Haemoptysis

Abstract

Haemoptysis is the expectoration of blood or blood-stained sputum resulting from haemorrhage into the respiratory tract. Massive haemoptysis (5% of cases) is usually defined as >600 ml in 24 hours. Haemoptysis is a common and non-specific symptom. It can vary from blood-streaked sputum to massive, life-threatening haemorrhage. Haemoptysis may originate from the bronchial arteries (90%), pulmonary arteries (5%), or non-bronchial collaterals. Haemoptysis causing haemodynamic instability and/or respiratory compromise is a medical emergency. Unexplained haemoptysis may herald a serious underlying lung condition and therefore requires a thorough diagnostic workup. The majority of patients can be safely investigated and managed as outpatients. Urgent workup or inpatient management will be determined by the rate and severity of bleeding, and knowledge of either the source of bleeding and/or the underlying condition. This chapter covers the approach to diagnosis, diagnostic tests, therapies, prognosis, and dealing with uncertainty.