Hemoptysis is the expectoration of blood originating from the lower respiratory tract. It is a significant clinical symptom that can indicate various underlying conditions.

Causes

The main causes of hemoptysis can be categorized into:

• Parenchymal diseases
• Airway diseases
• Vascular diseases

Common specific causes include:

• Bronchiectasis
• Tuberculosis
• Fungal infections
• Lung cancer
• Chronic bronchitis
• Pneumonia
• Pulmonary embolism
• Cardiovascular conditions (e.g., mitral stenosis, heart failure)
• Vasculitis (e.g., granulomatosis with polyangiitis)

Pathophysiology

Hemoptysis can occur due to:

• Bleeding from small vessels: Causing focal or diffuse alveolar hemorrhage
• Bleeding from large vessels: Often due to infectious, cardiovascular, or neoplastic diseases
• Complex capillary anastomoses between pulmonary and bronchial arteries
• Neovascularization in chronic inflammatory conditions
• Pulmonary arterial sources in certain cases

Clinical Presentation

Symptoms associated with hemoptysis may include:

• Cough with blood-tinged sputum
• Fever and purulent sputum in cases of infection
• Dyspnea and chest pain
• Weight loss and night sweats in cases of malignancy or tuberculosis

Diagnosis

Diagnostic approach includes:

• Detailed medical history and physical examination
• Chest X-ray
• CT angiography
• Bronchoscopy
• Laboratory tests (e.g., complete blood count, coagulation studies)

Treatment

Treatment depends on the underlying cause and severity:

• Conservative management for mild cases
• Bronchial artery embolization for massive or recurrent hemoptysis
• Antibiotics for infectious causes
• Bronchoscopic interventions for localized bleeding
• Surgery in select cases (e.g., localized bronchiectasis, resectable tumors)