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| {{Infobox_Disease | | | __NOTOC__ |
| Name = Hemoptysis |
| | {| class="infobox" style="float:right;" |
| ICD10 = {{ICD10|R|04|2|r|00}} |
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| ICD9 = {{ICD9|786.3}} |
| | | [[File:Siren.gif|link=Hemoptysis resident survival guide|41x41px]] || <br> || <br> |
| ICDO = |
| | | [[Hemoptysis resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] |
| Image = |
| | |} |
| Caption = |
| | {{Hemoptysis}} |
| OMIM = |
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| OMIM_mult = |
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| MedlinePlus = 003073 |
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| eMedicineSubj = |
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| eMedicineTopic = |
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| DiseasesDB = 5578 |
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| }}
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| {{SI}} | |
| {{CMG}}
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| {{EH}}
| | '''For hemoptysis resident survival guide, click [[Hemoptysis resident survival guide|here]].''' |
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| '''Hemoptysis''' or '''haemoptysis''' (see [[American and British English spelling differences#Simplification of ae .28.C3.A6.29 and oe .28.C5.93.29|American and British spelling differences]]) is the expectoration ([[cough]]ing up) of [[blood]] or of blood-stained [[sputum]] from the [[bronchi]], [[larynx]], [[vertebrate trachea|trachea]], or [[lungs]] (e.g. in tuberculosis or other respiratory infections). | | '''For patient information, click [[{{PAGENAME}} (patient information)|here]].''' |
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| It is not the same as [[hematemesis]], which refers to [[vomit]]ing up blood.
| | {{CMG}}; {{AE}} {{SSH}} |
| == Overview ==
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| * Hemoptysis is defined as coughing up blood from a source below the vocal cords.
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| * In most cases of hemoptysis, bleeding comes from the bronchial arteries as opposed to the pulmonary arteries.
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| * Massive hemoptysis may be fatal, although uncommon.
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| * 20% of the cases of hemoptysis are idiopathic in nature.
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| ==Causes==
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| This can be due to [[bronchitis]] or [[pneumonia]] most commonly, but also to [[lung cancer|lung neoplasm]] (in smokers, when hemoptysis is persistent), [[aspergilloma]], [[tuberculosis]], [[bronchiectasis]], [[coccidioidomycosis]], [[pulmonary embolism]], or [[Bubonic plague|pneumonic plague]].
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| Rarer causes include [[hereditary hemorrhagic telangiectasia]] (HHT or Rendu-Osler-Weber syndrome), or [[Goodpasture's syndrome]] and [[Wegener's granulomatosis]].
| | {{SK}} Spitting up blood; bloody sputum; coughing up blood; blood in sputum; haemoptysis |
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| In children it is commonly due to a [[foreign body]] in the [[respiratory tract]].
| | ==[[Hemoptysis overview|Overview]]== |
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| It can result from over-anticoagulation from treatment by drugs such as [[warfarin]].
| | ==[[Hemoptysis historical perspective|Historical Perspective]]== |
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| Cardiac causes like congestive heart failure and mitral stenosis should be ruled out.
| | == [[Hemoptysis classification|Classification]] == |
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| The origin of blood can be known by observing its color. Bright red, foamy blood comes from the respiratory tract while dark red, coffee-colored blood comes from the [[gastrointestinal tract]].
| | ==[[Hemoptysis pathophysiology|Pathophysiology]]== |
| ==Complete List of Differential Diagnoses== | | ==[[Hemoptysis causes|Causes]]== |
| * [[Actinomycosis]]
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| * [[Adult Respiratory Distress Syndrome]] (ARDS)
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| * [[Amyloidosis]]
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| * [[Aortic Aneurysm]]
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| * [[Arteriovenous malformation]] ([[AVM]])
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| * [[Aspergilloma]]
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| * Aspiration (foreign body)
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| * [[Behcet's Syndrome]]
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| * Biopsy
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| * Bleeding gums
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| * Bronchial [[adenoma]]
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| * [[Bronchitis]]
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| * [[Bronchiectasis]]
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| * [[Bronchogenic carcinoma]]
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| * Broncholithiasis
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| * Bronchoscopy
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| * [[Coagulopathy]]
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| * [[Cocaine]] use
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| * [[Congestive Heart Failure]]
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| * [[Cystic Fibrosis]]
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| * Cytotoxic drug use
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| * [[Echinococcal cyst]]
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| * [[Endometriosis]]
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| * [[Esophageal tumors]]
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| * Fistula (between vasculature and airway)
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| * [[Goodpasture's Syndrome]]
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| * [[Heart failure]]
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| * Hemorrhagic diathesis
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| * [[Henoch-Schonlein Purpura]]
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| * [[Histiocytosis X]]
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| * [[Idiopathic pulmonary hemosiderosis]]
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| * Intrathoracic [[endometriosis]]
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| * [[Laryngitis]]
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| * Laryngoscopy
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| * [[Lung abscess]]
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| * Lung contusion
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| * Malignant [[lymphoma]]
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| * [[Mediastinal tumors]]
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| * Mediastinoscopy
