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
- 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 stabilisation of the patient, further imaging can be carried out and appropriate measures taken to prevent rebleed
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