hemoptysia

Hemoptysis, sometimes written as hemoptysia, is the coughing up of blood or blood-streaked sputum originating from the lower respiratory tract. It ranges from streaks of blood to large-volume bleeding and may be accompanied by cough, shortness of breath, chest pain, or fever. Massive hemoptysis is a life-threatening emergency and requires rapid airway management and stabilization.

Common causes are broadly divided into infectious, inflammatory, neoplastic, vascular, and coagulation-related categories. Infections such as acute bronchitis, pneumonia, tuberculosis, and other lung infections are frequent, especially in high-prevalence areas. Chronic conditions like bronchiectasis, chronic obstructive pulmonary disease, and lung cancer are important etiologies. Pulmonary embolism with infarction, autoimmune or inflammatory diseases, and coagulopathies or anticoagulant therapy can also cause hemoptysis. Less common causes include arteriovenous malformations, pulmonary vasculitis, and iatrogenic injury.

Evaluation begins with a history focusing on the amount and duration of bleeding, timing relative to meals or exertion, comorbid conditions, medications, smoking, and exposures. Physical examination assesses respiratory status and hemodynamics. Initial investigations typically include chest imaging (chest X-ray, and CT scan if indicated), sputum analysis, complete blood count, coagulation studies, and renal/hepatic function. Bronchoscopy may be used to localize bleeding and provide therapeutic control in selected cases.

Management emphasizes stabilization, airway protection, and addressing the underlying cause. Supportive care may involve oxygen therapy and fluid management; antibiotics for infectious etiologies; bronchoscopic or radiologic interventions (such as embolization) to control bleeding; and treatment of coagulopathies. Prognosis depends on the underlying cause and the severity of bleeding, with prompt evaluation improving outcomes.