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. Most instances of massive hemoptysis take place in older children, usually with an underlying cardiac abnormality.

Pathophysiology

• Related to the underlying pulmonary or cardiac disease
• Vascular origin of hemoptysis is from 2 locations:
  • Pulmonary arteries: higher volume, lower pressure
  • Bronchial arteries: lower volume, higher pressure

Etiology

• More common causes:
  • Infection (pneumonia, bronchitis, viral illnesses)
  • Bronchiectasis
  • Cavitary infections (e.g., tuberculosis, abscess, histoplasmosis)
  • Cystic fibrosis
  • Congenital heart disease with collateral vessels or pulmonary hypertension
  • Foreign body aspiration
  • Tracheostomy-related complications
  • Trauma (pulmonary contusion, bronchoscopy, airway manipulation)
  • Aspiration
• Less common causes:
  • 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, Wegener granulomatosis, polyarteritis nodosa, systemic lupus erythematosus, Heiner syndrome
  • Sarcoidosis