Hemoptysis - Causes and Symptoms

Definition

Hemoptysis is the issue, with cough, of bright red blood from the respiratory tract. This manifestation can range from simple traces of blood in the sputum to serious life-threatening bleeding (massive hemoptysis).

The most common cause of hemoptysis is respiratory infections (such as bronchitis and pneumonia), which cause micro-lesions on the mucosal surfaces of the airways, which is why sputum appears tinged with blood. In most cases, when the infection resolves, the symptoms cease.

Patients with chronic respiratory infections can develop bronchiectasis, or dilation of the airways, following recurrent inflammatory processes, with accumulation of mucus. Therefore, in addition to having chronic cough and catarrh, they can sometimes expectorate blood.

Massive hemoptysis, on the other hand, is more common in patients with cystic fibrosis, where the airways dilate markedly, leading to the potential rupture of an adjacent artery.

Another possible cause of expectoration of respiratory blood is a lung tumor (in particular, a bronchogenic carcinoma). Depending on the context, also malignant tumors that metastasize to the lung, such as renal cell tumors, colon tumors, melanoma and breast cancer, must be taken into consideration.

Less common causes of hemoptysis include pulmonary edema, tuberculosis, inhalation of foreign bodies (especially in children) and cathemenial forms (in relation to the menstrual cycle) from ectopic endometrial tissue.

Hemoptysis of primary vascular origin can be observed in the presence of arteriovenous malformations, pulmonary embolism, mitral stenosis, congestive heart failure, aortic aneurysm, pulmonary artery rupture, vasculitis, coagulopathies and use of anticoagulant or thrombolytic drugs.

Up to one third of hemoptysis cases are classified as idiopathic. In the evaluation of the patient it is also indispensable to exclude other sources of bleeding (pseudo-hemoptysis), such as the oropharynx or the gastrointestinal tract, which can be confused with a true hemoptysis.