Coughing Up Blood (Hemoptysis): Causes

Pathogenesis (development of disease)

Hemoptysis can occur as a result of various respiratory diseases.

Etiology (Causes)

Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99).

• Pulmonary AV malformation – malformations in the vascular system of the lungs.

Respiratory system (J00-J99

• Bronchiectasis (synonym: bronchiectasis) – persistent irreversible saccular or cylindrical dilatation of the bronchi (medium-sized airways) that may be congenital or acquired; symptoms: chronic cough with “mouthful expectoration” (large-volume triple-layered sputum: foam, mucus, and pus), fatigue, weight loss, and decreased exercise capacity (e.g., due to cystic fibrosis) (6.8%)
• Bronchopulmonary fistula – communication between the bronchial airways and the pleural space.
• Infectious respiratory disease (22%):
  • Bronchitis – inflammation of the larger branched airways (bronchi).
  • Pneumonia – inflammation of the lungs
• Lung abscess – encapsulated collection of pus in the lungs.
• Pulmonary edema (accumulation of water in the lungs) – e.g. due toMitral stenosis (heart valve defect in which the opening of the mitral valve is narrowed).

Blood, blood-forming organs – immune system (D50-D90).

• Hemorrhagic diathesis (blood clotting disorders) such as thrombocytopenia (lack of platelets), hemophilia (bleeding disorder).

Endocrine, nutritional and metabolic diseases (E00-E90).

• Idiopathic pulmonary hemosiderosis (IPH) – rare disorder characterized by alveolar hemorrhage (0.1%).
• Cystic fibrosis (ZF) – genetic disease with autosomal recessive inheritance characterized by the production of secretions in various organs that need to be tamed.

Cardiovascular system (I00-I99).

• Arterial hypertension (high blood pressure).
• Vascular lesions (vascular injuries), unspecified
• Pulmonary embolism – detachment of a blood clot from the leg with occlusion of pulmonary vessels.
• Pulmonary infarction – complication of pulmonary embolism occurring with complete occlusion of a peripheral pulmonary artery branch (pulmonary artery)
• Mitral stenosis – heart valve defect in which the opening of the mitral valve is narrowed.
• Septic emboli (due to right heart endocarditis/pericarditis of the right heart).
• Pulmonary artery embolism (2.6%).
• Pulmonary hypertension (pulmonary hypertension)
• Vascular malformations (vascular malformations; 0.2%): eg.
  • Goodpasture syndrome (see below anti-GBM (under “musculoskeletal system and connective tissue“).
  • Osler-Weber-Rendu disease (synonyms: Osler disease; Osler syndrome; Osler-Weber-Rendu disease; Osler-Rendu-Weber disease; hereditary hemorrhagic telangiectasia, HHT) – autosomal-dominant inherited disorder in which telangiectasias (abnormal dilation of blood vessels) occur. These can occur anywhere, but are found especially in the nose (leading symptom: epistaxis (nosebleed)), mouth, face, and the mucous membranes of the gastrointestinal tract. Because the telangiectasias are very vulnerable, it is easy to tear and thus bleeding.

Infectious and parasitic diseases (A00-B99).

• Aspergillosis (mold infection), invasive (1.1%).
• Echinococcosis – infectious disease caused by the parasites Echinococcus multilocularis (fox tapeworm) and Echinococcus granulosus (dog tapeworm).
• Febrile infectious diseases such as influenza (true flu / viral flu).
• Helminthiasis (worm diseases)
• Leptospirosis (Weil’s disease) – infectious disease caused by leptospires.
• Plague
• Tuberculosis (consumption) (2.7%)

Mouth, esophagus (esophagus), stomach, and intestines (K00-K67; K90-K93).

• Bleeding from the digestive tract, unspecified.

Musculoskeletal system and connective tissue (M00-M99).

• Anti-GBM (glomerular basement membrane) disease (synonym: Goodpasture’s syndrome) – combination of hemorrhagic pulmonary infiltrates with glomerulonephritis (inflammation of the renal corpuscles) – necrotizing (tissue dying) vasculitis (vascular inflammation) of small to medium-sized vessels (small-vessel vasculitides), which is associated with granuloma formation (nodule formation) in the upper respiratory tract (nose, sinuses, middle ear, oropharynx) as well as the lower respiratory tract (lungs).
• Collagenoses, such as.
  • Dermatomyositis – inflammatory muscle disease (myositis/muscle inflammation) that also affects the skin (dermatitis/inflammation of the skin).
  • Polymyositis – inflammatory systemic disease of skeletal muscle.
  • Systemic lupus erythematosus (SLE) – systemic disease that affects the skin and connective tissue of the vessels, leading to vasculitides (vascular inflammation) of numerous organs such as the heart, kidneys, or brain
• Vasculitides – inflammatory rheumatic diseases characterized by a tendency to inflammation of the (mostly) arterial blood vessels.
  • Eosinophilic granulomatosis with polyangiitis (EGPA) – granulomatous (roughly, “granule-forming”) inflammation of small to medium-sized blood vessels in which the affected tissue is infiltrated (“walked through”) by eosinophilic granulocytes (inflammatory cells)
  • Granulomatosis with polyangiitis – necrotizing (tissue dying) vasculitis (vascular inflammation) of the small to medium-sized vessels (small-vessel vasculitides), which is accompanied by granuloma formation (nodule formation) in the upper respiratory tract (nose, sinuses, middle ear, oropharynx) and the lower respiratory tract (lungs).
  • Microscopic polyangiitis – necrotizing (tissue dying) vasculitis (vascular inflammation) of small (“microscopic”) blood vessels, although larger vessels may also be affected.
  • Periarteritis nodosa – necrotizing vasculitis (vascular inflammation), which usually affects medium-sized vessels.

Neoplasms – tumor diseases (C00-D48).

• Malignant neoplasms, unspecified.
• Benign neoplasms, unspecified
• Bronchial carcinoma (lung cancer) and metastases (daughter tumors) (17.4%)
• Laryngeal carcinoma (cancer of the larynx)
• Tracheal carcinoma (cancer of the trachea)

Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99).

• Hemorrhage from the respiratory tract, unspecified.
• Epistaxis (nosebleed)
• False hemoptysis (coughing up blood) – blood from the nose or throat, which is coughed up.
• Cryptogenic cough/cough of unclear cause (50%).
• Pulmonary hemorrhage
• Prolonged cough – cough that lasts for a long time.

Injuries, poisonings and other consequences of external causes (S00-T98).

• Foreign body/foreign body aspiration (= when a foreign body enters the larynx (voice box), trachea (windpipe), or bronchi).
• Craniocerebral Trauma (TBI).
• Thoracic trauma (chest injury)
• Injuries, fractures (bone fractures), unspecified.

Medication

• Anticoagulation (anticoagulant)* .
• Thrombolytic therapy (dissolving a thrombus with the help of medication)* .

Operations

• Endoscopic lung volume reduction (ELVR)* – method for treatment of severe emphysema.
• Lung biopsies (tissue removal from the lungs)* .

Further

• Right heart catheterization (minimally invasive medical examination of the heart through a catheter) * .
• Trauma (injury)/lung contusion (pulmonary contusion) (0.7 5)
• Dry room air

* Iatrogenic (“caused by a physician”; 5%).

Percentages (%) according to