Pulmonary hemorrhage is a leakage of blood from the pulmonary vasculature into the tissues of the lungs. There are numerous sources and causes of bleeding. Pulmonary hemorrhage is most noticeable by bloody sputum when coughing.
What is pulmonary hemorrhage?
In pulmonary hemorrhage, blood leaks from the vessels in the lungs into the surrounding lung tissue. The reason for the bleeding is small or large vascular lesions. In pulmonary hemorrhage, blood leaks from the vessels of the lung into the surrounding lung tissue. The reason for the bleeding are small or larger vascular lesions. These can be caused by different diseases. Small pulmonary hemorrhages often go unnoticed, while larger hemorrhages cause blood to leak from the nose or mouth. Massive pulmonary hemorrhages can severely obstruct breathing and thus be life-threatening. They should therefore be considered an emergency and accordingly require emergency medical treatment.
Causes
Pulmonary hemorrhage may have its source in the bronchial area and in the area of lung functional tissue. Pulmonary hemorrhage can occur with severe bronchitis. The most common causes of pulmonary hemorrhage in men over 45 years of age are pulmonary metastases and bronchial carcinomas. These are largely found in smokers. Bronchiectasis is the term used to describe an expansion of a bronchus. Bronchiectasis can be congenital or acquired through infections and inflammation of the airways. Characteristic of the disease is coughing up large amounts of foul-smelling secretions. The strong stimulus of coughing can cause vessels to burst, so that traces of blood can also be found in this secretion. Foreign bodies can also cause bleeding in the bronchial area. Children are particularly often affected. Especially nuts, marbles and smaller toy parts are often aspirated by children. Sharp-edged foreign bodies in particular can injure blood vessels in the bronchi and thus cause bleeding. For a long time, the most common cause of bleeding from pulmonary functional tissue was tuberculosis. The disease is caused by Mycobacterium tuberculosis and preferentially damages the lungs along with other organs. Severe pneumonia or lung abscess can also result in bleeding. Of course, injuries to the lungs, such as puncture wounds, also cause pulmonary hemorrhage. Vessels are more easily destroyed if they are already pre-damaged. Pulmonary embolism, pulmonary hypertension, Goodpasture’s syndrome, or arteriovenous malformations can cause bleeding due to damage to the vessels. Disease states that are associated with an increased tendency to bleed also increase the risk of pulmonary hemorrhage. These so-called hemorrhagic diatheses include diseases of the blood platelets or diseases of the clotting factors such as hemophilia, the bleeding disorder. Bleeding in the lungs can also be autoimmune in origin. Systemic lupus erythematosus, for example, can become apparent via blood in the sputum. Other causes of pulmonary hemorrhage include Osler syndrome, endometriosis, Wegener’s disease, or mycetoma. Pulmonary hemorrhage is primarily noticeable in the form of hemoptysis. In medical terminology, hemoptysis is also known as hemoptysis. In hemoptysis, sputum containing blood is coughed up. The blood filaments may be rather inconspicuous or make the sputum appear a slightly pinkish-red color. The enhancement of hemoptysis is hemoptysis. As a rule, the blood is bright red and covered with foam. Here, the affected person coughs up larger amounts of blood. An oppressive feeling in the chest, palpitations, coughing or a salty taste in the mouth can be harbingers of bleeding in the lungs, depending on the cause. Rather, pulmonary hemorrhage is a symptom of disease and is indicative of serious underlying conditions.
Diseases with this symptom
- Pneumonia
- Pulmonary hypertension
- Pulmonary embolism
- Wegener’s disease
- Osler’s disease
- Hemophilia
- Goodpasture’s syndrome
- Metastases
- Tuberculosis
- Cystic fibrosis
- Bronchiectasis
- Lung cancer
- Foreign body aspiration
- Bronchitis
- Systemic lupus erythematosus
Diagnosis and course
Various diagnostic procedures are used to clarify pulmonary hemorrhage and to localize the source of bleeding.Prior to instrumental diagnostics, anamnestic information from the patient can provide initial clues as to the cause of the bleeding. The patient’s medical history is followed by a physical examination. The lungs can then be examined more closely by X-ray. This often already shows the localization of the hemorrhage. A more precise determination is then usually made with the aid of bronchoscopy. The lower airways are examined with an endoscope. High-resolution computed tomography may also be used. It is particularly suitable for diagnosing tissue changes and localizing tumors.
Complications
Untreated pulmonary hemorrhage results in various complications, depending on the cause. In extreme cases, there is danger to life and limb. Within minutes, massive hemorrhage can threateningly restrict aspiration and thus the intake of vital oxygen. Affected persons suffer death by suffocation under these circumstances. In the case of mild bleeding such as reddish stained sputum, there is no immediate danger. Nevertheless, serious sequelae may develop. Fluid accumulations in the lungs irritate the tissue located there and promote severe inflammation or further worsen already existing diseases. Tuberculosis or even a developing
tuberculosis or an emerging tumor are also possible causes, which, if left untreated, can have a drastic effect on a patient’s life expectancy. Regular sputum discharges with red admixtures therefore always belong under medical supervision. In the event of more severe blood discharge from the mouth or nose, the source of which does not appear to be the oral cavity or upper respiratory tract, a physician should be consulted immediately. Depending on the therapy chosen for pulmonary hemorrhage, there may be incompatibilities or side effects with the medications. Anticoagulants used to rapidly stop extreme bleeding also increase the risk of blood clots. Recurrence from surgical incisions cannot be completely ruled out in severe, internal wounds caused by foreign bodies or ulcers. Permanent hospitalization with intensive monitoring until recovery is therefore appropriate.
