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Hemoptysis
Hemoptysis is the coughing up of blood or blood-stained mucus from the bronchi, larynx, trachea, or lungs. This can occur with lung cancer, infections such as tuberculosis, bronchitis, or pneumonia, and certain cardiovascular conditions.
Differential Diagnosis
Non Cardiopulmonary epistaxis, upper GI bleed, coagulopathy
Cardiac HF, mitral Stenosis
Pulmonary
Airway bronchitis (acute, chronic), bronchiectasis, malignancy, foreign body, trauma
Parenchyma
*   Malignancy lung cancer, metastasis
* Infections necrotizing pneumonia (Staphylococcus, Pseudomonas), abscess, septic emboli, TB, fungal
* Alveolar Hemorrhage Wegener’s granulomatosis, Churg Strauss, Goodpasture disease, pulmonary capillaritis, connective tissue disease
Vascular pulmonary embolism, pulmonary hypertension, AVM, iatrogenic
Pathophysiology
Massive Hemoptysis 100 to 600 mL blood in 24 h. Patients may die of asphyxiation (rather than exsanguination)

Clinical Features
History characterize hemoptysis (amount, frequency, previous history), cough (productive), dyspnea, chest pain, epistaxis, hematemesis, weight loss, fever, night sweats, exposure, travel, joint inflammation, rash, visual changes, past medical history (smoking, lung cancer, TB, thromboembolic disease, cardiac disease), medi cations (warfarin, ASA, NSAIDs, natural supplements)
Physical vitals, weight loss, clubbing, cyanosis, lymphadenopathy, Horner’s syndrome, respiratory and cardiac examination, leg swelling (HF or DVT), joint examination, skin examination
Investigations
Basic
Labs CBCD, electrolytes, urea, Cr, INR, PTT, urinalysis
Microbiology blood C&S, sputum Gram stain/ AFB/fungal/C&S/cytology
Imaging CXR, CT chest (warranted in most patients unless obvious explanation)
BRONCHOSCOPY warranted in most patients unless obvious explanation
Special
Etiology Workup ANA, p anca (myeloperoxidase MPO antibodies), c anca (antiproteinase 3 PR3 antibodies), anti GBM antibody, rheumatologic screen
ABG if respiratory distress
Managment
Acute ABC, O2, IV, intubation to protect airway if significant hemoptysis
Symptoms Control cough suppressants, sedatives, stool softeners. Transfusions. Urgent interventional bronchoscopy (topical epinephrine, cold saline, cautery). Angiographic arterial embolization. Lung resection
Treatment correct coagulopathy (vitamin K 10 mg SC x 1 dose or FFP); antibiotics; radiation for tumors; diuresis for HF; immunosup pression for vasculitis
Specific Entities
Goodpasture Disease
Pathophysiology antibasement membrane antibodies ͢   attack pulmonary and renal base ment membrane
Clinical Features hemoptysis and hematuria, with respiratory and renal failure if severe
Diagnosis lung/kidney biopsy

Treatment steroids, cyclophosphamide, plasma pheresis

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