Chapter 034. Cough and Hemoptysis (Part 4) pot

Chapter 034. Cough and
Hemoptysis
(Part 4)

Table 34-1 Differential Diagnosis of Hemoptysis

Source other than the lower respiratory tract
Upper airway (nasopharyngeal) bleeding
Gastrointestinal bleeding
Tracheobronchial source
Neoplasm (bronchogenic carcinoma, endobronchial metastatic tumor,
Kaposi's sarcoma, bronchial carcinoid)
Bronchitis (acute or chronic)
Bronchiectasis
Broncholithiasis
Airway trauma
Foreign body
Pulmonary parenchymal source
Lung abscess
Pneumonia
Tuberculosis
Mycetoma ("fungus ball")
Goodpasture's syndrome
Idiopathic pulmonary hemosiderosis
Wegener's granulomatosis
Lupus pneumonitis
Lung contusion
Primary vascular source
Arteriovenous malformation
Pulmonary embolism
Elevated pulmonary venous pressure (esp. mitral stenosis)

Pulmonary artery rupture secondary to balloon-tip pulmonary artery
catheter manipulation
Miscellaneous/rare causes
Pulmonary endometriosis (catamenial hemoptysis)
Systemic coagulopathy or use of anticoagulants or thrombolytic agents
Adapted from SE Weinberger: Principles of Pulmonary Medicine, 4th ed.
Philadelphia, Saunders, 2004, with permission
Although the relative frequency of the different etiologies of hemoptysis
varies from series to series, most recent studies indicate that bronchitis and
bronchogenic carcinoma are the two most common causes in the United States.
Despite the lower frequency of tuberculosis and bronchiectasis seen in recent
compared to older series, these two disorders still represent the most common
causes of massive hemoptysis in several series, especially worldwide. Even after
extensive evaluation, a sizable proportion of patients (up to 30% in some series)
have no identifiable etiology for their hemoptysis. These patients are classified as
having idiopathic or cryptogenic hemoptysis, and subtle airway or parenchymal
disease is presumably responsible for the bleeding.