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- Hemoptysis is the expectoration of blood from the respiratory tract. The term comes from the Greek words haima, meaning blood, and ptysis, meaning spitting.
- Bleeding from the respiratory tract can range from blood-streaked sputum to massive hemoptysis from the lung. The amount and nature of bleeding should be characterized by taking a careful history.
- The source of bleeding can be anywhere in the respiratory tract, from the nose to the alveolus.
- Consequences of hemoptysis may include exsanguination, hypoxemia, and anemia or there may be none.
Large series of pediatric patients with massive hemoptysis have not been described.
- Related to the underlying pulmonary or cardiac disease
- Vascular origin of hemoptysis is from two locations:
- Pulmonary arteries: higher volume, lower pressure
- Bronchial arteries: lower volume, higher pressure
- More common causes:
- Infection (pneumonia, bronchitis, viral illnesses)
- Bronchiectasis leading to erosion into a bronchial artery
- Trauma (pulmonary contusion, bronchoscopy, airway manipulation)
- Foreign body aspiration
- Cystic fibrosis
- Congenital heart disease with collateral vessels or pulmonary hypertension
- Tracheostomy-related complications
- Less common causes:
- Cavitary infections (e.g., tuberculosis, abscess, histoplasmosis)
- Factitious hemoptysis
- Congenital vascular or airway lesions (pulmonary arteriovenous malformation, hemangioma, bronchogenic cyst, pulmonary sequestration)
- Hemorrhagic diathesis, including anticoagulant therapy
- H-type tracheoesophageal fistula
- Pulmonary embolism
- Pulmonary hemosiderosis
- Tumors (teratomas, lymphomas)
- Immune mediated: Henoch-Schönlein purpura, Goodpasture syndrome, Anti-neutrophil cytoplasmic antibody (ANCA)-associated granulomatous vasculitis, polyarteritis nodosa, systemic lupus erythematosus, Heiner syndrome