
    • Aspirin/antiplatelet therapy
    • Anticoagulants
    • Penicillamine, amiodarone, propylthiouracil, bevacizumab
    • Cocaine (“crack”) lung
    • Organic solvents
  • Trauma:
    • Tracheobronchial rupture
    • Pulmonary contusion
  • Iatrogenic:
    • Bronchoscopy/lung biopsy
    • Pulmonary artery or central venous catheterization
    • Transtracheal aspirate
  • Miscellaneous:
    • Foreign-body aspiration
    • Catamenial hemoptysis (pulmonary endometriosis)
    • Amyloidosis
    • Idiopathic or cryptogenic (between 5% and 30%, depending on patient population)

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Citation

* When formatting your citation, note that all book, journal, and database titles should be italicized* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Hemoptysis ID - 307433 Y1 - 2016 PB - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307433/all/Hemoptysis ER -