Brief overview
- What is hemoptysis? Coughing up blood, i.e. coughing with bloody sputum. The attenuated form is called hemoptysis.
- Possible causes: Bronchitis, congenital or acquired bronchial outpouchings, malignant tumors in the lungs, pneumonia, pulmonary embolism, pulmonary abscess, pulmonary hypertension, vascular malformations, autoimmune diseases, increased bleeding tendency (e.g., due to certain medications), lung injuries.
- Brief overview
What is hemoptysis? Coughing up blood, i.e. coughing with bloody sputum. The attenuated form is called hemoptysis.
Possible causes: Bronchitis, congenital or acquired bronchial outpouchings, malignant tumors in the lungs, pneumonia, pulmonary embolism, pulmonary abscess, pulmonary hypertension, vascular malformations, autoimmune diseases, increased bleeding tendency (e.g., due to certain medications), lung injuries.
Hemoptysis must be distinguished from diseases in which blood can be discharged from the mouth in other ways – for example, nosebleeds, oral and dental injuries, and bleeding from the esophagus and stomach. At first glance, this is often not straightforward. In the case of hemoptysis, the ejected blood can often appear foamy due to the admixed air. If, on the other hand, it originates from the stomach, it is often black in color due to the action of gastric acid.
Hemoptysis: Causes and Possible Diseases
The hemorrhage underlying hemoptysis can occur at various stations of the respiratory system, and the possible causes are numerous. Looking first at the trachea and bronchi, for example, the following triggers are possible:
- Bronchitis (acute or chronic), which is an inflammation of the larger airways, usually caused by viral or bacterial infections.
- Bronchial carcinoma (lung cancer): In the case of a malignant growth of the bronchial mucosa, coughing up blood is often the first symptom – even before pain. However, bronchial carcinomas account for less than ten percent of the causes of hemoptysis.
- Lung metastases: These are metastases of other cancers that become lodged in the lungs. They frequently occur, for example, in colorectal cancer, kidney cancer and breast cancer.
If you follow the airways further down, you eventually reach the lung tissue. Here, too, various triggers can lead to hemoptysis:
- Pneumonia: It can also be accompanied by hemoptysis in rare cases.
- Lung abscess: If the collection of pus (abscess) in the lung is connected to an injured pulmonary vessel, hemoptysis may occur.
Other possible causes of hemoptysis include:
- Pulmonary embolism: This is when a pulmonary artery becomes blocked by an engulfed blood clot (embolus). This clot originates outside the lungs (often in the veins of the legs) and can enter a pulmonary vessel through the bloodstream. In addition to coughing up blood, possible symptoms include shortness of breath and chest pain.
- Vascular malformations: These include, for example, “short-circuit connections” (med. shunts) between arteries and veins come as well as pathological dilations of vessels in the context of hereditary Osler’s disease.
- Autoimmune diseases: For example, Goodpasture’s syndrome as well as Wegener’s granulomatosis can cause hemoptysis. Systemic lupus erythematosus also causes hemoptysis in rare cases.
- Lung injuries, e.g. as a result of an accident or a stab wound
Hemoptysis: When should you see a doctor?
Coughing up blood or bloody sputum is an urgent warning signal that should be clarified by a doctor immediately. There is not always a serious illness behind the symptom, but only a doctor can find that out. In general, the earlier the cause of hemoptysis is identified and treated, the better.
Hemoptysis: What does the doctor do?
Diagnostics
The physician first questions the patient in detail about the circumstances of the hemoptysis that has occurred (anamnesis):
- When did the hemoptysis first occur?
- How long did it last?
- How much blood did you cough up, and what did it look like?
- Do you have or have you had any other symptoms (fever, etc.)?
- Do you have any known pre-existing conditions?
The physician will listen to the patient’s lungs as well as draw blood to have important laboratory values determined (blood count, coagulation values, oxygen content in the blood, etc.). Diagnostic procedures such as chest X-ray, bronchoscopy or high-resolution computed tomography (HRCT) can be used to locate the source of the bleeding.
Therapy
In the case of acute hemorrhage, it is important to stop the bleeding as quickly as possible, which can often be done during a bronchoscopy.
Basically, the therapy of hemoptysis depends on the respective trigger. Consequently, drugs such as antibiotics or immunosuppressants are used. In other cases, chemotherapy, surgical interventions or targeted vessel occlusion (embolization) are necessary.
Emergency measures
Initial measures for acute hemoptysis may include administration of oxygen and volume substitution (i.e., replacement of lost blood volume with saline or other preparations), if needed. Often, the patient is positioned so that the lung portion is down with the source of bleeding. This is to prevent the uninjured lung from being disturbed in its function.