Coughing up blood, hemoptysis, or hemoptysis is the coughing up of blood, which may also have mucus mixed with it. It is caused by various respiratory or pulmonary diseases.
What is hemoptysis?
Coughing up blood is not a disease in its own right, but is a symptom of various diseases. In this case, a so-called sputum (mucous sputum) or only blood is coughed up. Coughing up blood is not a disease in itself, but a symptom of various diseases. In this case, a so-called sputum (mucous sputum) or only blood is coughed up, which originates either from the respiratory tract or the lungs. Normally it is venous, very rarely arterial. If the sputum is frothy and bubbly, it is arterial blood. In this form of hemoptysis, a physician should be consulted immediately. Hemoptysis should be distinguished from conditions such as nosebleeds, bleeding from the stomach or esophagus, or dental injuries, in which blood is also excreted from the mouth.
Causes
The causes of hemoptysis vary. Hemoptysis may occur in the setting of tuberculosis, a disease that is, however, very rare in Western countries. Another possibility is pulmonary embolism, in which there is a blockage of blood vessels in the lungs. In most cases, this blockage occurs due to thrombosis in the pelvis or legs. The blood platelets coalesce, causing a blood clot that breaks loose and clogs the blood vessels. Coughing up blood also occurs in the case of lung cancer, a ruptured lung or the infectious disease legionellosis. In these cases, the blood vessels of the lungs are damaged as physical pressure is exerted on the walls of the blood vessels and blood leaks out. Occasionally, an abscess or acute pulmonary congestion can also cause coughing up blood. Another cause is bronchiectasis, a condition in which there are expansions in the bronchi in the form of small pockets. These fill with pus, cause infection of the bronchial wall, and the tissue dies. Some forms of hemoptysis are also hereditary, such as Osler syndrome, in which small nodules form on the internal organs as well as the mucous membranes. Pulmonary hemorrhage and hemoptysis also occur in Ceelen-Gellerstedt syndrome, which is also a hereditary disease.
Diseases with this symptom
- Pulmonary hypertension
- Lung abscess
- Pulmonary embolism
- Lung cancer
- Ruptured lung
- Legionellosis
- Lupus
- Goodpasture’s syndrome
- Cor pulmonale
- Pneumonia
- Pleural effusion
- Osler’s disease
- Increased bleeding tendency
- Vascular malformation
- Ceelen-Gellerstedt syndrome
- Foreign body aspiration
- Bronchiectasis
- Tuberculosis
Diagnosis and course
The diagnosis of hemoptysis depends on the cause. Therefore, the physician will first look for the indirect or direct causes of hemoptysis. As part of the medical history, the physician will also ask how long the coughing up of blood has existed or under what circumstances the cough occurs. Other important factors are concomitant complaints and previous illnesses. The physician also pays particular attention to blood pressure and heart sounds. In addition, the sputum is analyzed in detail and the respiratory tract is thoroughly examined. A detailed examination of the sputum is very helpful for further diagnosis. For example, in true hemoptysis, the sputum is bright red in color, while bleeding from the stomach has a black consistency. It is also very important to listen to the lungs, because this may allow the doctor to localize the bleeding. Since it is not usually possible to determine immediately whether the blood is coming from the gastrointestinal tract or the respiratory tract, it is important to check both possibilities. In addition, a blood count is performed to detect any infections, anemia, or tumor markers. The source of hemoptysis can also be determined by bronchoscopy or x-ray examination. An X-ray examination often provides very important information, as the image shows typical changes that occur in tuberculosis, lung abscess, or pneumonia.A computed tomography scan can also be used to visualize the chest in detail and it is possible to find even small disease processes in the bronchi or lungs. A bronchoscopy is also used to localize the origin of the bleeding. In addition, the patient can also be administered medication to stop the hemoptysis during this examination.
Complications
Whether it is haemoptysis (coughing up small amounts of blood) or haemoptysis (coughing up larger amounts of blood), the complications are always serious. If the cause of hemoptysis is not treated, respiratory distress, hemorrhage, or shock may result. Retrosternal pain and nausea are also known complications. In rather rare cases, a benign or low-grade malignant bronchial carcinoid may develop. This carcinoid originates from the bronchial mucosa and is more commonly seen in men and women at younger ages. Lung metastases may also occur if treatment is not received as a result of hemoptysis. These are daughter tumors from other types of cancer. For example, kidney, colon or breast cancer. An advanced stage of the primary tumor can be assumed. The formation of a lung carcinoma in hemoptysis is also known. This is a malignant tumor of the bronchial mucosa. The fine tissue structure of a carcinoma and the tumor stage at the time of diagnosis form the basis for a prognosis. Similarly, pleural effusion (fluid accumulation with blood, lymph, and/or other components between the lungs and sternum) can occur as a complication of hemoptysis. Hemoptysis may be associated with increased vascular pressure in the blood vessels of the lungs. The result may be necrosis (death of tissue). If an onset of hemoptysis is not treated, rupture of the blood vessel wall may occur in the pulmonary vessels if left untreated.
