Hemoptysis (coughing up blood)
Hemoptysis is the coughing up of blood from the respiratory tract. Coughing up blood from the lungs (hemoptysis) is sometimes confused with bleeding from the mouth, throat, or gastrointestinal tract. Hemoptysis often looks frothy because it is mixed with air and sputum (secretions from the airway). It is usually bright red.
Tumors, especially those due to lung cancer, account for up to 20% of cases of hemoptysis. Doctors check for lung cancer in smokers older than 40 (and even in younger smokers if the person started smoking in adolescence) who develop hemoptysis, even if the sputum is only blood streaked. Death of lung tissue (see Pulmonary Embolism) from blockage of an artery by a blood clot (pulmonary embolism) may also cause hemoptysis.Inflammatory causes account for 80 to 90% of hemoptysis cases. Acute or chronic bronchitis is probably the most common cause, because bronchitis and, to a diminishing extent, bronchiectasis cause about 50% of all cases.
The diagnosis of hemoptysis is complicated by the number of possible causes. Bronchoscopy may be needed to identify the bleeding site. A scan using a radioactive marker (lung perfusion scan) may reveal a pulmonary embolism. Despite testing, the cause of hemoptysis is not found in 30 to 40% of cases; however, when hemoptysis is severe, the cause is usually found.
It is important to note the length of time during which hemoptysis occurs. Also important is whether it consists of mostly sputum with a small amount of blood, sputum and blood in nearly equal proportions, or nearly all blood. Also, note any symptoms, such as lightheadedness, dizziness, or thirst, that might indicate a severe amount of blood loss. Other symptoms, such as fever, chest pain, shortness of breath, and blood in the urine may also be important.
For irritation of the throat from violent coughing, cough suppressants may help. Specific treatment of the underlying cause may be recommended by the doctor. Cough suppression may or may not be desirable. Cough suppressants can prevent blood from spreading through the lungs, but they can also lead to airway obstruction from blood that accumulates.
Massive hemoptysis is a life-threatening emergency that requires treatment in an intensive care unit. The patient will be intubated (the insertion of a tube to help breathing) to protect the airway, and to allow evaluation of the source of the bleeding. Patients with lung cancer, bleeding from an aneurysm (blood clot), or persistent traumatic bleeding require chest surgery.