When should you go to the doctor?
Pulmonary hemorrhage is the result of a serious illness and requires immediate emergency medical evaluation. Whether a pulmonary hemorrhage is present can be recognized by some typical symptoms. For example, a doctor must be alerted if there is intense coughing up blood, pain in the lungs or frothy, bloody sputum. Other warning signs include pallor, shortness of breath and an increased heart rate. If the blood pressure falls below a value of 100/60, this indicates a pulmonary hemorrhage or other serious illness that must be treated immediately. If there is a concomitant loss of consciousness, first aid measures must be initiated until the emergency medical services arrive. In principle, complaints with the lungs should be clarified as quickly as possible so that pulmonary hemorrhage does not occur in the first place. Patients with bronchitis, smoker’s cough, pneumonia or lung metastasis should visit the emergency department at the first warning signs, such as a noticeable smell of blood in the mouth or stabbing pain in the lungs. Anyone who has swallowed a foreign body or has lung pain after an accident should also have this clarified quickly to avoid serious complications such as pulmonary hemorrhage.
Treatment and therapy
Treatment for pulmonary hemorrhage depends on the cause. Pneumonia and bronchitis are usually treated with antibiotics if the infection is bacterial. Antibiotics are also used for tuberculosis. Here, the drugs usually have to be administered for months. Carcinomas and metastases of the lung can be treated by surgery, chemotherapy or radiotherapy. However, bronchial carcinomas are usually discovered very late, so the tumors are often inoperable and can only be treated palliatively. If the pulmonary hemorrhage is caused by a foreign body, it must be removed from the affected bronchial or pulmonary segment as soon as possible. The foreign body can be removed either by bronchoscopy or in a surgical procedure. Bronchiectasis as a cause of bleeding is very difficult to treat. Therapy is usually conservative with antibiotics and respiratory therapy. In severe cases, surgery may be indicated.Autoimmune pulmonary hemorrhage is usually treated with glucocorticoids and immunosuppressants. In severe lung disease, such as advanced pulmonary hypertension, lung transplantation may be required.
Outlook and prognosis
The prognosis for pulmonary hemorrhage depends on the type and severity of the underlying condition. Untreated pulmonary hemorrhage presents with several complications and can lead to aspiration and subsequent death by suffocation. In less severe cases, there may be fluid buildup in the lungs, which can irritate the affected tissue and cause severe inflammation. More serious causes, such as bronchial carcinoma, are usually discovered late and often can only be treated palliatively. In autoimmune-related pulmonary hemorrhages, similar symptoms may recur even after recovery. If pulmonary hemorrhage is treated when the underlying disease is still in its early stages, there is a good chance of rapid recovery. If pulmonary hemorrhage is due to an infection, the symptoms can be treated with antibiotics; if the bleeding is due to a carcinoma or tumor, surgery or chemotherapy is required. Patients who have swallowed a foreign body have the best chances. If surgery or bronchoscopy is performed quickly, long-term consequences are unlikely. However, only a physician can give a final prognosis, since the outlook for pulmonary hemorrhage depends on a wide variety of factors.
Prevention
Not all pulmonary hemorrhages can be prevented. The most important preventive measure is certainly not smoking. Smokers carry a significantly higher risk of lung disease than nonsmokers. In particular, bronchial carcinomas occur preferentially in smokers. If the lungs are already damaged, further infections should be avoided at all costs. For example, it is recommended that patients with lung disease prevent possible complications of an infection with a flu vaccination. Of course, the vaccination does not prevent other diseases. Therefore, the immune system of patients should also be strengthened.
What you can do yourself
Pulmonary hemorrhage is a symptom of a serious illness and requires immediate medical attention. Until the emergency physician arrives, the lungs should be rested if possible. If there is a bloody cough, swallowing should be avoided to prevent further blood from entering the throat. It is also advisable to remain calm and check the symptoms. If there is accompanying heart palpitations, an oppressive feeling or a salty taste in the mouth, there is pulmonary hemorrhage. If there is bloody sputum, there may be another cause, but it need not be less severe than pulmonary hemorrhage. In the event of pulmonary hemorrhage, affected individuals should move to a semi-sitting position and, if possible, refrain from placing further stress on the lungs until emergency medical services arrive. Patients with lung disease and people with a weakened immune system or other health problems are also advised to take a course in emergency care. After surviving a pulmonary hemorrhage, it is important to strengthen the immune system and prevent possible infections with a vaccination. In general, a healthy lifestyle reduces the risk of pulmonary hemorrhage and reduces the risk of complications in the event of a hemorrhage.