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Haemoptysis
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• Haemoptysis means coughing up blood, irrespective of the

amount, from the respiratory tract

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Lung has two main vascular system that include pulmonary

circulation and bronchial circulation.
So Causes,
• Vascular erosion/infarction
• Vasculitis
• Vascular rupture - increase Pulmonary pressure in HF,
aneurysm, trauma Arteriovenous malformation
• AVMs - Broncovascular fistula
• Blood-Bleeding, cloting disorders
• Hormonal-catamenial
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Jitesh Kumar Shah note
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Jitesh Kumar Shah note
Causes
. of recrent
- hemoptysis
.

• Bronchiectasis,
• lung malignancies, and
• tuberculosis
• Cardiac
• Aspergilloma
• Vasculitis
• Catamenial
• Haematological L

Clinicay diffentiate haemoptysis and haematemesis

Evaluation
• History
• Physical examination
• Investigation

Age of onset
• Younger- Bronchiectasis, HHT, Pulmonary Renal Syndrome
• >50 years,
.
-
smoker

- Lung

cancer,

PTB .
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Jitesh
Jitesh Kumar kumar note
Shah Shah
Onset, duration, frequency, number of episode
\

Onset, duration, frequency, Possible Causes

number of episode
Sudden onset Infection, Pulmonary oedema,
PE, Pulmonary Haemorrage

Daily, > week Lung cancer, PTB, Lung

abscess

Monthly a women Catamenial haemoptysis

Over years, intermittent Bronchiectasis (Copious

purulent sputum),
Aspergilloma

Single episode(With pleuritic PE and infarction

chest pain and SOB)

Repeated Lung cancer

. .

Red
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bloody(Haemoptysis) Pattern -

Pattern of red blood Causes

Fresh blood Massive Haemoptysis

Pink, frothy/foamy Acute pulmonary oedema

(e.g.LVF), MS, Alveolar lung
cancer
L

Rusty red Pneumococcal pneumonia

"Currant jelly" Klebsiella pneumoniae

Blood streaked BC (Clear or clot), Chronic

bronchitis (purulent sputum),
Bronchiectasis
Productive : Increase amount
Purulent :
• Acute purulent → Rupture lung abscess or empyema
• Chronic purulent → Bronchiectasis

Watery :
• Large volume watery with pink tinge + acute Breathless →
Pulmonary oedema.
• Large volume watery with pink tinge, Over weeks →
Bronchorrhoea, Suggest alveolar cell lung cancer

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Jitesh Kumar Shah note
Amount(Quantity) of haemoptysis

Amount Causes
Small and repeated BC(Usually), Chr. bronchitis

Large(massive) with Commonly

fresh(Pure) >200 mL/24 hr
• Chr. Bronchitis
• Lung cancer eroding a
pulmonary vessel
• PTB
• bronchiectasis (such as in
cystic fibrosis)

Less commonly
• cavitatory disease (such as
bleeding into an aspergilloma)
• Lung abscess
• pulmonary vasculitis (e.g :
GPA)
• Trauma
• Hydatid cyst
• pulmonary arteriovenous
malformation

Associated symptoms
• Cough---
• Dyspnoea---
• Chest pain---
• Hoarseness of voice---
• Constitutional features----
• Bleeding from other sites---
• DVT---
• Past history
• Family history
• Medical history
Physical examination
• Finger clubbing suggests lung cancer or bronchiectasis;
• Other signs of malignancy, such as cachexia, hepatomegaly
and lymphadenopathy, should also be sought.
• Fever, pleural rub and signs of consolidation occur in
pneumonia or pulmonary infarction;
• a minority of patients with pulmonary infarction also have
unilateral leg swelling or pain suggestive of deep venous
thrombosis. Rashes.
• haematuria and digital infarcts point to an underlying systemic
disease, such as a vasculitis, which may be associated with
haemoptysis.

Investigation
In the vast majority of cases, however, the haemoptysis itself
is not life-threatening and a logical sequence of investigations
can be followed :
• chest X-ray, which may provide evidence of a localised lesion,
including tumour (malignant or benign), pneumonia, mycetoma
or tuberculosis.
• full blood count (FBC) and clotting screen
• bronchoscopy after acute bleeding has settled, which may
reveal a central lung cancer (not visible on the chest X-ray)
and permit biopsy and tissue diagnosis.
• CTPA, which may show underlying pulmonary thromboembolic
disease or alternative causes not seen on the chest X-ray
(e.g. pulmonary arteriovenous malformation or small or hidden
tumours).

Management
• In severe acute haemoptysis, the patient should be nursed
upright (or on the side of the bleeding, if this is known),
• Given high-flow oxygen and
•. resuscitated
- required.
as -.

• Bronchoscopy in the acute phase is difficult and often merely

shows blood throughout the bronchial tree.
• Infusions of the antifibrinolytic agent tranexamic acid or the
vasopressin precursor terlipressin may help to limit bleeding
but evidence of efficacy is limited.
• If radiology shows an obvious central cause, then rigid
bronchoscopy under general anaesthesia may allow intervention
to stop bleeding; L
• however, the source often cannot be visualised. Intubation
with a divided endotracheal tube may allow protected
ventilation of the unaffected lung to stabilise the patient.
• Bronchial arteriography and embolisation, or even emergency
surgery, can be life-saving in the acute situation

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