When should you see a doctor?
Hemoptysis occurs in various diseases of the lungs and airways. In hemoptysis, as coughing up blood is referred to in medical terms, blood is coughed up either pure or with mucus admixtures. Blood originating from respiratory tract or lungs is mostly venous – of darker color, rarely arterial – of lighter color, and in this case it is foamy and effervescent. If the blood is of arterial origin, it is essential to consult a doctor immediately, preferably an emergency physician. However, hemoptysis from venous blood also requires urgent medical attention. Causes of hemoptysis include various diseases such as tuberculosis, legionellosis, pulmonary embolism, ruptured lung and bronchiectasis. The two hereditary diseases Osler syndrome and Ceelen-Gellerstedt syndrome can also trigger hemoptysis. It is best for people affected by hemoptysis to consult their family doctor first. He or she will take a comprehensive medical history. He or she can be expected to consult other specialists: Radiologists, pulmonologists or oncologists. In addition, the involvement of a gastroenterologist may be useful, since in the case of hemoptysis it is often not initially clear whether the coughed-up blood actually originates from the lungs or the respiratory tract, or whether it does come from the upper gastrointestinal tract. As part of the investigation of hemoptysis, a computed tomography scan often provides informative results.
Treatment and therapy
Depending on the cause of hemoptysis, treatment of the condition then follows. Antibiotics are given for inflammation or infection, and chemotherapy or radiation therapy is used for lung cancer. If the cause of hemoptysis is a hereditary disease, treatment options are relatively limited. For example, Gellerstedt syndrome, which occurs at a young age, still cannot be treated effectively, and many affected individuals die within 12 years of the onset of hemoptysis.
Outlook and prognosis
Hemoptysis should always be treated by a physician. If the symptom is not treated, respiratory distress may result from swallowing blood. Patients usually also complain of nausea or headache. The loss of blood also increases the feeling of dizziness. It is not uncommon for the causes of hemoptysis to be cancer. In these cases, no general prognosis can be given. Treatment here is with chemotherapy or surgical intervention and, if detected early, can lead to success and completely combat the problem.If hemoptysis is caused by inflammation or infection, antibiotics can be used. These usually lead to a positive course of the disease after about a week. The patient has no further complaints or problems after the disease. It is not uncommon for a patient to have a panic attack due to coughing up blood, as blood is often associated with a serious illness. Going to the doctor provides certainty.
Prevention
Because coughing up blood is only a symptom of a disease, preventive measures are relatively difficult. A fairly good prevention is possible for thrombosis, here regular exercise and avoiding long periods of sitting help to reduce the formation of blood clots. A healthy diet and reducing or avoiding nicotine consumption are also highly recommended.
Here’s what you can do yourself
As a severe symptom of various clinical pictures in the respiratory tract and other organs, coughing up blood (hemoptysis) should not be underestimated. Pure treatment on your own should be categorically ruled out here. Especially if the patient is a child, the parents should present the child to the pediatrician on the same day. Unlike an ordinary cough, hemoptysis cannot be alleviated with medications such as a cough blocker or similar agents. The bloody sputum is extremely alarming and the affected person should go directly to the emergency room or to the doctor, because only there can the cause of the hemoptysis be determined. Since a number of highly contagious diseases such as pneumonia or tuberculosis are also associated with hemoptysis, it is important not to wait unnecessarily. It is advisable to take a sample of the sputum with you to be examined. If hemoptysis is accompanied by severe breathing difficulties, the emergency physician must be called immediately. However, if the affected person has already received a diagnosis that includes possible hemoptysis (e.g., lung cancer), it is sufficient to inform the attending physician and to seek inpatient care on his or her recommendation. Depending on the cause of the hemoptysis, it can be quickly controlled or at least reduced by the physician. Those affected, on the other hand, who do not seek medical treatment may be risking their lives.
