Haemoptysis
Haemoptysis is the expectoration of blood or bloodstained sputum. With massive haemoptysis, the main priorities are to secure the airway and initiate emergency resuscitative measures before establishing a diagnosis.
Causes
Respiratory
Figure 31 Chest X-ray of a patient with widespread tuberculosis.
Note the multiple small areas of consolidation (arrows).
Vascular
History
Onset
Sudden onset of haemoptysis can occur with pulmonary embolism and acute respiratory tract infections; the remaining conditions tend to pursue chronic recurrent courses. Although the amount of blood expectorated is not very useful as a discriminating feature, small amounts of blood sufficient to stain the sputum pink are characteristic of pulmonary oedema.
Acute onset of cough with haemoptysis may occur with respiratory tract infections and pulmonary embolism. Associated sputum production may be purulent and longstanding with chronic bronchitis and bronchiectasis. This is accompanied by flecks of blood when lung carcinoma, TB or mitral stenosis is present.
Dyspnoea
A long history of dyspnoea may be associated with chronic lung disease or mitral stenosis. Acute onset of dyspnoea that occurs with pulmonary embolism may be accompanied by pleuritic chest pain. Dyspnoea that is associated with pulmonary oedema may have a variable speed of onset and is often worse on recumbency.
Weight loss
Progressive weight loss is suggestive of TB or bronchial carcinoma, especially with a background of heavy smoking. Night sweats may be an additional accompanying feature of TB.
Other sites of bleeding
Other bleeding sites should be excluded as haematuria may be due to Goodpasture’s syndrome. Epistaxis and haemoptysis occur together with Wegener’s granulomatosis and hereditary haemorrhagic telangiectasia. Epistaxis per se may occasionally be confused with haemoptysis when expectorated sputum is mixed with blood originating from the nasal passages.
