Consult the medical resource doctors trust

UpToDate is one of the most respected medical information resources in the world, used by over 360,000 doctors and thousands of patients to find answers to medical questions.

  • Content written by a faculty of over 4,000 physicians from leading medical institutions
  • Unbiased: free of advertising or pharmaceutical funding
  • Evidence-based treatment recommendations
  • Continuously updated to incorporate new medical findings

Related Searches

Etiology and evaluation of hemoptysis in adults

INTRODUCTION

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. The term massive hemoptysis is reserved for bleeding that is potentially acutely life-threatening; it has been defined by a number of different criteria, often ranging from more than 100 to more than 600 ml of blood over a 24 hour period [1].

The evaluation of hemoptysis that is not immediately life-threatening is reviewed here. The acute evaluation and management of massive hemoptysis is discussed separately. (See "Causes and management of massive hemoptysis in adults" and "Diagnostic approach to massive hemoptysis in adults".)

VASCULAR ORIGIN OF HEMOPTYSIS

Blood traversing the lungs can arrive from one of two sites — 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. There are generally one or two bronchial arteries for each lung, typically arising from the aorta and less commonly from the intercostal arteries. These vessels provide the nutritive blood supply to the airways, hilar lymph nodes, visceral pleura, and some portions of the mediastinum [2].

Despite the quantitatively smaller contribution of the bronchial circulation to pulmonary blood flow, the bronchial arteries are generally a more important source of hemoptysis than the pulmonary circulation. In addition to being perfused at a higher pressure, they also supply blood to the airways and to lesions within the airways. In some circumstances, such as bronchiectasis, the bronchial circulation becomes hyperplastic and tortuous, and can be a source of massive hemoptysis.

DIFFERENTIAL DIAGNOSIS OF HEMOPTYSIS

Although the term hemoptysis typically refers to expectoration of blood originating from the lower respiratory tract, it must be recognized that blood from the upper respiratory tract and the upper gastrointestinal tract can be expectorated and can mimic blood coming from the lower respiratory tract.
To continue reading this article you need to subscribe.

