Coughing or expectoration of bright red blood originating from the lungs.
Causes: bronchitis, necrotizing pneumonias, influenza, Klebsiella species, lung abscess, fungal infections, tuberculosis, non-tuberculosis mycobacteria, amebiasis, bronchiectasis, cystic fibrosis, broncholithiasis, arterio-venous malformations, heart failure, mitral valve stenosis, aortic aneurysm, brnochovascular fistula, pulmonary embolism pulmonary infarction, vasculitis, Wegener’s granulomatosis, Goodpasture’s syndrome, SLE, lung cancer, bronchial adenoma, carcinoid, endobronchial metastases, pulmonary injury, needle biopsy of the lung, idiopathic pulmonary hemosiderosis, aspiration, pulmonary capillary hemangiomatosis, antiplatelet drugs, penicillamine, and nitrofurantoin.
Most common causes in U.S. bronchitis, lung cancer and pneumonia, while bronchiectasis is a common cause in other areas of the world.
Pseudohemoptysis can result from epistaxis or hematemesis where expectorated blood does not originate from the lungs.
Every episode of hemoptysis must be confirmed, quantitated and rate of bleeding determined.
Can be classified as either submassive or massive based on the amount of blood expectorated over time.
No criteria exists separate massive from submassive hemoptysis.
Generally the amount of hemoptysis leading to airway obstruction approaches greater than 200 mL per deciliter and is considered massive hemoptysis.
Two groups of hemoptysis: new cases with no known underlying cause or disease and those with known causes.
Cryptogenic hemoptysis refers to hemoptysis of unknown origin despite clinical evaluation.
Approximately 7-25% of cases of hemoptysis are cryptogenic after testing including CT scan of chest and bronchoscopy.
Greater than 90% of life-threatening hemoptysis originates from the bronchial arteries which supply the tracheobronchial tree and lung parenchyma.
Between five and 10% of hemoptysis episodes come from the pulmonary arteries which supply the capillaries that envelope the pulmonary alveoli participating gaseous exchange.
Hemoptysis originating from bronchial artery aneurysms or malformations can be severe since the bronchial circulation originates from the thoracic aorta.
Hemoptysis of the pulmonary arterial system bleeding is associated with lower pressures and produce smaller volumes of hemoptysis.