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Haemoptysis

 
 
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Overview

  • Haemoptysis is the coughing up of bloody or blood-tinged sputum. This may be due to disease of the airways, pulmonary parenchyma or pulmonary vasculature.

Aetiology

    • Causes of Haemoptysis

    • Tracheobronchial

    • Cancer
    • Acute bronchitis
    • Chronic bronchitis
    • Bronchiectasis
    • Foreign body aspiration
    • Parenchymal

    • Infection - pneumonia, lung abscess, tuberculosis
    • Inflammatory - Goodpasture’s, Wegener’s granulomatosis
    • Lung contusion
    • Vascular

    • Pulmonary embolism
    • Arteriovenous malformation
    • Not True Haemoptysis

    • Haematemesis (upper GI bleed)
    • Oral source of bleeding
    • Nasopharyngeal bleed

History of Presenting Complaint

    • Onset

    • Whether the sputum was red from the start or began with a cough with or without sputum production.
    • Sputum

      The colour, volume and consistency of the sputum.
    • Bright or dark red sputumHaemoptysis
    • Yellow / green sputum with red streaksSuggestive of infectious cause
    • Pink, frothy sputumCharacteristic of acute pulmonary oedema
    • Coffee groundsSuggestive of haematemesis
    • Associated Symptoms

      Whether the cough is associated with any other symptoms.
    • FeversSuggestive of upper / lower respiratory tract infection
    • Pleuritic chest painSuggestive of pneumonia or PE
    • Chest pain and shortness of breathConcerning for PE
    • Duration

    • Whether the has been coughing up blood for days, weeks, months or years.
    • Course

      The frequency & length of coughing episodes, and whether it varies throughout the day.
    • Worse in the morningCharacteristic of smoker’s cough (chronic bronchitis)
    • Exacerbating Factors

      Whether the cough is triggered by anything.
    • Exacerbated by environmental allergensSuggestive of asthma or chemical exposure
 
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