Pulmonology Book

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Hemoptysis Causes

Aka: Hemoptysis Causes, Bloody Sputum Causes, Pseudohemoptysis, Pulmonary Hemorrhage Causes
  1. See Also
    1. Hemoptysis
  2. Causes: Respiratory Tract - Common
    1. Infection (60-70% of Hemoptysis in children; 18% in outpatient adults, 23% of inpatient adults)
      1. Acute Bronchitis (26% of Hemoptysis)
        1. Viral Bronchitis
        2. Streptococcus Pneumoniae
        3. HaemophilusInfluenzae
        4. Moraxella catarrhalis
      2. Pneumonia (10% of Hemoptysis)
        1. Staphylococcus aureus
        2. Pseudomonas aeruginosa
      3. Tuberculosis (0.2% of Hemoptysis in outpatient adults, 2.5% of inpatients, 65% in low resource countries)
        1. Nontuberculous Mycobacteria may also cause Hemoptysis
      4. Influenza
      5. Leptospirosis
      6. Lung Abscess
      7. Fungal organisms (e.g. fungal ball or mycetoma)
        1. Aspergillosis
        2. Actinomycosis
        3. Blastomycosis
      8. Parasite Infections
        1. Paragonimiasis (trematode or fluke infection)
    2. Lung Cancer (7% of Hemoptysis in children, 4% in outpatient adults, 18% in inpatient adults)
      1. Hemoptysis is rarely due to metastases
      2. Bronchial Tumors
    3. Obstructive Lung Disease (6% of Hemoptysis in outpatient adults)
      1. Asthma
      2. Chronic Obstructive Pulmonary Disease (COPD)
      3. Bronchiectasis (e.g. Cystic Fibrosis)
  3. Causes: Respiratory Tract - Less Common
    1. Trauma
      1. Lung Contusion
      2. Airway Trauma (hematoma, fistula)
      3. Airway Foreign Body (esp. children)
      4. Post-procedure (e.g. lung biopsy, heart catheterization, bronchoscopy)
    2. Cardiovascular causes
      1. Pulmonary venous Hypertension (Acute Pulmonary Edema)
        1. Congestive Heart Failure
        2. Severe Mitral valve stenosis
      2. Pulmonary Hypertension
      3. Bronchovascular Fistula
      4. Dieulafoy Lesion
      5. Pulmonary Embolism or infarction
      6. Aneurysm (e.g. thoracic artery, aorta)
      7. Arteriovenous Malformation
      8. Pulmonary artery rupture
      9. Systemic Coagulopathy
      10. Catamenial Hemoptysis (pulmonary Endometriosis)
      11. Endocarditis (right-sided)
    3. Rheumatologic causes
      1. Goodpasture's Syndrome (anti-glomerular basement membrane disease)
      2. Granulomatosis with Polyangiitis (previously known as Wegener's Granulomatosis)
      3. Lupus pneumonitis
      4. Idiopathic pulmonary Hemosiderosis
      5. Henoch-Schonlein Purpura
      6. Behcet Disease
      7. Takayasu Arteritis
      8. Sarcoidosis
      9. Antiphospholipid Syndrome
      10. Mixed cryoglobulinemia
    4. Other Lung and Tracheobronchal causes
      1. Bronchiectasis (e.g. Cystic Fibrosis)
      2. Broncholithiasis
      3. Acute Lung Allograft rejection
      4. Idiopathic pulmonary Hemosiderosis
      5. Pulmonary Capillary Hemangiomatosis
      6. Lymphangiomyomatosis
    5. Medications and Toxins
      1. Anticoagulation
      2. Thrombolytics
      3. Bevacizumab (Avastin)
      4. Cocaine Inhalation
    6. Hematologic
      1. Coagulopathy
      2. Thrombocytopenia
  4. Causes: Pseudohemoptysis
    1. Non-respiratory tract sources
      1. Nasopharyngeal source of bleeding
        1. Evaluate for Oral Ulceration, Gingivitis, tongue Varices, Epistaxis, sinus drainage or pharyngeal source
      2. Upper Gastrointestinal Bleeding (peptic ulcer, Varices)
        1. Coffee ground Emesis or darker blood (contrast with frothy Bloody Sputum from the airway)
        2. Associated with gastrointestinal symptoms (e.g. Nausea or Vomiting)
        3. Evaluate for epigastric tenderness or stigmata of Chronic Liver Disease
    2. Other causes
      1. Malingering
      2. Serratia marecens
        1. Associated with recent hospitalization, broad spectrum antibiotic use, or Mechanical Ventilation
        2. Gram Negative Bacteria produces a red pigment that may appear bloody
        3. Sputum exam negative for Red Blood Cells
  5. Causes: Blood streaked Sputum
    1. Upper respiratory inflammation
      1. Nose or nasopharynx
      2. Gums
      3. Larynx
    2. Severe coughing paroxysms
    3. Trauma
  6. Causes: Pink Sputum
    1. Blood and secretions mix in alveoli, small Bronchioles
    2. Conditions associated with pink Sputum
      1. Pneumonia
      2. Pulmonary Edema
  7. Causes: Heavy Bleeding into respiratory tree
    1. Pulmonary Tuberculosis
    2. Lung Abscess
    3. Bronchiectasis
    4. Pulmonary Infarction
    5. Pulmonary Embolism
    6. Pulmonary artery rupture
    7. Arteriovenous Malformation
    8. Bronchogenic Carcinoma
    9. Broncholithiasis
    10. Mitral Stenosis
    11. ActinomycosisLung Abscess
    12. BlastomycosisLung Abscess
  8. References
    1. Abdulmalak (2015) Eur Respir J 46(2): 503-11 [PubMed]
    2. Bhalla (2017) Int J Mycobacteriol 6(3): 307-10 [PubMed]
    3. Earwood (2015) Am Fam Physician 91(4): 243-9 [PubMed]
    4. Gagnon (2017) Can Respir J 2017:1565030 +PMID:29430203 [PubMed]
    5. O'Gurek (2022) Am Fam Physician 105(2): 144-51 [PubMed]
    6. Simon (2017) Pediatr Pulmonol 52(2):255-9 [PubMed]

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