A more recent article on this topic is available. A focused physical examination can lead to the diagnosis in most cases. In children, lower respiratory tract infection and foreign body aspiration are common causes. In adults, bronchitis, bronchogenic carcinoma, and pneumonia are the major causes. Chest radiographs often aid in diagnosis and assist in using two complementary diagnostic procedures, fiberoptic bronchoscopy and high-resolution computed tomography, which are useful in difficult cases and when malignancy is suspected.
The goals of management are threefold: bleeding cessation, aspiration prevention, and treatment of the underlying cause. Mild hemoptysis often is caused by an infection that can be managed on an outpatient basis with close monitoring.
Hemoptysis PowerPoint PPT Presentations
If hemoptysis persists, consulting with a pulmonologist should be considered. Patients with risk factors for malignancy or recurrent hemoptysis also require further evaluation with fiberoptic bronchoscopy or high-resolution computed tomography.
In up to 34 percent of patients, no cause of hemoptysis can be found. Hemoptysis is defined as the spitting of blood derived from the lungs or bronchial tubes as a result of pulmonary or bronchial hemorrhage. Patients with evidence of parenchymal disease should have high-resolution CT, and those with a mass should be considered for bronchoscopy. Patients with normal chest radiograph, no risk factors for cancer, and findings not suggestive for infection should be considered for bronchoscopy or high-resolution CT.
After extensive initial investigation, closely follow smokers older than 40 years who have unexplained hemoptysis. After confirming the presence of blood, an initial task is differentiating between hemoptysis, pseudohemoptysis i. In the primary care setting, the most common causes of hemoptysis are acute and chronic bronchitis, pneumonia, tuberculosis, and lung cancer.
The differential diagnosis and underlying etiologies are listed in Table 1. Pulmonary artery rupture secondary to balloon-tip pulmonary artery catheter manipulation.
Adapted with permission from Weinberger SE. Principles of pulmonary medicine.After you enable Flash, refresh this page and the presentation should play. Get the plugin now. Toggle navigation. Help Preferences Sign up Log in. To view this presentation, you'll need to allow Flash.
Click to allow Flash After you enable Flash, refresh this page and the presentation should play. View by Category Toggle navigation. Products Sold on our sister site CrystalGraphics. Title: Diagnosis and Management of Massive Hemoptysis. Tags: diagnosis hemoptysis management massive weck. Latest Highest Rated. At least in early series, in operable patients, mortality rates were lower in patients managed surgically than in medically managed patients though medical management was conservative, i.
All patients had imaging and bronchoscopy Results Cryptogenic hemoptysis in 13 of all patients referred for hemoptysis N 84 of Data available in N 81 Mean age Chest film with alveolar infiltrate in 20 Bronchoscopy showed endobronchial blood in 93 N 75 Localized acute bleeding in 39 Conservative management no surgery, no bronchial arteriogram in N 31 mean 65 ml blood Bronchial arteriography in N 50 mean ml From Savale L et al. In all 50 bronchial arteriograms, abnormality found Arterial enlargement 86 Local hypervascularity 64 Systemic to pulmonary shunt 8 Contrast extravasation 8 Unable to cannulate artery or spinal artery seen in 14 From Savale L et al.
Bleeding controlled of those treated conservatively mean 65 ml blood 30 ml 91 of those with bronchial arteriography Surgery needed in N 6 during initial hospitalization because of failed bronchial arteriogram N 4 or uncontrolled bleeding N 2 and N 3 later because of recurrence In 5 of 9, Dieulafoy disease superficial vessel From Savale L et al. Am J Respir Crit Care - 87 Conclusions Regarding the Treatment of Massive Hemoptysis in In general, bronchial embolization is a reasonable first-line treatment for massive hemoptysis under the following conditions The source of bleeding has been lateralized.
Experienced angiographers are available. Bleeding is not so profuse as to require a single, definitive treatment. The presumed cause of massive hemoptysis is likely to be controlled by bronchial embolization e. Exsanguinating hemoptysis is occurring e.
