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Hemoptysis

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

Rosen, Peter, et al., editors. "Hemoptysis." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307433/all/Hemoptysis.
Hemoptysis. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307433/all/Hemoptysis. Accessed April 23, 2019.
Hemoptysis. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307433/all/Hemoptysis
Hemoptysis [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 23]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307433/all/Hemoptysis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Hemoptysis ID - 307433 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307433/all/Hemoptysis PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -