Hemoptysis: Diagnosis and Management

Hemoptysis: Diagnosis and Management
JACOB L. BIDWELL, M.D. and ROBERT W. PACHNER, M.D.
University of Wisconsin Medical School, Milwaukee, Wisconsin
Hemoptysis is the spitting of blood that originated in the lungs or bronchial tubes. The patient’s history should help
determine the amount of blood and differentiate between hemoptysis, pseudohemoptysis, and hematemesis. A focused
physical examination can lead to the diagnosis in most cases. In children, lower respiratory tract infection and foreign
body aspiration are common causes. In adults, bronchitis, bronchogenic carcinoma, and pneumonia are the major
causes. Chest radiographs often aid in diagnosis and assist in using two complementary diagnostic procedures, fiberop-
tic bronchoscopy and high-resolution computed tomography, which are useful in difficult cases and when malignancy
is suspected. The goals of management are threefold: bleeding cessation, aspiration prevention, and treatment of the
underlying cause. Mild hemoptysis often is caused by an infection that can be managed on an outpatient basis with
close monitoring. If hemoptysis persists, consulting with a pulmonologist should be considered. Patients with risk
factors for malignancy or recurrent hemoptysis also require further evaluation with fiberoptic bronchoscopy or high-
resolution computed tomography. In up to 34 percent of patients, no cause of hemoptysis can be found. (Am Fam
Physician 2005;72:1253-60. Copyright © 2005 American Academy of Family Physicians.)
Hemoptysis is defined as the spitting infeCtion
of blood derived from the lungs Infection is the most common cause of
or bronchial tubes as a result of hemoptysis, accounting for 60 to 70 percent
pulmonary or bronchial hemor-
of cases.5 Infection causes superficial mucosal
rhage.1 Hemoptysis is classified as nonmassive inflammation and edema that can lead to
or massive based on the volume of blood loss; the rupture of the superficial blood vessels.
however, there are no uniform definitions for In a retrospective study6 of inpatient and
these categories.2 In this article, hemoptysis outpatient hemoptysis in the United States,
is considered nonmassive if blood loss is less bronchitis caused 26 percent of cases, pneu-
than 200 mL per day.3 The lungs receive blood monia caused 10 percent, and tuberculosis
from the pulmonary and bronchial arterial accounted for 8 percent. Invasive bacteria
systems.4 The low-pressure pulmonary system (e.g., Staphylococcus aureus, Pseudomonas
tends to produce small-volume hemoptysis, aeruginosa) or fungi (e.g., Aspergillus spe-
whereas bleeding from the bronchial system, cies) are the most common infectious causes
which is at systemic pressure, tends to be pro-
of hemoptysis. Viruses such as influenza
fuse.4 Blood loss volume is more also may cause severe hemoptysis.7 Human
useful in directing management immunodeficiency virus (HIV) infection
the first step in making a 
than in reaching a diagnosis.
predisposes patients to several conditions
diagnosis is to differentiate 
After confirming the pres-
that may produce hemoptysis, including pul-
hemoptysis from pseudo­
ence of blood, an initial task monary Kaposi’s sarcoma.8
hemoptysis or hematemesis.
is differentiating between
hemoptysis, pseudohemoptysis CanCer
(i.e., the spitting of blood that does not come Primary lung cancers account for 23 per-
from the lungs or bronchial tubes), and cent of cases of hemoptysis in the United
hematemesis (i.e., the vomiting of blood).
States.6 Bronchogenic carcinoma is a com-
mon lung cancer responsible for hemoptysis
Causes of Hemoptysis
in 5 to 44 percent of all cases.9,10 Bleeding
In the primary care setting, the most common from malignant or benign tumors can be
causes of hemoptysis are acute and chronic secondary to superficial mucosal invasion,
bronchitis, pneumonia, tuberculosis, and erosion into blood vessels, or highly vascular
lung cancer. The differential diagnosis and lesions. Breast, renal, and colon cancers have
underlying etiologies are listed in Table 1.5
a predilection for lung metastasis; however,
October 1, 2005 ◆ Volume 72, Number 7
www.aafp.org/afp
American Family Physician  1253

---

Hemoptysis
sort: Key reCommendations for praCtiCe
Evidence
Clinical recommendation
rating
Reference
Patients with evidence of parenchymal disease should have high-resolution
C
5
CT, and those with a mass should be considered for bronchoscopy.
Patients with normal chest radiograph, no risk factors for cancer,
C
5
and findings not suggestive for infection should be considered for
bronchoscopy or high-resolution CT.
After extensive initial investigation, closely fol ow smokers older than
C
6, 12, 13
40 years who have unexplained hemoptysis.
CT=computed tomography.
A = consistent, good-quality, patient-oriented evidence; B = inconsistent or limited-quality, patient-oriented
evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information
about the SORT evidence rating system, see page 1154 or http://www.aafp.org/afpsort.xml.
metastatic lung carcinoma rarely results in 0.95, respectively. Therefore, the presence or
bleeding.6 Obstructive lesions may cause a absence of hemoptysis alone has no signifi-
secondary infection, resulting in hemoptysis.
cant effect on the likelihood of pulmonary
embolism.11
pulmonary venous Hypertension
Cardiovascular conditions that result in idiopatHy
pulmonary venous hypertension can cause Idiopathic hemoptysis is a diagnosis of exclu-
cardiac hemoptysis. The most common of sion. In 7 to 34 percent of patients with
these is left ventricular systolic heart failure. hemoptysis, no identifiable cause can be
Other cardiovascular causes include severe found after careful evaluation.6,12,13 Prognosis
mitral stenosis and pulmonary embolism. for idiopathic hemoptysis usually is good,
Although hemoptysis is a recognized pulmo-
and the majority of patients have resolution
nary embolism symptom, pulmonary embo-
of bleeding within six months of evaluation.14
lism is an uncommon cause of hemoptysis. However, results from one study13 found
For example, in a patient without under-
an increasing incidence of lung cancer in
lying cardiopulmonary disease, the positive smokers older than 40 years with idiopathic
and negative likelihood ratios for hemop-
hemoptysis, and suggested that these patients
tysis in pulmonary embolism are 1.6 and may warrant close monitoring.13
Table 1
differential diagnosis of Hemoptysis
source other than the lower  
pulmonary parenchymal source
primary vascular source
respiratory tract
Lung abscess
Arteriovenous malformation
Upper airway (nasopharyngeal) bleeding
Pneumonia
Pulmonary embolism
Gastrointestinal bleeding
Tuberculosis
Elevated pulmonary venous pressure
tracheobronchial source
Mycetoma (“fungus bal ”)
(especial y mitral stenosis)
Neoplasm (bronchogenic carcinoma,
Goodpasture’s syndrome
Pulmonary artery rupture secondary to
endobronchial metastatic tumor,
Idiopathic pulmonary
bal oon-tip pulmonary artery catheter
Kaposi’s sarcoma, bronchial carcinoid)
hemosiderosis
manipulation
Bronchitis (acute or chronic)
Wegener’s granulomatosis
miscellaneous and rare causes
Bronchiectasis
Lupus pneumonitis
Pulmonary endometriosis
Broncholithiasis
Long contusion
Systemic coagulopathy or use of
Airway trauma
anticoagulants or thrombolytic agents
Foreign body
Adapted with permission from Weinberger SE. Principles of pulmonary medicine. 3d ed. Philadelphia: Saunders, 1998.
1254  American Family Physician
www.aafp.org/afp
Volume 72, Number 7 ◆ October 1, 2005

---

Hemoptysis
Table 2
differentiating features of Hemoptysis  
and Hematemesis
Hemoptysis
Hematemesis
aspiration, with most cases occurring
in children younger than four years.
History
Another important cause is bronchi-
Absence of nausea
Presence of nausea
ectasis, which often is secondary to
and vomiting
and vomiting
cystic fibrosis. Primary pulmonary
Lung disease
Gastric or hepatic disease
tuberculosis is a rare cause estimated
Asphyxia possible
Asphyxia unusual
to occur in less than 1 percent of
sputum examination
cases.15 Although uncommon, trauma
Frothy
Rarely frothy
is another possible cause. Blunt-force
Liquid or clotted
Coffee ground
trauma may result in hemoptysis sec-
appearance
appearance
ondary to pulmonary contusion and
Bright red or pink
Brown to black
hemorrhage. Bleeding caused by suf-
laboratory
focation, deliberate or accidental, also
Alkaline pH
Acidic pH
should be considered.16
Mixed with macrophages Mixed with food
and neutrophils
particles
patient History 
Information from references 4, 17, and 18.
Historic clues are useful for differen-
tiating hemoptysis from hematemesis
(Table 24,17,18). Patient history also can
Hemoptysis in CHildren 
help identify the anatomic site of bleeding,
The major cause of hemoptysis in children differentiate between hemoptysis and pseu-
is lower respiratory tract infection. The sec-
dohemoptysis, and narrow the differential
ond most common cause is foreign body diagnosis (Table 34,5,17,18). Factors such as age,
Table 3
diagnostic Clues in Hemoptysis: physical History
Clinical clues
Suggested diagnosis*
Anticoagulant use
Medication effect, coagulation disorder
Association with menses
Catamenial hemoptysis
Dyspnea on exertion, fatigue, orthopnea, paroxysmal
Congestive heart failure, left ventricular dysfunction,
nocturnal dyspnea, frothy pink sputum
mitral valve stenosis
Fever, productive cough
Upper respiratory infection, acute sinusitis, acute bronchitis,
pneumonia, lung abscess
History of breast, colon, or renal cancers
Endobronchial metastatic disease of lungs
History of chronic lung disease, recurrent lower
Bronchiectasis, lung abscess
respiratory track infection, cough with copious
purulent sputum
HIV, immunosuppression
Neoplasia, tuberculosis, Kaposi’s sarcoma
Nausea, vomiting, melena, alcoholism, chronic use
Gastritis, gastric or peptic ulcer, esophageal varices
of nonsteroidal anti-inflammatory drugs
Pleuritic chest pain, calf tenderness
Pulmonary embolism or infarction
Tobacco use
Acute bronchitis, chronic bronchitis, lung cancer, pneumonia
Travel history
Tuberculosis, parasites (e.g., paragonimiasis, schistosomiasis, amebiasis,
leptospirosis), biologic agents (e.g., plague, tularemia, T2 mycotoxin)
Weight loss
Emphysema, lung cancer, tuberculosis, bronchiectasis, lung abscess, HIV
HIV = human immunodeficiency virus.
*—Arranged from most to least common diagnosis for each clinical clue.
Information from references 4, 5, 17, and 18.
October 1, 2005 ◆ Volume 72, Number 7
www.aafp.org/afp
American Family Physician  1255

