Blood is coughed up, eg frothy, alkaline, and bright red, often in a context of known chest disease (vomited blood is acidic and dark).
Respiratory causes:
1 Infective | tb; bronchiectasis; bronchitis; pneumonia; lung abscess; copd; fungi (eg aspergillosis); viruses (from pneumonitis, cryoglobulinaemia, eg with hepatitis viruses, hiv-associated pneumocystosis, or mai, p411). Helminths: paragonimiasis (p445); hydatid (p444); schistosomiasis. |
2 Neoplastic | Primary or secondary. |
3 Vascular | Lung infarction (pe); vasculitis (anca-associated; ra; sle); hereditary haemorrhagic telangiectasia; av malformation; capillaritis. |
4 Parenchymal | Diffuse interstitial fibrosis; sarcoidosis; haemosiderosis; Goodpasture's syndrome; cystic fibrosis. |
5 Pulmonary hypertension | Idiopathic, thromboembolic, congenital cyanotic heart disease (p150), pulmonary fibrosis, bronchiectasis. |
6 Coagulopathies | Any—eg thrombocytopenia, p338; dic; warfarin excess. |
7 Trauma/foreign body | Eg post-intubation, or an eroding implanted defibrillator. |
8 Pseudo-haemoptysis | Munchausen's (p720); aspirated haematemesis; red pigment (prodigiosin) from Serratia marcescens in sputum. |
1 Infective | tb; bronchiectasis; bronchitis; pneumonia; lung abscess; copd; fungi (eg aspergillosis); viruses (from pneumonitis, cryoglobulinaemia, eg with hepatitis viruses, hiv-associated pneumocystosis, or mai, p411). Helminths: paragonimiasis (p445); hydatid (p444); schistosomiasis. |
2 Neoplastic | Primary or secondary. |
3 Vascular | Lung infarction (pe); vasculitis (anca-associated; ra; sle); hereditary haemorrhagic telangiectasia; av malformation; capillaritis. |
4 Parenchymal | Diffuse interstitial fibrosis; sarcoidosis; haemosiderosis; Goodpasture's syndrome; cystic fibrosis. |
5 Pulmonary hypertension | Idiopathic, thromboembolic, congenital cyanotic heart disease (p150), pulmonary fibrosis, bronchiectasis. |
6 Coagulopathies | Any—eg thrombocytopenia, p338; dic; warfarin excess. |
7 Trauma/foreign body | Eg post-intubation, or an eroding implanted defibrillator. |
8 Pseudo-haemoptysis | Munchausen's (p720); aspirated haematemesis; red pigment (prodigiosin) from Serratia marcescens in sputum. |
Rare causes refuse to be classified neatly: vascular causes may have infective origins, eg hydatid cyst may count as a foreign body,
and infection,
and vascular if it fistulates with the aorta;
ditto for infected (mycotic) aneurysm rupture,
or
tb aortitis. Infective causes entailing coagulopathy: dengue; leptospirosis.
In monthly haemoptysis, think of lung endometriosis.
℞
Haemoptysis may need treating in its own right, if massive (eg trauma,
tb, hydatid cyst, cancer,
av malformation): call chest team, consider intervential radiology input (danger is drowning: lobe resection, endobronchial tamponade, or arterial embolization may be needed). Set up
ivi, do
cxr, blood gases,
fbc,
inr/
aptt, crossmatch. If distressing, give
prompt iv morphine, eg if inoperable malignancy.