Read the rest of this article and others like it

The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use (click here) ©2009 UpToDate, Inc.
References Top
  1. Thompson, AB, Teschler, H, Rennard, SI. Pathogenesis, evaluation, and therapy for massive hemoptysis. Clin Chest Med 1992; 13:69.
  2. Cahill, BC, Ingbar, DH. Massive hemoptysis. Assessment and management. Clin Chest Med 1994; 15:147.
  3. Johnston, H, Reisz, G. Changing spectrum of hemoptysis. Underlying causes in 148 patients undergoing diagnostic flexible fiberoptic bronchoscopy. Arch Intern Med 1989; 149:1666.
  4. Santiago, S, Tobias, J, Williams, AJ. A reappraisal of the causes of hemoptysis. Arch Intern Med 1991; 151:2449.
  5. Hirshberg, B, Biran, I, Glazer, M, Kramer, MR. Hemoptysis: Etiology, evaluation, and outcome in a tertiary referral hospital. Chest 1997; 112:440.
  6. Meduri, GU, Stover, DE, Lee, M, et al. Pulmonary Kaposi's sarcoma in the acquired immune deficiency syndrome: Clinical, radiographic, and pathologic manifestations. Am J Med 1986; 81:11.
  7. Macintosh, EL, Parrott, JCW, Unruh, HW. Fistulas between the aorta and tracheobronchial tree. Ann Thorac Surg 1991; 51:515.
  8. Heffner, JE, Miller, KS, Sahn, SA. Tracheostomy in the intensive care unit. Part 2: Complications. Chest 1986; 90:430.
  9. Savale, L, Parrot, A, Khalil, A, et al. Cryptogenic hemoptysis: from a benign to a life-threatening pathologic vascular condition. Am J Respir Crit Care Med 2007; 175:1181.
  10. Kuzucu, A, Gurses, I, Soysal, O, et al. Dieulafoy's disease: a cause of massive hemoptysis that is probably underdiagnosed. Ann Thorac Surg 2005; 80:1126.
  11. Glimp, RA, Bayer, AS. Pulmonary aspergilloma. Diagnostic and therapeutic considerations. Arch Intern Med 1983; 143:303.
  12. Shapiro, MJ, Albelda, SM, Mayock, RL, et al. Severe hemoptysis associated with pulmonary aspergilloma. Percutaneous intracavitary treatment. Chest 1988; 94:1225.
  13. Sareli, AE, Janssen, WJ, Sterman, D, et al. Clinical problem-solving. What's the connection? - A 26-year-old white man presented to our referral hospital with a 1-month history of persistent cough productive of white sputum, which was occasionally tinged with blood. N Engl J Med 2008; 358:626.
  14. Finley, TN, Aronow, A, Cosentino, AM, et al. Occult pulmonary hemorrhage in anticoagulated patients. Am Rev Respir Dis 1975; 112:23.
  15. Westcott, JL. Percutaneous transthoracic needle biopsy. Radiology 1988; 169:593.
  16. Cordasco, EM Jr, Mehta, AC, Ahmad, M. Bronchoscopically induced bleeding. A summary of nine years' Cleveland Clinic experience and review of the literature. Chest 1991; 100:1141.
  17. Tashkin, DP, Khalsa, M-E, Gorelick, D, et al. Pulmonary status of habitual cocaine smokers. Am Rev Respir Dis 1992; 145:92.
  18. Forrester, JM, Steele, AW, Waldron, JA, et al. Crack lung: An acute pulmonary syndrome with a spectrum of clinical and histopathologic findings. Am Rev Respir Dis 1990; 142:462.
  19. Haim, DY, Lippmann, ML, Goldberg, SK, Walkenstein, MD. The pulmonary complications of crack cocaine. A comprehensive review. Chest 1995; 107:233.
  20. Espaulella, J, Armengol, J, Bella, F, et al. Pulmonary endometriosis: Conservative treatment with GnRH agonists. Obstet Gynecol 1991; 78:535.
  21. Di Palo, S, Mari, G, Castoldi, R, et al. Endometriosis of the lung. Respir Med 1989; 83:255.
  22. Augoulea, A, Lambrinoudaki, I, Christodoulakos, G. Thoracic endometriosis syndrome. Respiration 2008; 75:113.
  23. Sandler, A, Gray, R, Perry, MC, et al. Paclitaxel-carboplatin alone or with bevacizumab for non-small-cell lung cancer. N Engl J Med 2006; 355:2542.
  24. Cho, YJ, Murgu, SD, Colt, HG. Bronchoscopy for bevacizumab-related hemoptysis. Lung Cancer 2007; 56:465.
  25. Hannan, AT, Brown, M, Bigman, O. Pulmonary artery catheter-induced hemorrhage. Chest 1984; 85:128.
  26. Adelman, M, Haponik, EF, Bleecker, ER, et al. Cryptogenic hemoptysis. Clinical features, bronchoscopic findings, and natural history in 67 patients. Ann Intern Med 1985; 102:829.
  27. Herth, F, Ernst, A, Becker, HD. Long-term outcome and lung cancer incidence in patients with hemoptysis of unknown origin. Chest 2001; 120:1592.
  28. Khalil, A, Soussan, M, Mangiapan, G, et al. Utility of high-resolution chest CT scan in the emergency management of haemoptysis in the intensive care unit: severity, localization and aetiology. Br J Radiol 2007; 80:21.
  29. Heimer, D, Bar-Ziv, J, Scharf, SM. Fiberoptic bronchoscopy in patients with hemoptysis and nonlocalizing chest roentgenograms. Arch Intern Med 1985; 145:1427.
  30. Jackson, CV, Savage, PJ, Quinn, DL. Role of fiberoptic bronchoscopy in patients with hemoptysis and a normal chest roentgenogram. Chest 1985; 87:142.
  31. Poe, RH, Israel, RH, Marin, MG, et al. Utility of fiberoptic bronchoscopy in patients with hemoptysis and a nonlocalizing chest roentgenogram. Chest 1988; 93:70.
  32. Lederle, FA, Nichol, KL, Parenti, CM. Bronchoscopy to evaluate hemoptysis in older men with nonsuspicious chest roentgenograms. Chest 1989; 95:1043.
  33. O'Neil, KM, Lazarus, AA. Hemoptysis. Indications for bronchoscopy. Arch Intern Med 1991; 151:171.
  34. Gong, H Jr, Salvatierra, C. Clinical efficacy of early and delayed fiberoptic bronchoscopy in patients with hemoptysis. Am Rev Respir Dis 1981; 124:221.
  35. Set, PAK, Flower, CDR, Smith IE, et al. Hemoptysis: Comparative study of the role of CT and fiberoptic bronchoscopy. Radiology 1993; 189:677.
  36. McGuinness, G, Beacher, JR, Harkin, TJ, et al. Hemoptysis: prospective high-resolution CT/bronchoscopic correlation. Chest 1994; 105:1155.
white circle LOG IN
white circle DEMO