3 Haemoptysis

Definition
Haemoptysis (blood spitting) is the symptom of coughing up blood from the lungs. Blood from the nose, mouth or pharynx that may also be spat out is termed ‘spurious haemoptysis’.
KEY POINTS
• Blood from the proximal bronchi or trachea is usually bright red. It may be frankly blood or mixed with mucus and debris, particularly from a tumour.
• Blood from the distal bronchioles and alveoli is often pink and mixed with frothy sputum.
Important diagnostic features
The sources, causes and features are listed below.
Spurious haemoptysis
Mouth and nose
• Blood dyscrasias: associated nose bleeds, spontaneous
bruising.
• Scurvy (vitamin C deficiency): poor hair/teeth, skin bruising.
• Dental caries, trauma, gingivitis.
• Oral tumours: painful intraoral mass, discharge, fetor.
• Hypertensive/spontaneous: no warning, brief bleed, often
recurrent.
• Nasal tumours (common in South-East Asia).

True hacmoptysis
Larynx and trachea
• Foreign body: choking, stridor, pain.
• Carcinoma: hoarse voice, bovine cough.
Bronchus
• Carcinoma: spontaneous haemoptysis, chest infections,
weight loss, monophonic wheezing.
• Adenoma (e.g. carcinoid): recurrent chest infections, carcinoid syndrome.
• Bronchiectasis: chronic chest infections, fetor, blood mixed
with purulent sputum, physical examination shows TB or severe
chest infections.
• Foreign body: recurrent chest infections, sudden-onset inexplicable ‘asthma’.
Lung
• TB: weight loss, fevers, night sweats, dry or productive cough.
• Pneumonia/lung abscess: features of acute chest sepsis,
swinging fever.
• Pulmonary infarct (secondary to PE): pleuritic chest pain,
tachypnoea, pleural rub.
• Aspergilloma.
Cardiac
• Mitral stenosis: frothy pink sputum, recurrent chest infections.
• LVF: frothy pink sputum, pulmonary oedema.

KEY INVESTIGATIONS
All
• Clotting: blood dyscrasias.
• EBO: infections, dyscrasias.
• Chest X-ray (AP and lateral).
?Foreign body ?Cardiac cause ?Tumour ?lnfection ?lnfarction/PE
Bronchoscopy. EGG Sputum cytology Sputum MC+S V/Q scan
Echocardiography. CT scan ?CT scan. CT scan.
Bronchoscopy.