Hemoptysis: Causes and relevant question.

All the information below can be referred to Harrisons text book of Medicine.

What is hemoptysis ?

Hemoptysis is the expectoration of blood from the respiratory tract.

What can hemoptysis be confused with?

Hematemesis and epistaxis

What are the causes of Hemoptysis?

Tracheobronchial (Airway )	Parenchymal (Lungs)	Cardiogenic	Vascular	Miscellaneous
Carcinoma (bronchogenic, endobronchial, metastatic)	Tuberculosis (most common cause globally)	Mitral Stenosis	Pulmonary embolism	Systemic Coagulopathy
Acute/ Chronic Bhronicitis	Pneumonia	Left Heart failure	Raised pulmonary venous pressure (Mitral stenosis)	Anticoagulant/ Antiplatelet therapy
Bronchoectasis	Lung Abscess			Pulmonary Endometriosis (Catamenial  Hemoptysis )
Airway trauma	Wegener Granulomatosis			Endobronchial Biopsy (Iatrogenic)
Foreign Body	Good Pasture syndrome
Nasopharyngeal bleeding	Lung Contusion
	Inhalational Injury (Burn, Smoke, Toxin, Cocaine)

Bold are very important causes and MUST say causes of hemoptysis.
Red one is the most important of all.

What is the source of hemoptysis?

Medium and large sized airway of Lungs in close proximity to bronchial artery and vein.

Which pneumonia are associated with hemoptysis?

Tuberculosis with cavitary lesions (Most common)

CAP with cavitary lesions (Staphylococcus aureus, Klebsiella )
COPD patient (Streptococcus pneumonaie, H. Influenzae, Moraxella catarallis)

Which Carcinoma of lungs are more likely to cause hemoptysis? Why?

Squamous cell carcinoma and small cell carcinoma

These are large Cancers arising from proximal airway and centrally located and hence can produce hemoptysis.

Why there is hemoptysis in Mitral stenosis/ Congestive Heart Failure?

Congestive heart failure with transmission of elevated left arterial pressure, if severe enough can lead to rupture of small alveolar capillary. Thus hemoptysis is rarely frank bright red, rather it is pink frothy sputum or blood tinged secretions.

What is massive hemoptysis?

Hemoptysis greater than 200-600 ml in 24 hours. It is a medical emergency as patient can exsanguinate and drown on his own aspirate.

What is the source of profuse hemoptysis?

Massive hemorrhage can occur if the source of the blood is from the high pressure systemic circulation that is the BRONCHIAL ARTERY. But the bleeding is not so massive if the source is low pressure pulmonary circulation that is alveolar capillary bleeding.

Source: Harrison

 

Causes of Hemoptysis