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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