Chapter 034. Cough and Hemoptysis (Part 4) pot

Cough and Hemoptysis Part 4 Table 34-1 Differential Diagnosis of Hemoptysis Source other than the lower respiratory tract Upper airway nasopharyngeal bleeding Gastrointestinal bleed

Chapter 034 Cough and

Hemoptysis

(Part 4)

Table 34-1 Differential Diagnosis of Hemoptysis

Source other than the lower respiratory tract

Upper airway (nasopharyngeal) bleeding

Gastrointestinal bleeding

Tracheobronchial source

Neoplasm (bronchogenic carcinoma, endobronchial metastatic tumor, Kaposi's sarcoma, bronchial carcinoid)

Bronchitis (acute or chronic)

Bronchiectasis

Broncholithiasis

Airway trauma

Foreign body

Pulmonary parenchymal source

Lung abscess

Pneumonia

Tuberculosis

Mycetoma ("fungus ball")

Goodpasture's syndrome

Idiopathic pulmonary hemosiderosis

Wegener's granulomatosis

Lupus pneumonitis

Lung contusion

Primary vascular source

Arteriovenous malformation

Pulmonary embolism

Elevated pulmonary venous pressure (esp mitral stenosis)

Pulmonary artery rupture secondary to balloon-tip pulmonary artery catheter manipulation

Miscellaneous/rare causes

Pulmonary endometriosis (catamenial hemoptysis)

Systemic coagulopathy or use of anticoagulants or thrombolytic agents

Adapted from SE Weinberger: Principles of Pulmonary Medicine, 4th ed

Philadelphia, Saunders, 2004, with permission

Although the relative frequency of the different etiologies of hemoptysis varies from series to series, most recent studies indicate that bronchitis and bronchogenic carcinoma are the two most common causes in the United States Despite the lower frequency of tuberculosis and bronchiectasis seen in recent compared to older series, these two disorders still represent the most common causes of massive hemoptysis in several series, especially worldwide Even after extensive evaluation, a sizable proportion of patients (up to 30% in some series) have no identifiable etiology for their hemoptysis These patients are classified as

having idiopathic or cryptogenic hemoptysis, and subtle airway or parenchymal disease is presumably responsible for the bleeding