Hemoptysis

Hemoptysis is a topic covered in the 5-Minute Pediatric Consult.

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Basics

Description

  • 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.

Epidemiology

Large series of pediatric patients with massive hemoptysis have not been described.

Pathophysiology

  • 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

Etiology

  • 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
    • Sarcoidosis

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