hemoptysis

Hemoptysis is the expectoration of blood or blood-tinged sputum from the lower airways, including the trachea and bronchi. It is distinct from hematemesis, which is vomiting blood from the gastrointestinal tract. Massive hemoptysis is often defined as more than about 300 mL of blood in 24 hours or any amount that causes hemodynamic instability or respiratory compromise.

Causes of hemoptysis are diverse and vary by population. Common infectious causes include acute bronchitis, pneumonia, and tuberculosis. Chronic inflammatory or structural lung diseases such as bronchiectasis, chronic obstructive pulmonary disease with infection, and lung abscess can also produce bleeding. Malignancy of the lung or mediastinal structures is a notable cause, particularly in older individuals. Vascular etiologies include pulmonary embolism with infarction and less often arteriovenous malformations. Autoimmune and vasculitic disorders (for example, granulomatosis with polyangiitis, Goodpasture syndrome) can present with hemoptysis. Coagulation disorders and anticoagulant therapy increase bleeding risk, as do iatrogenic causes such as post-procedural bleeding.

Evaluation begins with assessing airway, breathing, and circulation, followed by a focused history and physical exam. Investigations typically include complete blood count, coagulation studies, and imaging, most commonly chest radiography and chest computed tomography. Sputum samples and microbiology may be useful to identify infection or tuberculosis. Bronchoscopy can localize the bleeding source and allow therapeutic measures or obtain samples; it is particularly helpful when initial studies do not identify a cause or in ongoing bleeding.

Management aims to stabilize the patient, control bleeding, and treat the underlying cause. In massive or ongoing hemoptysis, securing the airway and hemodynamic stability is paramount. Temporary measures during bronchoscopy or radiologic intervention may include topical vasoconstrictors or tamponade. Definitive care may involve bronchial artery embolization or, rarely, surgical resection for localized disease. After stabilization, management focuses on treating the underlying condition and addressing any anemia or coexisting risk factors.