|
Hemoptysis is the coughing up of blood from the respiratory system.
Although hemoptysis can often be frightening, most causes turn out not to be serious.
Causes
Infection is the most common cause. Sometimes the cause is blood from the nose that has traveled down to the airways and then is coughed up. Unexplained or large amounts of blood in the sputum require evaluation by a doctor.
Tumors, especially those due to lung cancer, account for up to 20% of cases of hemoptysis. Death of lung tissue from blockage of an artery by a blood clot (pulmonary embolism—see Pulmonary Embolism (PE): Pulmonary Embolism ) may also cause hemoptysis.
Other causes include high blood pressure in the pulmonary veins, as may occur in heart failure and mitral valve stenosis. Other lung circulation problems, including arteriovenous malformations or inflammatory conditions of the pulmonary blood vessels, may also cause hemoptysis.
Evaluation
If hemoptysis is severe, persistent, or unexplained, a diagnostic evaluation is necessary. Doctors check for lung cancer in smokers older than 40 (and even in younger smokers if the person started smoking in adolescence) who develop hemoptysis, even if the sputum is only blood streaked. A chest x-ray is usually the first test done. A flexible viewing tube (bronchoscope) may be needed to identify the bleeding site. A scan using a radioactive marker (lung perfusion scan (see Pulmonary Embolism (PE): Diagnosis) or other imaging test may reveal a pulmonary embolism. Despite testing, the cause of hemoptysis is not found in 30 to 40% of cases. When hemoptysis is severe, however, the cause is usually found.
Treatment
Bleeding may produce clots that block the airways and lead to further breathing problems. Therefore, coughing is important to keep the airways clear and should not be suppressed with antitussive drugs.
Hemoptysis is usually mild and usually stops by itself or when the disorder causing the bleeding (for example, heart failure or infection) is successfully treated.
If a large clot blocks a major airway, doctors may have to remove the clot using bronchoscopy. Rarely, hemoptysis is severe or does not stop by itself. If so, a tube may need to be inserted through the mouth or nose into the windpipe or lower into the airways to help keep the airways open. If the source of bleeding is a major blood vessel, a doctor may try to close off the bleeding vessel using a procedure called bronchial artery embolization. Using x-rays for guidance, the doctor passes a catheter into the vessel and then injects a chemical, fragments of a gelatin sponge, or a wire coil to block the blood vessel and thereby stop the bleeding. Sometimes bronchoscopy or surgery may be needed to stop severe or continuing bleeding, or surgery may be needed to remove a diseased portion of the lung. These high-risk procedures are used only as last resorts. If clotting abnormalities are contributing to the bleeding, a transfusion of plasma, clotting factors, or platelets may be needed.
Last full review/revision November 2006 by James H. Fisher, MD
| 