Life-threatening hemoptysis is not likely to be successfully controlled by bronchial embolization, e. Whether your application is business, how-to, education, medicine, school, church, sales, marketing, online training or just for fun, PowerShow. And, best of all, most of its cool features are free and easy to use.
You can use PowerShow. Or use it to find and download high-quality how-to PowerPoint ppt presentations with illustrated or animated slides that will teach you how to do something new, also for free. Or use it to upload your own PowerPoint slides so you can share them with your teachers, class, students, bosses, employees, customers, potential investors or the world. That's all free as well! For a small fee you can get the industry's best online privacy or publicly promote your presentations and slide shows with top rankings.
But aside from that it's free. We'll even convert your presentations and slide shows into the universal Flash format with all their original multimedia glory, including animation, 2D and 3D transition effects, embedded music or other audio, or even video embedded in slides.
All for free. Most of the presentations and slideshows on PowerShow. You can choose whether to allow people to download your original PowerPoint presentations and photo slideshows for a fee or free or not at all. Check out PowerShow.Toggle navigation. Help Preferences Sign up Log in. Featured Presentations. Hemoptysis - Tachypnea, tachycardia, rales, ronchi. Blood tinged secretions.
A-a gradient Migration of Foley catheter balloon used to tamponade epistaxis. Near drowning Tachypnea, tachycardia, rales, ronchi. Airways diseases The most common source of hemoptysis is airways disease Inflammatory diseases, such as bronchitis or bronchiectasis Neoplasms, If the bleeding occurs monthly, it may be menstrual-related, Pattern of blood Patients with bronchitis or bronchiectasis usually have recurrent, brief episodes.
Rejet par la bouche, de sang venant de la partie sous glottique de Anywhere from blood-tinged sputum to massive bleeding Sputum resembles anchovy sauce in amebic lung abscess. Coughing up of blood. A 42 yearold woman with chronic hemoptysis - A 42 yearold woman with chronic hemoptysis.
A 30 yearold woman with hemoptysis - The patient developed severe R pleuritic CP, temp to Temperature and dysphagia resolved within 5 hours and chest wall pain resolved The patient developed severe R pleuritic CP, temp to Eisenmenger Syndrome - Pulmonary vascular obstructive disease that develops as a Epistaxis, hemoptysis, massive bleeding. Not fully understood. Pulmonary vascular obstructive disease that develops as a Chitra Rajeswari Dr Mitral Stenosis Dr.Endoscopic Laryngotracheal Evidence of Haemoptysis
Night sweats. DNA Probe. Wet Mount. Weight loss. Respiratory Symptoms Zhao Li, M. Pleural Effusion - Evaluation if pleural fluid Evaluation if pleural fluid Evaluation if pleural fluid Evaluation if pleural fluid Hayat Kamfar Dr.
Saad Alsaedi Pediatric department Continue. Non-specific EKG changes. Rt sided Ht strain Management and Treatment Congo hemorrhagic fever Nonsmoker 0.Hemoptysis is the coughing up of blood or blood-stained mucus from the bronchilarynxtracheaor lungs.
In other words, it is the airway bleeding.
This can occur with lung cancerinfections such as tuberculosisbronchitisor pneumoniaand certain cardiovascular conditions. In such cases, there are always severe injuries. The primary danger comes from choking, rather than blood loss. The most common causes for hemoptysis in adults are chest infections such as bronchitis or pneumonia. Other common causes include lung cancers and tuberculosis. Less common causes include aspergillomabronchiectasiscoccidioidomycosispulmonary embolismpneumonic plagueand cystic fibrosis.
Rarer causes include hereditary hemorrhagic telangiectasia HHT or Rendu-Osler-Weber syndromeGoodpasture's syndromeand granulomatosis with polyangiitis. A rare cause of hemoptysis in women is endometriosiswhich leads to intermittent hemoptysis coinciding with menstrual periods.
