Hemoptysis

By
Anjana v sivan
Hemoptysis

Hemoptysis is coughing up blood from the

respiratory tract. The blood can come from the
nose, mouth, throat, the airway passages leading to
the lungs. The word "hemoptysis" comes from the
Greek "haima," meaning "blood," and "ptysis,"
which means "a spitting"
Pseudohemoptesis
Causes:
Blood not from lower respiratory tract it come
from above the vocal cords:
Mouth
Pharynx
Nose
Aspiration
of
hemate
msis
Colonizati
on by
Massive Hemoptesis:
It is the amount of blood that can not be
cleared from the dead space (150ml).
It is about 600ml blood/24 h

X-sanguating Hemoptesis:

Rate of bleeding >150ml/h

Pathophysiologic
Factors:
1-Dual Circulation:

The lungs have a dual blood supply.

The pulmonary arterial circulation, a high-
compliance, low-pressure system that
terminates in the pulmonary capillary bed, is
responsible for gas exchange.
In addition, the lungs are supplied by the
bronchial arteries, branches of the aorta
that bring nutrients to the lung
parenchyma and major airways. The
bronchial arteries, like all systemic
arteries, are a high-pressure system. Most
cases of hemoptysis result from
disruption of branches of the bronchial
arterial tree.
2- Vascular Mechanisms:

•
Aneurysm formation
•
Vasculitis
•
Pulmonary Embolism
•
Inflammation
•
Broncholithiasis
•
Direct invasion
central pulmonary
artery trauma
Cause
s
Blood-tinged mucus in a healthy nonsmoker
usually indicates a mild infection and is generally
no cause for concern. Indeed, the most
common cause of Hemoptysis is the least
serious – a ruptured small blood vessel caused
by coughing and/or a bronchitic infection

In patients with a history of smoking or who are

otherwise at risk for lung disease, however,
Hemoptysis is often a sign of serious illness,
including cancer
Common Causes of
Hemoptysis
Infectious:
•

Chronic bronchitis
Bronchiectasis
Tuberculosis
Nontuberculous mycobacteria
Lung abscess
Necrotizing pneumonia
Mycetoma
Cystic fibrosis
 Neoplastic
Lung cancer
Bronchial adenoma
Metastatic disease (osteogenic sarcoma,
choriocarcinoma)
•
Vasculitic
Wegener's granulomatosis
Systemic lupus erythematosus
Churge Strauss syndrome
Cardiovascular

Severe left ventricular heart failure

Mitral stenosis
Pulmonary embolism or infarction
Septic pulmonary embolism or right-sided
endocarditis
Aortic aneurysm or bronchovascular
fistula
Miscellaneous

Idiopathic Pulmonary Hemosiderosis

Aspirated foreign body
Pulmonary contusion or trauma
Posttransthoracic needle biopsy or
transbronchial lung biopsy
Factitious hemoptysis
Bleeding Diathesis
 Anticoagulant therapy
 Deficiency of vitamin K–dependent factors:
prothrombin (II), Stuart factor (X), factor VII,
Christmas factor (IX)
 Disseminated intravascular coaulation
 Fibrinolytic therapy: urokinase,
streptokinase.
Evaluation of Hemoptysis
1-Types of
Hemoptesis:

Blood tinged

sputum Blood

streaked
 Red current jully

 Frank Hemoptesis

2-Degree of
Rusty sputum
Hemoptysis:

Massive

Non massive
Causes of Blood streaked Sputum:

 Upper respiratory inflammation

 Nose or Nasopharynx
 Gums
 Larynx

Severe coughing paroxysms

Trauma
Causes of Pink
Sputum :
 Blood and secretions mix in alveoli, small
bronchioles
 Conditions associated with pink Sputum
– Pneumonia
– Pulmonary edema
Causes of Heavy Bleeding into
Respiratory tree :
• Pulmonary Tuberculosis
• Lung Abscess
• Bronchiectasis
• Pulmonary infarction
• Pulmonary Embolism
• Bronchogenic Carcinoma
• Broncholithiasis
• Mitral Stenosis
• Actinomycosis Lung
• Abscess Blastomycosis
Lung Abscess
Diagnosis

History:
To differentiate between source of Hemoptysis:

Respiratory

Gastrointestinal

Anticoagulant therapy

Mitral valve disease
Physical Examination

 The doctor will examine the patient's nose,

throat, mouth, and chest for bleeding from
these areas and for signs of chest trauma. The
doctor also listens to the patient's breathing
and heart beat for indications of heart
abnormalities or lung disease.
Laboratory Tests

 Laboratory tests include blood tests to rule out

clotting disorders, and to look for food
particles or other evidence of blood from the
stomach. Sputum can be tested for fungi,
bacteria, or parasites.
X - Ray and Bronchoscopy

 Chest x rays and bronchoscopy are the most

important studies for evaluating hemoptysis.
They are used to evaluate the cause, location,
and extent of the bleeding.
Value of Bronchoscope

1-Dignostic:

Localize site of bleeding

F.B aspiration

Adenoma
2-Therapeutic:

Arrest bleeding

Suction and lavage

Preservation
ventilation of non
bleeding lung
Type of Bronchoscope


The rigid bronchoscope is more preferable
than fiber optic one due to it has wide
channel for suction of blood and for
therapeutic treatment to arrest bleeding.
Imaging and other tests
 Computed Tomography scans (CT scans) are used to
detect aneurysms and to confirm x-ray results.
 Ventilation-perfusion scanning is used to rule out
pulmonary embolism. The doctor may also order an
angiogram to rule out pulmonary embolism, or to
locate a source of bleeding that could not be seen with
the bronchoscope.
 In spite of the number of diagnostic tests, the cause of
Hemoptysis cannot be determined in 20-30% of
cases.
Complication of Hemoptysis
 Asphyxia
 Shock
 Anemia
 Renal failure
 Atelectasis
 Pulmonary
infection
 Management
•
Three Goals of
Therapy:
•
Prevent asphyxiation
•
Stop bleeding
•
Treat primary
disease
Airway Control
•
Supplemental oxygen
•
Positioning
•
Cough control
•
Endotracheal
intubation a.
selective
Volume intubation
Resuscitation
Laboratory Evaluation

Hematocrit
Platelet count
Coagulation
profile
Arterial blood gas, if appropriate
Renal function testing
Type and cross match blood
Smear, culture and cytology of sputum
DLCO for pulmonary hemorrhage
Consultations
Surgica
l Definitive: resection


Medica
l Antibiotics if indicated


 Medical management if nonlocalized bleeding,

severely impaired pulmonary function, disseminated

terminal carcinoma, advanced bilateral pulmonary
disease, vasculitis
Modalities

Bronchial artery Embolization

Balloon Tamponade
Intracavitary Anti-fungal therapy

Mortality
Medically managed patients with massive Hemoptysis: 75%
Surgically managed patients with massive Hemoptysis:
23%
Role of Surgery in Hemoptysis

Surgery is indicated in the following situations:


Leaky thoracic aneurysm

Chest trauma

A-V fistula

Localized bronchiectasis

Chronic lung abscess
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