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This article uses citations that link to broken or outdated sources. Please improve the article or discuss this issue on the talk page. Help on using footnotes is available. (June 2013) |
Hemoptysis
| Specialty |
Pulmonology |
| ICD-10 |
R04.2 |
| ICD-9 |
786.30 |
| DiseasesDB |
5578 |
| MedlinePlus |
003073 |
| MeSH |
D006469 |
Hemoptysis[a] or haemoptysis is the act of coughing up blood or blood-stained mucus from the bronchi, larynx, trachea, or lungs. This can occur with lung cancer, infections such as tuberculosis, bronchitis, or pneumonia, and certain cardiovascular conditions. Hemoptysis is considered massive if there is more than 300mL of blood lost in 24 hours. In such cases, the primary danger comes from choking, rather than blood loss. [1]
Contents
- 1 Differential diagnosis
- 2 Diagnosis
- 3 Treatment
- 4 Notes
- 5 References
- 6 External links
Differential diagnosis
There are many conditions involving hemoptysis, including but not limited to bronchitis and pneumonia most commonly, but also lung cancers (in smokers, hemoptysis is often persistent), aspergilloma, tuberculosis, bronchiectasis, coccidioidomycosis, pulmonary embolism, pneumonic plague, and cystic fibrosis. Rarer causes include hereditary hemorrhagic telangiectasia (HHT or Rendu-Osler-Weber syndrome), Goodpasture's syndrome, and granulomatosis with polyangiitis. In children, hemoptysis is commonly caused by the presence of a foreign body in the airway. The condition can also result from over-anticoagulation from treatment by drugs such as warfarin.
Blood-laced mucus from the sinus or nose area can sometimes be misidentified as symptomatic of hemoptysis (such secretions can be a sign of nasal or sinus cancer, but also a sinus infection). Extensive non-respiratory injury can also cause one to cough up blood. Cardiac causes like congestive heart failure and mitral stenosis should be ruled out.
The origin of blood can be identified by observing its color. Bright-red, foamy blood comes from the respiratory tract, whereas dark-red, coffee-colored blood comes from the gastrointestinal tract. Sometimes hemoptysis may be rust-colored.
The most common cause of minor hemoptysis is bronchitis.[2]
- Lung cancer, including both non-small cell lung carcinoma and small cell lung carcinoma.[3][4]
- Sarcoidosis[5]
- Aspergilloma[6]
- Tuberculosis[7]
- Histoplasmosis[8]
- Pneumonia
- Pulmonary edema
- Foreign body aspiration and aspiration pneumonia
- Goodpasture's syndrome[9]
- Granulomatosis with polyangiitis[10]
- Eosinophilic granulomatosis with polyangitis (Churg-Strauss syndrome)
- Bronchitis[11]
- Bronchiectasis[11]
- Pulmonary embolism[12]
- Anticoagulant use[12]
- Trauma[12]
- Lung abscess[12]
- Mitral stenosis
- Tropical eosinophilia
- Drug induced
- Bleeding disorders
- Hughes-Stovin Syndrome and other variants of Behçet's disease
Diagnosis
Diagnostic approach to solving the puzzle of hemoptysis.
- Past history, history of present illness, family history
- history of tuberculosis, bronchiectasis, chronic bronchitis, mitral stenosis, etc.
- history of cigarette smoking, occupational diseases by exposure to silica dust, etc.
- Blood
- duration, frequency, amount
- Amounts of blood: large amounts of blood, or is there blood-streaked sputum
- Probable source of bleeding: Is the blood coughed up, or vomited?
- Bloody sputum
- color, characters: blood-streaked, fresh blood, frothy pink, bloody gelatinous.
- Accompanying symptoms
- fever, chest pain, coughing, purulent sputum, mucocutaneous bleeding, jaundice.
- Imaging examination
- chest X-ray, CT scan and 3D reconstruction images or CT virtual bronchoscopy, bronchial angiography.
