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Etiology and evaluation of hemoptysis in adults

Steven E Weinberger, MD
Section Editor
Praveen N Mathur, MB, BS
Deputy Editor
Helen Hollingsworth, MD


Hemoptysis, or the expectoration of blood, can range from blood-streaking of sputum to the presence of gross blood in the absence of any accompanying sputum. Hemoptysis has a broad differential, but the cause can be determined in the majority of patients (table 1). It is important to identify the cause and location of bleeding in order to guide treatment.

The evaluation of nonmassive hemoptysis that is not immediately life-threatening will be reviewed here. The acute evaluation and management of massive (life-threatening) hemoptysis are discussed separately. (See "Overview of massive hemoptysis" and "Massive hemoptysis: Causes" and "Massive hemoptysis: Initial management".)


The term massive hemoptysis is reserved for bleeding that is potentially acutely life-threatening; it has been defined by a number of different criteria, ranging from 100 mL to more than 600 mL of blood over a 24 hour period [1,2]. In our clinical practice, we define massive hemoptysis as either ≥500 mL of expectorated blood over a 24 hour period or bleeding at a rate ≥100 mL/hour.

Patients with mild-to-moderate hemoptysis and adequate gas exchange generally do not require hospitalization and the evaluation can proceed in a stepwise fashion as described below. Massive hemoptysis requires a prompt response to ensure adequate ventilation, protect the airway, and control the hemoptysis. (See "Overview of massive hemoptysis" and "Massive hemoptysis: Initial management".)


Blood traversing the lungs can arrive from one of two sources: pulmonary arteries or bronchial arteries. Virtually the entire cardiac output courses through the low-pressure pulmonary arteries and arterioles en route to being oxygenated in the pulmonary capillary bed. In contrast, the bronchial arteries are under much higher systemic pressure, but carry only a small portion of the cardiac output. Bleeding from a bronchial artery is the cause of massive hemoptysis in 90 percent of cases.


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Literature review current through: Sep 2016. | This topic last updated: Jun 1, 2016.
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