Hemoptysis

Hemoptysis

ICD-10	R04.2
ICD-9	786.3
DiseasesDB	5578
MedlinePlus	003073
MeSH	D006469

Hemoptysis or haemoptysis (pronounced /hɨˈmɒptɨsɪs/) is the expectoration (coughing up) of blood or of blood-stained sputum from the bronchi, larynx, trachea, or lungs (e.g. in tuberculosis or other respiratory infections or cardiovascular pathologies).

Differential diagnosis

There are many factors involving Hemoptysis, including bronchitis or pneumonia most commonly, but also to lung neoplasm (in smokers, when hemoptysis is persistent), aspergilloma, tuberculosis, bronchiectasis, coccidioidomycosis, pulmonary embolism, or pneumonic plague.

Rarer causes include hereditary hemorrhagic telangiectasia (HHT or Rendu-Osler-Weber syndrome), or Goodpasture's syndrome and Wegener's granulomatosis. In children it is commonly due to a foreign body in the respiratory tract. It can result from over-anticoagulation from treatment by drugs such as warfarin. Cardiac causes like congestive heart failure and mitral stenosis should be ruled out. It can be sometimes be confused with mucus from the sinus or nose area, which can be a sign of nasal or sinus cancer, but also a sinus infection. Extensive injury can cause one to cough up blood.

The origin of blood can be known by observing its color. Bright red, foamy blood comes from the respiratory tract while dark red, coffee-colored blood comes from the gastrointestinal tract. Sometimes hemoptysis may be rust colored.

• Lung cancer, including both non-small cell lung carcinoma and small cell lung carcinoma.
• Sarcoidosis
• Aspergilloma
• Tuberculosis
• Histoplasmosis
• Pneumonia
• Foreign body aspiration and aspiration pneumonia
• Goodpasture's syndrome
• Wegener's granulomatosis
• Bronchitis
• Bronchiectasis
• Pulmonary embolism
• Anticoagulant use
• Trauma
• Lung abscess
• Mitral stenosis

Diagnostic approach

File:Hemoptysis.png

Diagnostic approach to solving the puzzle of hemoptysis.

In general, hemoptysis requires a systematic and thorough evaluation to discover its cause. (Hemoptysis in a patient with chronic bronchitis during an acute exacerbation is a possible exception because it is usually mild and self-limited.) However, if the hemoptysis is massive, recurrent, or won't go away, then further evaluation is indicated.

Is it really hemoptysis? The history in most cases will suggest that blood is actually being coughed up from the lungs, but it may be difficult at times to distinguish hemoptysis from bleeding in the upper respiratory tract (such as the nasopharynx or sinuses), or blood from the gastrointestinal tract that was regurgitated or vomited.

Is the bleeding massive (i.e. life-threatening)? This is important not only for necessitating a different approach to management, but will often alter the differential diagnosis, or list of possible causes. Massive or life-threatening hemoptysis is more than 200 ml (or a little under a half pint) total in one day. Any amount of bleeding at a high rate, even over a short period of time, should be managed as being potentially life-threatening because blood will flood the airways and cause asphyxiation.

What does the medical evaluation consist of? Generally, the initial evaluation will consist of a careful history and thorough physical examination. The doctor will ask about any acute or chronic pulmonary symptoms, including cough, shortness of breath, wheezing, or if you have had any previous lung disease. The history or physical may uncover findings suggesting a certain cause, such as underlying heart disease, vasculitis, or pulmonary thromboembolism. Systemic symptoms, such as fever, night sweats, weight loss, and malaise may be present in chronic infection, cancer, or inflammatory diseases. Depending upon the situation, the initial evaluation often occurs in the Emergency Department of a hospital

What tests might be done? Generally, the first test will be a two-view (front and side) chest x-ray. The chest x-ray can be unrevealing, however, despite the presence of an important disease as the cause for the hemoptysis. Blood tests, including complete blood count (CBC) and coagulation studies (PT/PTT) are commonly ordered tests for patients with hemoptysis. Depending on the patient age and clinical circumstances, sputum testing for infection and/or cancer may be obtained. Chest CT scanning (contrast, high-resolution, or spiral) is a non-invasive and sensitive x-ray technique that can help the doctor determine the cause of hemoptysis. Ventilation-Perfusion (V/Q) scan is useful in evaluating for thromboembolic disease. The decision whether to perform fiberoptic bronchoscopy should be made in consultation with a lung specialist (pulmonologist). An echocardiogram can help examine the functioning of the heart and heart valves. On rare occasions, more invasive testing is required, including surgery (such as thoracoscopy, mediastinoscopy, or thoracotomy).

Treatment

Treatment depends largely upon the underlying cause. Many modalities of treatment can be used, like, iced saline, or topical vasoconstrictors, such as adrenalin or vasopressin can be used. Selective bronchial intubation can be used to collapse lung in which the hemorrhage is occurring, also endobrachial tamponade can be used. Laser photocoagulation 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. Surgical option is usually the last resort, and can involve, lobectomy or pneumonectomy.

External links

• Haemoptysis at GPnotebook
• Haemoptysis Virtual Cancer Centre

ar:نفث الدم zh:咳血