- Laboratory tests
- blood test: WBC
- Sputum: cells and bacterial examinations, sputum culture
- Bronchial fiber endoscopy[13]
Treatment
Treatment depends on the underlying cause. Treatments include iced saline, and topical vasoconstrictors such as adrenalin or vasopressin. Selective bronchial intubation can be used to collapse the lung that is bleeding. Also, endobronchial 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.[14] Surgical option is usually the last resort, and can involve, removal of a lung lobe or removal of the entire lung. Non–small-cell lung cancer can also be treated with erlotinib or gefitinib.[15] Cough suppressants can increase the risk of choking. [16]
Notes
- ^ Pronounced and also known as emptysis.
References
- ^ Sabatine, [edited by] Marc S. (2014). Pocket medicine (Fifth edition. ed.). [S.l.]: Aspen Publishers, Inc. ISBN 1451193785.
- ^ Sabatine, [edited by] Marc S. (2014). Pocket medicine (Fifth edition. ed.). [S.l.]: Aspen Publishers, Inc. ISBN 1451193785.
- ^ Google Health – Google
- ^ Google Health – Google
- ^ Sarcoidosis Signs & Symptoms - Sarcoidosis - HealthCommunities.com
- ^ MedlinePlus Encyclopedia Pulmonary aspergilloma
- ^ Google Health – Google
- ^ Histoplasmosis Symptoms - Diseases and Conditions - Mayo Clinic
- ^ Pediatric Goodpasture Syndrome at eMedicine
- ^ Wegener's granulomatosis Symptoms - Diseases and Conditions - Mayo Clinic
- ^ a b Hemoptysis Causes - Hemoptysis - HealthCommunities.com
- ^ a b c d Other Causes of Hemoptysis - Hemoptysis - HealthCommunities.com
- ^ Richard F.LeBlond. Diagnostics. US: McGraw-Hill Companies, Inc. ISBN 0-07-140923-8.
- ^ Uppsala Academic Hospital > Guidelines for treatment of acute lung diseases. August 2004. Authors: Christer Hanson, Carl-Axel Karlsson, Mary Kämpe, Kristina Lamberg, Eva Lindberg, Lavinia Machado Boman, Gunnemar Stålenheim
- ^ Welcome to Elgg
- ^ Sabatine, [edited by] Marc S. (2014). Pocket medicine (Fifth edition. ed.). [S.l.]: Aspen Publishers, Inc. ISBN 1451193785.
External links
- Haemoptysis at GPnotebook
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Symptoms and signs relating to the respiratory system (R04–R07, 786)
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Medical examination and history taking
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| Auscultation |
- Stethoscope
- Respiratory sounds
- Stridor
- Wheeze
- Crackles
- Rhonchi
- Hamman's sign
- Pleural friction rub
- Fremitus
- Bronchophony
- Elicited findings
- Percussion
- Pectoriloquy
- Whispered pectoriloquy
- Egophony
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| Breathing |
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Rate
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- Apnea
- Dyspnea
- Hyperventilation
- Hypoventilation
- Hyperpnea
- Tachypnea
- Hypopnea
- Bradypnea
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Pattern
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- Biot's respiration
- Cheyne–Stokes respiration
- Kussmaul breathing
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Other
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- Respiratory distress
- Respiratory arrest
- Orthopnea/Platypnea
- Trepopnea
- Asphyxia
- Breath holding
- Mouth breathing
- Snoring
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| Other |
- Chest pain
- Precordial catch syndrome
- Pleurisy
- Clubbing
- Schamroth's window test
- Hippocratic fingers
- Cyanosis
- Cough
- Sputum
- Hemoptysis
- Epistaxis
- Silhouette sign
- Post-nasal drip
- Hiccup
- COPD
- asthma
- Curschmann's spirals
- Charcot–Leyden crystals
- chronic bronchitis
- sarcoidosis
- pulmonary embolism
- Hampton hump
- Westermark sign
- pulmonary edema
- Hamman's sign
- Golden S sign
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Index of the respiratory system
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| Description |
- Anatomy
- Physiology
- Development
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| Disease |
- Congenital
- Neoplasms and cancer
- Chest trauma
- Infection
- common cold
- pneumonia
- tuberculosis
- Other
- Symptoms and signs
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| Treatment |
- Procedures
- Drugs
- nasal
- throat
- obstructive airway diseases
- cough and cold
- histaminergics
- pulmonary arterial hypertension
- other
- Surgery
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