Coughing up blood is also known as hemoptysis. The blood originates from either the lungs or the bronchial tubes (the airway connecting the lungs with the lower end of the trachea). Hemoptysis can range from just a mild red-colored staining of the coughed-up sputum to coughing up of fresh blood. The coughed up sputum or blood may contain blood clots also. Coughing up more than 200 ml of blood per day is usually considered massive hemoptysis which usually requires urgent medical and/or surgical intervention in an intensive care setting.
Causes of Coughing Up Blood
The most important causes of coughing blood in the adults are bronchitis, lung cancer, pneumonia and tuberculosis (rare in developed nations). However, in children, lower respiratory tract infections and aspiration of foreign body are the most common causes. The table given below mentions the most important causes of hemoptysis.
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Cause |
Comments |
|---|---|
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Tumors |
Neoplasm in the lung or bronchial tree can cause hemoptysis. Hemoptysis in persons at risk (age > 40 yrs and/or smoker) requires thorough evaluation for presence of lung cancer. |
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Bronchitis |
Both acute and chronic bronchitis (inflammation of the bronchi) can cause hemoptysis. It is one of the most common causes. |
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Pneumonia |
It is inflammation of the lung tissue, often caused by infection. Pneumonia is also a common cause of hemoptysis. |
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Lung Abscess |
Localized collection of pus in the lungs caused by infections is known as lung abscess. |
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Tuberculosis |
This is the most important cause of hemoptysis in developing countries. In developed countries, tuberculosis is an unlikely cause for coughing up blood unless the person is immunocompromised (AIDS, anti-cancer therapy, etc.) or has history of travel to a developing nation. |
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Lung / Airway Trauma |
Injury to lung (lung contusion) or the airways (bronchi, trachea) can cause coughing of blood. |
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Foreign Body in Airway |
Foreign body in trachea or bronchus can cause hemoptysis. This is more common in children. |
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Bronchiectasis |
Destruction of bronchus resulting in localized dilation of bronchial tree is known as bronchiectasis. |
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Pulmonary Embolism |
Sudden blockage of the pulmonary artery or its branch by emboli is known as pulmonary embolism. It is a rare cause of hemoptysis. |
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Arteriovenous Malformations |
AV malformations are abnormal connections between the veins and arteries. AV malformations in lung tissue can cause hemoptysis. |
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Pulmonary Aspergilloma |
Mycetoma or pulmonary aspergilloma is a fungal infection (aspergillus species) that grows in a lung cavity. |
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Idiopathic |
Many times no cause for the hemoptysis is found even after thorough evaluation. Such cases are referred to as idiopathic. |
General Approach to Management of Hemoptysis
Stopping the coughing up of blood and prevention of aspiration is the immediate goal of management. Further treatment is focused on the cause of the hemoptysis.
- One of the most important steps in the management of coughing up blood is thorough evaluation for the presence of cancer in high-risk individuals (old age and/or history of smoking tobacco).
- Mild hemoptysis caused by non-malignant conditions is usually treated conservatively on outpatient basis. Treatment depends upon the cause of hemoptysis. E.g. bronchitis and pneumonia are treated with antibiotics. Chest X-ray, CT-scan and bronchoscopy are the main diagnostic modalities used for the evaluation of hemoptysis.
- Massive hemoptysis requires immediate intensive care with hospitalization. Maintaining airway for respiration is the most important step as death is usually caused by the asphyxiation (and not blood loss). Emergency surgery might be needed depending upon the cause of the hemoptysis.