II. Causes: Respiratory Tract

  1. Common Causes of respiratory tract bleeding
    1. Infection (60-70% of Hemoptysis)
      1. Acute Bronchitis (26% of Hemoptysis)
      2. Pneumonia (10% of Hemoptysis)
        1. Staphylococcus aureus
        2. Pseudomonas aeruginosa
      3. Tuberculosis (8% of Hemoptysis)
      4. Influenza
      5. Lung Abscess
      6. Fungal organisms (e.g. fungal ball or mycetoma)
        1. Aspergillosis
        2. Actinomycosis
        3. Blastomycosis
    2. Lung Cancer (23% of Hemoptysis)
      1. Hemoptysis is rarely due to metastases
    3. Obstructive Lung Disease
      1. Asthma
      2. Chronic Obstructive Pulmonary Disease (COPD)
      3. Bronchiectasis
  2. Less common causes of respiratory tract bleeding
    1. Trauma
      1. Lung Contusion
      2. Airway Trauma
      3. Airway Foreign Body (esp. children)
    2. Cardiovascular causes
      1. Pulmonary venous Hypertension
        1. Congestive Heart Failure
        2. Severe Mitral valve stenosis
      2. Pulmonary Embolism
      3. Arteriovenous malformation
      4. Pulmonary artery rupture
      5. Systemic coagulopathy
      6. Catamenial Hemoptysis (pulmonary Endometriosis)
    3. Pulmonary causes
      1. Goodpasture's Syndrome
      2. Wegener's Granulomatosis
      3. Lupus pneumonitis
      4. Idiopathic pulmonary hemosiderosis
    4. Tracheobronchal causes
      1. Bronchiectasis
      2. Broncholithiasis

III. Causes: Pseudohemoptysis

  1. Non-respiratory tract sources
    1. Nasopharyngeal source of bleeding
      1. Evaluate for Oral Ulceration, Gingivitis, tongue Varices, Epistaxis, sinus drainage or pharyngeal source
    2. Upper Gastrointestinal Bleeding
      1. Coffee ground Emesis or darker blood (contrast with frothy Bloody Sputum from the airway)
      2. Associated with gastrointestinal symptoms (e.g. Nausea or Vomiting)
      3. Evaluate for epigastric tenderness or stigmata of Chronic Liver Disease
  2. Other causes
    1. Malingering
    2. Serratia marecens
      1. Associated with recent hospitalization, broad spectrum antibiotic use, or Mechanical Ventilation
      2. Gram Negative Bacteria produces a red pigment that may appear bloody
      3. Sputum exam negative for Red Blood Cells

IV. Causes: Blood streaked Sputum

  1. Upper respiratory inflammation
    1. Nose or nasopharynx
    2. Gums
    3. Larynx
  2. Severe coughing paroxysms
  3. Trauma

V. Causes: Pink Sputum

  1. Blood and secretions mix in alveoli, small Bronchioles
  2. Conditions associated with pink Sputum
    1. Pneumonia
    2. Pulmonary edema

VI. Causes: Heavy Bleeding into respiratory tree

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