Hemoptysis

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