Hemoptysis or haemoptysis (UK) is the term for coughing up blood. This may vary from blood-streaked sputum to expectoration of bright red blood with no other mucoid discharge. The term hemoptysis is not defined by the amount of blood that is expectorated but rather by the presence of bleeding that originates from the airways or lungs. In some cases, blood in the mouth may be the only evident symptom apart from occasional coughing. With certain causes like pneumococcal pneumonia, a rust colored sputum may be the only indication of hemoptysis. Read more on sputum color and types of sputum.
It is not uncommon for bleeding from the mouth, nasal cavity or gastrointestinal tract to be mistaken for hemoptysis. This is discussed further under :
The lining of the airways and lungs is very thin and any injury can cause bleeding. With most acute conditions, this may be microscopic or even absent but in chronic respiratory diseases and those conditions that results in extensive damage, hemoptysis may present as coughing up blood streaked mucus or even overt hemorrhage (frank hemoptysis).
Signs and Symptoms
Hemoptysis is an indication of pathology in the respiratory tract. It is often associated with cancer and tuberculosis but there are various other causes that may also be responsible. The presence of other signs and symptoms provides a better indication of the possible cause. It is also important to note the duration and frequency as both acute and chronic conditions may lead to hemoptysis. Some of the other symptoms that may be seen with certain causes of hemoptysis includes :
- Fever and night sweats (tuberculosis, pneumonia – fever without night sweats)
- Unintentional weight loss (tuberculosis or cancer)
- Clubbing (bronchiectasis or cancer)
- Skin rashes (vasculitis, HIV)
Causes of Hemoptysis
Lung cancer with or without spread to the bronchi may cause hemoptysis. Benign tumors like a bronchial adenoma may also be responsible.
Acute respiratory tract infections may lead to blood-streaked mucus although frank hemoptysis only tends to occur with chronic infections like tuberculosis, actinomycosis and suppurative pneumonia. Hempotysis may also occur with a lung abscess. Fungal infections like pulmonary aspergilloma (mycetoma) and parasites like flukes.
Any chest trauma that leads to hemoptysis needs to be investigated immediately. Foreign bodies may include inhaled objects that usually lodges in the airways and is more frequently seen in children. Iatrogenic causes include trauma following diagnostic procedures like a bronchoscopic biopsy.
Cardiovascular causes of hemptysis includes :
- left ventricular failure (acute)
- mitral valve disease
- pulmonary infarction
- vasculitis – Wegener’s granulomatosis
- aortic aneurysm
Blood-related disorders that may cause hemoptysis includes :
The use of anticoagulants may also be responsible for hemoptysis particularly if a respiratory tract condition arises, which on its own may not be associated with hemoptysis.