---

Hemoptysis
nutrition status, and comor-
these patients are at higher risk for lung
low­risk patients with nor­
bid conditions can assist in the cancer.19 Chronic obstructive pulmonary
mal chest radiographs can 
diagnosis and management of disease also is an independent risk factor for
be treated on an outpatient 
hemoptysis.
hemoptysis.
basis with close monitor­
Once true hemoptysis is sus-
Environmental exposure to asbestos, arse-
ing and appropriate oral 
pected, the investigation should nic, chromium, nickel, and certain ethers
antibiotics, if medication is 
focus on the respiratory system. increases risk for hemoptysis. Bronchial ade-
clinically indicated.
Blood from the lower bronchial nomas, although malignant, are slow grow-
tree typically induces cough, ing and may present with occasional bleeding
whereas a history of epistaxis or expectorat-
over many years. Malignancy in general,
ing without cough would be consistent with especially adenocarcinomas, can induce a
an upper respiratory source but does not hypercoagulable state, thereby increasing
exclude a lower tract site.
the risk for a pulmonary embolism. A his-
Bleeding is difficult to quantify clinically. tory of chronic, purulent sputum produc-
Patients may find it difficult to discern tion and frequent pneumonias, including
whether they are throwing up, coughing, or tuberculosis, may represent bronchiecta-
spitting out bloody material. The amount sis. Association of hemoptysis with menses
of blood loss usually is overestimated by (i.e., catamenial hemoptysis) may represent
patients and physicians, but an attempt to intrathoracic endometriosis.20
determine the volume and rate of blood
A travel history may be helpful. Tubercu-
loss should be made. Methods of deter-
losis is endemic in many parts of the world,
mination include observing as the patient and parasitic etiologies should be consid-
coughs and the use of a graduated container. ered.21,22 In regions where drinking from
Blood-streaked sputum deserves the same springs is common, there are case reports of
diagnostic consideration as blood alone. hemoptysis caused by leeches attaching to
The amount or frequency of bleeding does the upper respiratory tract mucosa.23 Also,
not correlate with the diagnosis or incidence biologic weapons such as plague may cause
of cancer.
hemoptysis.17,24
It is helpful to determine whether there
have been previous episodes of hemopty-
physical examination
sis and what diagnostic assessments have Historic clues often will narrow the differ-
been done. Mild hemoptysis recurring spo-
ential diagnosis and help focus the physical
radically over a few years is common in examination (Table 44,5,17). Examining the
smokers who have chronic bronchitis punc-
expectoration may help localize the source of
tuated with superimposed acute bronchitis. bleeding.4,17,18 The physician should record
Because smoking is an important risk factor, vital signs, including pulse oximetry levels,
to document fever, tachycardia, tachypnea,
weight changes, and hypoxia. Constitutional
the authors
signs such as cachexia and level of patient
distress also should be noted. The skin and
JACOB L. BIDWELL, M.D., is a University of Wisconsin assistant professor of
Family Medicine at St. Luke’s Medical Center in Milwaukee and serves as medical
mucous membranes should be inspected for
director of Walker’s Point Community Clinic. Dr. Bidwell received his under-
cyanosis, pallor, ecchymoses, telangiectasia,
graduate and medical degrees from the University of Wisconsin, Madison. He
gingivitis, or evidence of bleeding from the
completed his family medicine residency at St. Luke’s Medical Center.
oral or nasal mucosa.
The examination for lymph node
ROBERT W. PACHNER, M.D., is clinical assistant professor with the University
of Wisconsin Department of Family Medicine in Milwaukee. Dr. Pachner gradu-
enlargement should include the neck,
ated from the Medical Col ege of Wisconsin and completed a family practice
supraclavicular region, and axillae. The car-
residency at St. Luke’s Medical Center.
diovascular examination includes an evalua-
tion for jugular venous distention, abnormal
Address correspondence to Jacob L. Bidwel , M.D., University of Wisconsin Medical
School, 2801 W. Kinnickinnie River Parkway, Suite 175, Milwaukee, WI 53215
heart sounds, and edema. The physician
(e-mail: jbidwel @fammed.wisc.edu). Reprints are not available from the authors.
should check the chest and lungs for signs of
1256  American Family Physician
www.aafp.org/afp
Volume 72, Number 7 ◆ October 1, 2005

---

Hemoptysis
consolidation, wheezing, rales, and trauma. bronchoscopy include male sex, older than
The abdominal examination should focus 40 years, a smoking history of more than
on signs of hepatic congestion or masses, 40 pack-years, and duration of hemoptysis
with an inspection of the extremities for for more than one week.26
signs of edema, cyanosis, or clubbing.4,25
Fiberoptic bronchoscopy is preferred if
neoplasia is suspected; it is diagnostic for
diagnostic evaluation
central endobronchial disease and allows for
Figure 15 presents an algorithm for the evalu-
direct visualization of the bleeding site. It
ation of nonmassive hemoptysis. After a also permits tissue biopsy, bronchial lavage,
careful history and examination, a chest or brushings for pathologic diagnosis. Fiber-
radiograph should be obtained (Table 54,17). optic bronchoscopy also can provide direct
If a diagnosis remains unclear, further imag-
therapy in cases of continued bleeding.
ing with chest computed tomography (CT) Rigid bronchoscopy is the preferred tool
or direct visualization with bronchoscopy for cases of massive bleeding because of its
often is indicated. In high-risk patients greater suctioning and airway maintenance
with a normal chest radiograph, fiberoptic capabilities.
bronchoscopy should be considered to rule
High-resolution CT has become increas-
out malignancy. Risk factors that increase ingly useful in the initial evaluation of
the likelihood of finding lung cancer on hemoptysis and is preferred if parenchymal
Table 4
diagnostic Clues in Hemoptysis: physical examination
Clinical clues
Suggested diagnosis*
Cachexia, clubbing, voice hoarseness, Cushing’s syndrome,
Bronchogenic carcinoma, small cell lung cancer, other
hyperpigmentation, Horner’s syndrome
primary lung cancers
Clubbing
Primary lung cancer, bronchiectasis, lung abscess, severe
chronic lung disease, secondary lung metastases
Dul ness to percussion, fever, unilateral rales
Pneumonia
Facial tenderness, fever, mucopurulent nasal discharge,
Acute upper respiratory infection, acute sinusitis
postnasal drainage
Fever, tachypnea, hypoxia, hypertrophied accessory respiratory
Acute exacerbation of chronic bronchitis, primary lung
muscles, barrel chest, intercostal retractions, pursed lip
cancer, pneumonia
breathing, rhonchi, wheezing, tympani to percussion, distant
heart sounds
Gingival thickening, mulberry gingivitis, saddle nose, nasal
Wegener’s granulomatosis
septum perforation
Heart murmur, pectus excavatum
Mitral valve stenosis
Lymph node enlargement, cachexia, violaceous tumors on skin
Kaposi’s sarcoma secondary to human immunodeficiency
virus infection
Orofacial and mucous membrane telangiectasia, epistaxis
Osler-Weber-Rendu disease
Tachycardia, tachypnea, hypoxia, jugulovenous distention,
Congestive heart failure caused by left ventricular
S3 gal op, decreased lung sounds, bilateral rales, dul ness
dysfunction or severe mitral valve stenosis
to percussion in lower lung fields
Tachypnea, tachycardia, dyspnea, fixed split S2, pleural friction
Pulmonary thromboembolic disease
rub, unilateral leg pain and edema
Tympani to percussion over lung apices, cachexia
Tuberculosis
*—Arranged from most to least common diagnosis for each clinical clue.
Information from references 4, 5, and 17.
October 1, 2005 ◆ Volume 72, Number 7
www.aafp.org/afp
American Family Physician  1257

---

Hemoptysis
diagnosing nonmassive Hemoptysis
History and physical examination
Suggests gastrointestinal
Suggests lower
or upper airway source
respiratory
tract source
Pseudohemoptysis or hematemesis
Chest radiograph
Examine to identify source; consider
referral if clinically indicated.
Normal
Mass
Other parenchymal
disease
No risk factors for cancer,
No risk factors for cancer,
Risk factors
Consider chest CT
High-resolution CT
history not suggestive
history suggestive
for cancer
for staging.
of lower respiratory
of lower respiratory
tract infection
tract infection
May observe or consider
Observe and consider
bronchoscopy or
use of oral antibiotic.
high-resolution CT.
Cessation of bleeding
Recurrence of
Bronchoscopy
No specific
Suggests diagnosis
and no recurrence
hemoptysis
diagnosis
suggested
Laboratory evaluation
No further evaluation
focused toward
No specific diagnosis
Suggests diagnosis
suspected diagnosis
suggested
Laboratory evaluation
High-resolution CT
focused toward
suspected diagnosis
Laboratory evaluation
focused toward
suspected diagnosis
figure 1. algorithm for diagnosing nonmassive hemoptysis. (CT = computed tomography.)
Adapted with permission from Harrison TR, Braunwald E. Cough and hemoptysis. In: Harrison’s Principles of internal medicine. 15th ed. New York:
McGraw-Hil , 2001:208.
disease is suspected. Its complementary use management
with bronchoscopy gives a greater posi-
nonmassive Hemoptysis
tive yield of pathology12,27,28 and is use-
The overall goals of management of the
ful for excluding malignancy in high-risk patient with hemoptysis are threefold: bleed-
patients.29 Its role in hemoptysis continues ing cessation, aspiration prevention, and
to evolve, and further studies are needed to treatment of the underlying cause. As with
evaluate its effect on patient management any potentially serious condition, evaluation
and outcome. Patients with recurrent or of the “ABCs” (i.e., airway, breathing, and
unexplained hemoptysis may need addi-
circulation) is the initial step.
tional laboratory evaluation to establish a
The most common presentation is acute,
diagnosis (Table 65,17).
mild hemoptysis caused by bronchitis.
1258  American Family Physician
www.aafp.org/afp
Volume 72, Number 7 ◆ October 1, 2005