Blood-laced mucus from the sinus or nose area can sometimes be misidentified as symptomatic of hemoptysis such secretions can be a sign of nasal or sinus cancerbut also a sinus infection. Extensive non-respiratory injury can also cause one to cough up blood. Cardiac causes like congestive heart failure and mitral stenosis should be ruled out. The origin of blood can be identified by observing its color.
Bright-red, foamy blood comes from the respiratory tract, whereas dark-red, coffee-colored blood comes from the gastrointestinal tract. Sometimes hemoptysis may be rust-colored. Treatment depends on the underlying cause. Treatments include iced salineand topical vasoconstrictors such as adrenalin or vasopressin.
Selective bronchial intubation can be used to collapse the lung that is bleeding. Also, endobronchial tamponade can be used. Laser photocoagulation can be used to stop bleeding during bronchoscopy.
Diagnosis and management of hemoptysis
Angiography of bronchial arteries can be performed to locate the bleeding, and it can often be embolized. Cough suppressants can increase the risk of choking. From Wikipedia, the free encyclopedia. Medical symptom: bloody mucus from coughing.
This article uses citations that link to broken or outdated sources. Please improve the article or discuss this issue on the talk page. Help on using footnotes is available. June Learn how and when to remove this template message. Pocket medicine Fifth ed. LeBlond Clinical Radiology. Mayo Foundation for Medical Education and Research. Retrieved 3 March August November February BMJ Open. European Radiology.Hemoptysis is the expectoration of blood that originates from the lower respiratory tract.
This article aims to provide a comprehensive literature review on hemoptysis, analyzing its causes and pathophysiologic mechanisms, and providing details about anatomy and imaging of systemic bronchial and nonbronchial arteries responsible for hemoptysis. Strengths and limits of chest radiography, bronchoscopy, multidetector computed tomography MDCTMDCT angiography and digital subtraction angiography to assess the cause and lead the treatment of hemoptysis were reported, with particular emphasis on MDCT angiography.
Treatment options for recurrent or massive hemoptysis were summarized, highlighting the predominant role of bronchial artery embolization. Finally, a guide was proposed for managing massive and non-massive hemoptysis, according to the most recent medical literature. In clinical practice hemoptysis is a common symptom, which may require further investigation.
It is defined as the expectoration of blood that originates from the lower respiratory tract 1. Bleeding from the upper airways is excluded from this definition. The blood volume expectorated over 24 hours is generally used for distinguishing massive and nonmassive hemoptysis, although the choice of a cutoff value is controversial 3. Volumes of to mL of blood 4 — 9 have been described as indicative of massive hemoptysis, but no specific volume has been universally accepted.
Asphyxia due to the flooding of the airways rather than exsanguination is usually the cause of death, and it is commonly accompanied by cardiovascular collapse. Therefore, prompt recognition of severe hemoptysis and identification of its causes are mandatory to initiate an adequate treatment and to avoid fatal complications 6.
Imaging plays a relevant role in managing this clinical condition. This article aims to provide a comprehensive review on massive and nonmassive hemoptysis, with particular emphasis on the pathophysiologic mechanisms, the anatomy of systemic and pulmonary arteries responsible for hemoptysis, and the role of imaging modalities in diagnosing causes and helping treatment.
Strengths and limitations of the various diagnostic modalities will be analyzed and a guide for managing hemoptysis, according to the most recent medical literature, will be proposed. Hemoptysis has multiple causes usually categorized under parenchymal diseases, airway diseases, and vascular diseases. Bleeding may originate from small or large lung vessels Bleeding from the small vessels usually causes a focal or diffuse alveolar hemorrhage and is mainly due to immunologic, vasculitic, cardiovascular, and coagulatory causes Table 1.
