Hemoptysis pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]
Overview
Pathophysiology
Physiology
- Lung has two main vascular systems that include pulmonary circulation and bronchial circulation.
- There are multiple anastomoses between pulmonary and bronchial arteries which create physiologic right to left shunts.
- Pulmonary circulation
- It provides gas exchange where deoxygenated blood enters the lungs through pulmonary arteries and oxygenated blood returns to circulation through pulmonary veins.
- Pulmonary arteries
- Pulmonary veins
- Pulmonary circulation
-
- Bronchial vessels provide blood and nutrients to the bronchi and connective tissue of the lungs. They supply blood to the respiratory bronchioles and the visceral pleura of the lung.
- Bronchial arteries carry oxygenated blood to the lung tissues. They are arised from the thoracic aorta. There are usually two branches to the left lung and one to the right lung.
- Bronchial veins return the deoxygenated blood from the lung tissues to the systemic circulation. The right side drains into the azygos vein and the left side drains into the left superior intercostal vein or the accessory hemiazygos vein.
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Pathogenesis
- Hemoptysis is an important symptom that has different etiologies and pathogenesis mechanisms.[3]
- Blood in the hemoptysis is mostly originated from the Lung. However, it could be from the gastrointestinal system as well.
- Primary origin of the blood comes from bronchial arteries.[4][5]
- Other sources of bleeding might be:[6]
- Aorta
- Intercostal arteries
- Coronary arteries
- Thoracic arteries
- The upper and inferior phrenic arteries
- Pulmonary vessels
- Hemoptysis may happen following infarction and ischemia of pulmonary parenchyma. It is seen in following conditions:
- Pulmonary emboli
- Vasculitis including:
- Infections including:
- Staphylococcus aureus
- Pseudomonas aeruginosa
- Aspergillus fumigatus
- The phycomycetes
- Another mechanism of hemoptysis is vascular engorgement with erosion. It is seen in following conditions:
- Acute infection such as
- Viral bronchitis
- Bacterial bronchitis
- Chronic infection such as
- Toxic exposure
- Acute infection such as
Associated Conditions
- There are multiple conditions that are associated with hemoptysis which include:
- Granulomatosis with polyangiitis
- Sarcoidosis
- Immunodeficiency
- Indoor ice hockey play
References
- ↑ "File:2119 Pulmonary Circuit.jpg - Wikimedia Commons".
- ↑ "File:Pulmonary Blood Circulation.png - Wikimedia Commons".
- ↑ "Hemoptysis - Clinical Methods - NCBI Bookshelf".
- ↑ Ittrich, H.; Klose, H.; Adam, G. (2014). "Radiologic Management of Haemoptysis: Diagnostic and Interventional Bronchial Arterial Embolisation". RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren. 187 (04): 248–259. doi:10.1055/s-0034-1385457. ISSN 1438-9029.
- ↑ Noë, G.D.; Jaffé, S.M.; Molan, M.P. (2011). "CT and CT angiography in massive haemoptysis with emphasis on pre-embolization assessment". Clinical Radiology. 66 (9): 869–875. doi:10.1016/j.crad.2011.03.001. ISSN 0009-9260.
- ↑ Sakr, L.; Dutau, H. (2010). "Massive Hemoptysis: An Update on the Role of Bronchoscopy in Diagnosis and Management". Respiration. 80 (1): 38–58. doi:10.1159/000274492. ISSN 1423-0356.