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| * [[Metastases]]
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| * [[Mitral Stenosis]]
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| * [[Nosebleed]]
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| * [[Oral Candidiasis]]
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| * [[Osler-Weber-Rendu Syndrome]]
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| * [[Pharyngitis]]
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| * [[Pneumonia]]
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| * [[Polyarteritis Nodosa]]
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| * [[Primary pulmonary hypertension]]
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| * Pulmonary arteriovenous fistula
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| * Pulmonary congestion
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| * [[Pulmonary Embolism]]
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| * [[Pulmonary fibrosis]]
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| * Pulmonary [[hemangioma]]
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| * Pulmonary [[hemosiderosis]]
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| * [[Pulmonary Infarction]]
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| * Ruptured [[aortic aneurysm]]
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| * Ruptured bronchi
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| * [[Sarcoidosis]]
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| * Septic [[pulmonary emboli]]
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| * Shrapnel
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| * Spirometry
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| * [[Systemic Lupus Erythematosus]]
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| * Tonsillectomy
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| * [[Tracheitis]]
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| * [[Trauma]]
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| * [[Tuberculosis]]
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| * Violent [[coughing]]
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| * [[Wegener's Granulomatosis]] <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
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| ==Diagnostic workup== | | ==[[Hemoptysis differential diagnosis|Differentiating Hemoptysis from other Diseases]]== |
| [[Image:hemoptysis.png]] | |
| == Laboratory Findings ==
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| * [[Complete blood count]] ([[CBC]])
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| * [[Sputum]] for acid-fast stain
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| * [[Cytology]]
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| * [[Gram stain]] / culture
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| * [[Prothrombin time]]/[[partial thromboplastin time]] ([[PT]] / [[PTT]])
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| * [[Pulse oximetry]]
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| * [[Urinalysis]]
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| * [[Blood urea nitrogen]] ([[BUN]])/[[creatinine]])
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| * Possible immunologic tests
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| * [[Arterial blood gases]]
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| ==== Electrolyte and Biomarker Studies ==== | | ==[[Hemoptysis epidemiology and demographics|Epidemiology and Demographics]]== |
| * [[Electrolytes]]
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| ==== Chest X Ray ====
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| * [[Chest X-ray]] for both major and minor [[hemoptysis]]
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| ==== MRI and CT ====
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| * Chest [[CT scan]] to show focal bleeding
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| === Other Diagnostic Studies ===
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| * [[Bronchoscopy]]
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| == Treatment == | | ==[[Hemoptysis risk factors|Risk Factors]]== |
| * Treat underling etiologies for minor hemoptysis
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| * Special attention to '''airway, breathing''' and '''circulation'''
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| * Administration of supplemental O2
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| * Stablize hemodynamics
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| * Cough suppression
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| * Intubation
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| === Acute Pharmacotherapies === | | ==[[Hemoptysis screening|Screening]]== |
| * IV [[estrogen]]
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| === Surgery and Device Based Therapy === | | ==[[Hemoptysis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| * Bronchoscopic balloon tamponade
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| * Arteriography and embolization
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| * Emergent thoracic surgery
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| ==External links== | | ==Diagnosis== |
| * {{MerckManual|6|63|g}}
| | [[Hemoptysis diagnostic study of choice|Diagnostic Study of Choice]] | [[Hemoptysis history and symptoms|History and Symptoms]] | [[ Hemoptysis physical examination|Physical Examination]] | [[Hemoptysis laboratory findings|Laboratory Findings]] | [[Hemoptysis electrocardiogram|Electrocardiogram]] | [[Hemoptysis x ray|X-Ray Findings]] | [[Hemoptysis echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[Hemoptysis CT scan|CT-Scan Findings]] | [[Hemoptysis MRI|MRI Findings]] | [[Hemoptysis other imaging findings|Other Imaging Findings]] | [[Hemoptysis other diagnostic studies|Other Diagnostic Studies]] |
| * {{GPnotebook|-254803961}}
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| * [http://www.virtualcancercentre.com/symptoms.asp?sid=58 Haemoptysis] Virtual Cancer Centre
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| ==References==
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| {{Reflist|2}}
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| {{Symptoms and signs}}
| | ==Treatment== |
| {{SIB}}
| | [[Hemoptysis medical therapy|Medical Therapy]] | [[Hemoptysis surgery |Surgery]] | [[Hemoptysis primary prevention|Primary Prevention]] | [[Hemoptysis secondary prevention|Secondary Prevention]] | [[Hemoptysis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Hemoptysis future or investigational therapies|Future or Investigational Therapies]] |
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| {{WH}}
| | ==Case Studies== |
| {{WS}}
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| [[Category:Pulmonology]] | | [[Hemoptysis case study one|Case #1]] |
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| [[Category:Signs and symptoms]] | | [[Category:Medicine]] |
| | [[Category:Gastroenterology]] |
| | [[Category:Up-To-Date]] |
| | [[Category:Emergency medicine]] |