Causes of bleeding from the large vessels include infectious, cardiovascular, congenital, neoplastic, and vasculitic diseases Table 2. However, the most frequent diseases causing hemoptysis are bronchiectasis, tuberculosis, fungal infections, and cancer 47.
Two arterial vascular systems supply blood to the lungs: the pulmonary arteries and the bronchial arteries. The bronchial arteries supply nourishment to the extra- and intrapulmonary airways and to the pulmonary arteries vasa vasorumwithout being involved in the gas exchange 8. Mediastinal lymph nodes and nerves, visceral pleura, esophagus, vasa vasorum of the aorta, and pulmonary veins are also provided by the bronchial arteries 4.To view the entire topic, please sign in or purchase a subscription.
The Washington Manual of Medical Therapeutics helps you diagnose and treat hundreds of medical conditions. Explore these free sample topics:. Aortic Regurgitation. Mitral Stenosis. Hemoptysis is the coughing up of blood or blood-stained mucus. It is a sign of an underlying pulmonary pathologic process. It can be life-threatening and as such requires rapid identification, workup, and treatment.
It may also be classified by the anatomic location of the bleeding. There are various other classifications in the literature based on appearance, frequency, rate, volume, and potential for clinical consequences of the hemoptysis that may suggest an underlying etiology or predict outcome and thus help guide in diagnosis and management.
However, considerable overlap exists in the clinical presentation both within and between etiologies. The incidence of each cause of hemoptysis varies considerably. Listed are some of the most common causes of hemoptysis. The source of hemoptysis depends on the etiology and location of the underlying pathologic process. There's more to see -- the rest of this entry is available only to subscribers. Washington Manual of Medical Therapeutics.
Tags Type your tag names separated by a space and hit enter. Hemoptysis is a topic covered in the Washington Manual of Medical Therapeutics. General Principles. Citation Williams, Dominique, et al. Washington Manualwww.
Wolters Kluwer Health; Accessed April 18, In Williams, D. Wolters Kluwer Health. Hemoptysis [Internet]. Want to read the entire topic? Browse sample topics. Contact Us. Email Phone Best time to call:. Morning Afternoon. Want to see more products from Unbound Medicine? Explore our products.Hemoptysis is coughing up of blood from the respiratory tract. In hemoptysis, the blood generally arises from this bronchial circulation, except when pulmonary arteries are damaged by trauma, by erosion of a granulomatous or calcified lymph node or tumor, or, rarely, by pulmonary arterial catheterization or when pulmonary capillaries are affected by inflammation.
Blood-streaked sputum is common in many minor respiratory illnesses, such as upper respiratory infection and viral bronchitis. The differential diagnosis is broad see table Some Causes of Hemoptysis. Tuberculosis TB. Cavitary Aspergillus infection is increasingly recognized as a cause but is not as common as cancer. Foreign body aspiration. The most common causes of massive hemoptysis have changed over time and vary by geographic region but include the following:. Bronchogenic carcinoma.
TB and other pneumonias. Suggestive Findings. Tracheobronchial source. Bronchitis acute or chronic. Chronic: Cough on most days of the month or for 3 months per year for 2 successive years in patients with known COPD or smoking history.
Chronic cough typically in an infant or young child without symptoms of an upper respiratory infection. Tumor bronchogenic, bronchial, metastatic, Kaposi sarcoma. Pulmonary parenchymal source. Active granulomatous disease tuberculousfungal, parasitic, syphilitic or mycetoma fungus ball. Goodpasture syndrome. Granulomatosis with polyangiitis. Biopsy of any affected area eg, kidney, skin with cANCA testing and demonstration of vasculitis in small to medium-sized arteries.
Lung abscess. Fever, cough, dyspnea, and pleuritic chest pain in patients with a history of systemic lupus erythematosus. Primary vascular source.
Aortic aneurysm with leakage into the pulmonary parenchyma. Dyspnea while lying flat orthopnea or appearing 1—2 hours after falling asleep paroxysmal nocturnal dyspnea.