---

Hemoptysis
Table 5
diagnostic Clues in Hemoptysis: Chest radiograph
Chest radiograph finding
Suggested diagnosis*
Cardiomegaly, increased
Chronic heart failure, mitral valve stenosis
pulmonary vascular distribution
Cavitary lesions
Lung abscess, tuberculosis, necrotizing carcinoma
Diffuse alveolar infiltrates
Chronic heart failure, pulmonary edema, aspiration, toxic injury
Hilar adenopathy or mass
Carcinoma, metastatic disease, infectious process, sarcoid
Hyperinflation
Chronic obstructive pulmonary disease
Lobar or segmental infiltrates
Pneumonia, thromboembolism, obstructing carcinoma
Mass lesion, nodules,
Carcinoma, metastatic disease, Wegener’s granulomatosis,
granulomas
septic embolism, vasculitides
Normal or no change from
Bronchitis, upper respiratory infection, sinusitis, pulmonary
baseline
embolism
Patchy alveolar infiltrates
Bleeding disorders, idiopathic pulmonary hemosiderosis,
(multiple bleeding sites)
Goodpasture’s syndrome
*—Arranged from most to least common diagnosis for each clinical clue.
Information from references 4 and 17.
Table 6
diagnostic Clues in Hemoptysis: laboratory tests
Test
Diagnostic findings
White blood cell count and
Elevated cell count and differential shifts may be present
differential
in upper and lower respiratory tract infections
Hemoglobin, hematocrit
Decreased in anemia
Platelet count
Decreased in thrombocytopenia
Prothrombin time, International
Increased in anticoagulant use, disorders of coagulation
Normalized Ratio, partial
thromboplastin time
Arterial blood gases
Hypoxia, hypercarbia
D-dimer
Elevated in pulmonary embolism
Sputum Gram stain, culture,
Pneumonia, lung abscess, tuberculosis, mycobacterial
acid-fast bacil us smear and culture
infections
Sputum cytology
Neoplasm
Purified protein derivative skin test
Positive increases risk for tuberculosis
Human immunodeficiency virus test
Positive increases risk for tuberculosis, Kaposi’s sarcoma
Erythrocyte sedimentation rate
Elevated in infection, autoimmune disorders (e.g., Wegener’s

syndrome, systemic lupus erythematosus, sarcoid,
Goodpasture’s syndrome), may be elevated in neoplasia
Information from references 5 and 17.
Low-risk patients with normal chest radio-
warrants an outpatient bronchoscopic exam-
graphs can be treated on an outpatient basis ination. For patients with a normal chest
with close monitoring and appropriate oral radiograph and risk factors for lung cancer or
antibiotics, if clinically indicated. If hemop-
recurrent hemoptysis, outpatient fiberoptic
tysis persists or remains unexplained, an bronchoscopy also is indicated to rule out
outpatient evaluation by a pulmonologist neoplasm. High-resolution CT is indicated
should be considered.
when clinical suspicion for malignancy exists
An abnormal mass on a chest radiograph and sputum and bronchoscopy do not yield
October 1, 2005 ◆ Volume 72, Number 7
www.aafp.org/afp
American Family Physician  1259

---

Hemoptysis
any pathology. High-resolution CT also is
etiology, evaluation, and outcome in a tertiary referral
indicated when chest radiography reveals
hospital. Chest 1997;112:440-4.

11. Anish EJ, Mayewski RJ. Pulmonary embolism. In: Black
peripheral or other parenchymal disease.
ER, ed. Diagnostic strategies for common medical
problems. Philadelphia: American Col ege of Physicians,
massive Hemoptysis
1999:325-37.
The mortality rate from massive hemoptysis 12. Set PA, Flower CD, Smith IE, Chan AP, Twentyman OP,
Shneerson JM. Hemoptysis: comparative study of the
depends on the bleeding rate and etiol-
role of CT and fiberoptic bronchoscopy. Radiology
ogy. Hemoptysis greater than 1,000 mL per
1993;189:677-80.
24 hours in the presence of malignancy car-
13. Herth F, Ernst A, Becker HD. Long-term outcome and
ries a mortality rate of 80 percent30; therefore,
lung cancer incidence in patients with hemoptysis of
unknown origin. Chest 2001;120:1592-4.
massive hemoptysis warrants a more aggres-
14. Adelman M, Haponik EF, Bleecker ER, Britt EJ. Cryp-
sive, expedient approach. These patients
togenic hemoptysis. Clinical features, bronchoscopic
require intensive care and early consultation
findings, and natural history in 67 patients. Ann Intern
Med 1985;102:829-34.
with a pulmonologist. In cases of massive or 15. Pianosi P, al-sadoon H. Hemoptysis in children. Pediatr
life-threatening hemoptysis, diagnosis and
Rev 1996;17:344-8.
therapy must occur simultaneously. Airway 16. Godfrey S. Hemoptysis in children. Pediatr Pulmonol
maintenance is vital because the primary
Suppl 2004;26:177-9.
mechanism of death is asphyxiation, not 17. Corder R. Hemoptysis. Emerg Med Clin North Am
2003;21:421-35.
exsanguination. Supplemental oxygen and 18. Camacho JR, Prakash UB. 46-year-old man with chronic
fluid resuscitation are essential. Assistance
hemoptysis. Mayo Clin Proc 1995;70:83-6.
by a cardiothoracic surgeon should be con-
19. Humphrey LL, Teutsch S, Johnson M; U.S. Preventive
sidered because emergency surgical inter-
Services Task Force. Lung cancer screening with sputum
vention may be needed.
cytologic examination, chest radiography, and com-
puted tomography. Ann Intern Med 2004;140:740-53.
Author disclosure: Nothing to disclose.
20. Weber F. Catamenial hemoptysis. Ann Thorac Surg
2001;72:1750-1.

