Haemoptysis refers to coughing out blood. Generally, it appears bright red in colour as opposed to blood from gastrointestinal tract which appears dark red. It is considered an alarming sign of a serious underlying aetiology.
Massive haemoptysis is referred to as expectoration of > 100-600 mL of blood over a 24 hour period 6.
In 90% of cases, the source of bleeding is the bronchial artery. In the remainder of cases, either the pulmonary artery or another non-bronchial artery (e.g. intercostal, internal thoracic) is the source of bleeding.
The following are the most common causes
- bronchogenic carcinoma
- pneumococcal pneumonia
- pulmonary metastasis
- pulmonary contusion
- pulmonary thromboembolism
- mitral stenosis
- iatrogenic during catheter manipulation of pulmonary artery
- foreign body
- airway trauma
- lung abscess
- Goodpasture syndrome
- granulomatosis with polyangiitis (Wegener disease)
- tracheal invasion, e.g. from thyroid cancer
Treatment and prognosis
Approach to haemoptysis
This approach can be followed for small amounts of blood or streaks of blood in sputum. The underlying cause can be life-threatening; however, it is not an emergency.
Bronchoscopy followed by a contrast-enhanced CT scan must be carried to detect the cause. The above-mentioned common causes and certain uncommon and rare causes must be kept in mind.
Approach to massive haemoptysis
- examine the patient to rule out a non-pulmonary cause of bleeding, such as from the upper airway or gastrointestinal tract
- confirm and localise the site of bleed with bronchoscopy
- CT imaging may help in characterisations of lesions if time permits
- arteriography will help localise the vessels involved and also enable embolisation
- after the patient is stable, further imaging can be carried out and the appropriate measures taken to prevent rebleed
- 1.Bruzzi JF, Rémy-Jardin M, Delhaye D et-al. Multi-detector row CT of hemoptysis. Radiographics. 2006;26 (1): 3-22. Radiographics (full text) - doi:10.1148/rg.261045726 - Pubmed citation
- 2.Yoon YC, Lee KS, Jeong YJ et-al. Hemoptysis: bronchial and nonbronchial systemic arteries at 16-detector row CT. Radiology. 2005;234 (1): 292-8. doi:10.1148/radiol.2341032079 - Pubmed citation
- 3.Yoon W, Kim YH, Kim JK et-al. Massive hemoptysis: prediction of nonbronchial systemic arterial supply with chest CT. Radiology. 2003;227 (1): 232-8. doi:10.1148/radiol.2271020324 - Pubmed citation
- 4.Uflacker R, Kaemmerer A, Neves C et-al. Management of massive hemoptysis by bronchial artery embolization. Radiology. 1983;146 (3): 627-34. Pubmed citation
- 5.Rémy J, Arnaud A, Fardou H et-al. Treatment of hemoptysis by embolization of bronchial arteries. Radiology. 1977;122 (1): 33-7. Pubmed citation
- 6.Fauci A, Braunwald E, Kasper D et-al. Harrison's principles of internal medicine. McGraw-Hill Professional. ISBN:0071476911. Read it at Google Books - Find it at Amazon
- 7.Davidson's Principles and Practice of Medicine: With STUDENT CONSULT Online Access, 22e (Principles & Practice of Medicine (Davidson's)). Churchill Livingstone. ISBN:0702050350. Read it at Google Books - Find it at Amazon