Hemoptysis

The detection of blood in sputum - hemoptysis (coughing up blood) - is of great clinical importance. Depending on the blood content, the sputum may become pink, red or brown. In Russian literature, the terms "haemoptysis" and "haemoptoe" can be found to denote hemoptysis. These terms cannot be considered synonyms: in practical terms, it is important to distinguish between bloody impurities in sputum (haemoptysis) and the release of pure scarlet blood (haemoptae), which is usually foamy. In this case, blood can be detected in sputum (usually mucous or mucopurulent) both in the form of bloody streaks, which is typical for haemoptysis, and in the form of individual clots or a scarlet mass with an alkaline reaction (pulmonary hemorrhage - haemoptoe). Massive haemoptoe is spoken of in pulmonary hemorrhages in the volume of more than 200 ml/day. Usually in such a case, urgent bronchoscopy and appropriate surgical intervention are required - occlusion of the bronchial artery or bronchus, resection of a lobe or segment of the lung, ligation of the bronchial arteries, etc.

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Causes of Hemoptysis (Coughing Up Blood)

The reasons for the appearance of blood in sputum can be divided into three groups.

1. Inflammatory diseases - bronchiectasis, bronchitis, pulmonary tuberculosis (involving the bronchi or cavernous process), lung abscess, pneumonia (especially caused by Klebsiella ), acute respiratory viral infections.
2. Neoplasms - lung cancer (primarily bronchigenic).
3. Other conditions.

Causes of coughing up blood

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Features of coughing up blood in various diseases

In lobar pneumonia, the presence of blood in the sputum gives it a characteristic rusty hue - “rusty sputum”.

• In bronchogenic cancer, hemoptysis is usually moderate but persistent; less frequently, sputum in the form of "raspberry jelly" is noted (usually with pronounced tumor damage). With the constant release of small portions of fresh blood over several days, bronchogenic cancer should be suspected, the likelihood of which is highest in a man who has smoked for a long time.
• In bronchiectatic disease, due to erosions of the bronchial mucosa in areas of inflammation or atrophy, the walls of small vessels are easily damaged.
• The disintegration of lung tissue (abscess, tuberculous cavity, aseptic necrosis in Wegener's granulomatosis, hemorrhagic alveolitis in systemic vasculitis) is often accompanied by massive bleeding.
• In mitral stenosis, high pressure in the left atrium and, consequently, high pressure in the pulmonary veins can cause damage to the small veins of the bronchi and hemoptysis. In the case of mitral stenosis, hemoptysis serves as a clinical guide to assess the degree of pulmonary hypertension.
• In acute left ventricular failure, due to acute blood stagnation in the vessels of the pulmonary circulation (including the pulmonary capillaries), pulmonary edema develops, in which a large amount of bloody foamy fluid is released from the respiratory tract.

Treatment with anticoagulant drugs causes a decrease in the clotting ability of the blood.

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Diagnosis of hemoptysis (coughing up blood)

First of all, it is necessary to exclude the entry of blood into the sputum from the nose, nasopharynx, ulcers of the larynx, polyps of the upper respiratory tract, as well as bleeding from dilated veins of the esophagus and gastric bleeding. Of great diagnostic importance is the detection of episodes of acute respiratory viral infections or venous thrombosis (especially deep veins of the lower extremities (usually accompanied by leg edema) with pulmonary embolism and pulmonary infarction) preceding hemoptysis.

Diagnostic tactics when detecting hemoptysis require taking into account the following points.

• If hemoptysis is detected, a thorough examination is necessary to determine its cause.
• The recurrence of hemoptysis in a patient may be caused not only by the disease with which hemoptysis was associated in the past, therefore, with any episode of the appearance of blood in the sputum, a repeated full examination is necessary, despite a recent examination for the same reason.

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