21. Soni PN, Reddy I, Rauff S. Pneumonia and severe hae-
referenCes
moptysis. Lancet 1998;352:198.
22. Procop GW, Marty AM, Scheck DN, Mease DR, Maw
1. Stedman TL. Stedman’s Medical dictionary. 27th ed.
GM. North American paragonimiasis. A case report.
Philidelphia: Lipincott Wil iams & Wilkins, 2000.
Acta Cytol 2000;44:75-80.
2. Thompson AB, Teschler H, Rennard SI. Pathogenesis,
23. Kaygusuz I, Yalcin S, Keles E. Leeches in the larynx. Eur
evaluation, and therapy for massive hemoptysis. Clin
Arch Otorhinolaryngol 2001;258:455-7.
Chest Med 1992;13:69-82.
24. Inglesby TV, Dennis DT, Henderson DA, Bartlett JG,
3. Knott-Craig CJ, Oostuizen JG, Rossouw G, Joubert
Ascher MS, Eitzen E, et al. Plague as a biological
JR, Barnard PM. Management and prognosis of mas-
weapon: medical and public health management.
sive hemoptysis. Recent experience with 120 patients.
JAMA 2000;283:2281-90.
J Thorac Cardiovasc Surg 1993;105:394-7.
25. Gregory RK, Chang J, Singh R, Powles TJ. Clubbing,
4. Cahill BC, Ingbar DH. Massive hemoptysis. Assessment
arthralgia and haemoptysis in a patient with metastatic
and management. Clin Chest Med 1994;15:147-67.
carcinoma of the breast. Ann Oncol 1996;7:756-7.
5. Harrison TR, Braunwald E. Hemoptysis. In: Harrison’s
26. O’Neil KM, Lazarus AA. Hemoptysis. Indications for
Principles of internal medicine. 15th ed. New York:
bronchoscopy. Arch Intern Med 1991;151:171-4.
McGraw-Hil , 2001:203-6.
27. McGuinness G, Beacher JR, Harkin TJ, Garay SM,
6. Reisz G, Stevens D, Boutwell C, Nair V. The causes
Rom WN, Naidich DP. Hemoptysis: prospective high-
of hemoptysis revisited. A review of the etiologies
resolution CT/bronchoscopic correlation. Chest
of hemoptysis between 1986 and 1995. Mo Med
1994;105:1155-62.
1997;94:633-5.
28. Tasker AD, Flower CD. Imaging the airways. Hemop-
7. Bond D, Vyas H. Viral pneumonia and hemoptysis. Crit
tysis, bronchiectasis, and small airways disease. Clin
Care Med 2001;29:2040-1.
Chest Med 1999;20:761-73,vi i.
8. Nelson JE, Forman M. Hemoptysis in HIV-infected
29. Colice GL. Detecting lung cancer as a cause of hemop-
patients. Chest 1996;110:737-43.
tysis in patients with a normal chest radiograph: bron-
9. Santiago S, Tobias J, Wil iams AJ. A reappraisal of
choscopy vs CT. Chest 1997;111:877-84.
the causes of hemoptysis. Arch Intern Med 1991;151:
30. Jean-Baptiste E. Clinical assessment and manage-
2449-51.
ment of massive hemoptysis. Crit Care Med 2000;28:
10. Hirshberg B, Biran I, Glazer M, Kramer MR. Hemoptysis:
1642-7.
1260  American Family Physician
www.aafp.org/afp
Volume 72, Number 7 ◆ October 1, 2005

---