Hemoptysis（咯血）

Xiaolong Wang(王晓龙）
Vice professor
Emergency Department
The 2nd affiliated hospital of CMU
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 Contents
Definition
Pathophsiology
Etiology
Clinical feature
Diagnosis and diffrential diagnosis
key points of inquiry
Cases
Summary

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 New words

Hemoptysis－－－咯血
Hemate’mesis－－－呕血
Bronchiectasis－－－支气管扩张
Tuberculosis－－－结核
Purulent sputum－－－脓痰
Bronchoscopy－－－支气管镜
Angiograph－－－血管造影

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 Definition
• Hemoptysis the expectoration of blood from
the lower respiratory tract( ’trachea, bronchus and
lung).

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 Definition
“Pseudohemoptysis” （ 假 性 咯 血 ） : bleeding
originates but not from the lower respiratory
tract.Bleeding from nose, pharynx , throat or mouth.
• Hematemesis( 呕 血 ) ： blood is thrown up from
esophagus or gastrointestinal tract.

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 Pathophsiology

The lungs are supplied with a dual circulation

1) the pulmonary arteries
Arise from the right ventricle;
Low pressure(mean pulmonary artery pressure
is less than 20 mmHg)
2) the bronchial arteries
Originate at the aorta;High pressure(mean
aortic artery pressure is more than 65 mmHg) 6
 Pathophsiology

• Mostly (95%): low-pressure pulmonary

arteries → pulmonary capillary bed, which
is responsible for gas-exchange.
• Others (5%): high-pressure bronchial
arteries, which supplies oxygen and
nutrition to bronchus and parenchyma.
– Supply major airways and supporting
structures
– Is frequently the source of hemoptysis
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 Pathophsiology

• Mostly (95%): low-pressure

arise from the right ventricle 8

 Hemoptysis originate
• Blood usually from bronchial circulation
• Rarely from pulmonary circulation
– Usually produce small-volume hemoptysis

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 Definition
• Hemoptysis is a symptom of many
underlying disorders.
• The amount of hemoptysis may range
from blood-stained to massive , even life-
threatening.

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 Etiology
• Respiratory and cardiovascular diseases are major
causes
• Blood dyscrasias (leukemia and aplastic anemia)
• Infectious diseases (epidemic hemorrhage fever)
• Rheumatic diseases (SLE, wegener’s ranulomatosis)
• Iatrogenic hemorrhage
 Etiology
Respiratory disorders caused hemoptysis:
• Bronchial diseases
bronchiectasis(支扩) , bronchial tuberculosis,
bronchial lung cancer
• Pulmonary diseases
pneumonia ,tuberculosis, lung abscess, blood
vessel disorders

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 Etiology
⚫ Cardiovascular disease
pulmonary embolism, ‘mitral( 二 尖 瓣 ) stenosis,
left-ventricular （ 心 室 ） failure, and severe
pulmonary hypertension.

⚫ Other diseases
hematologic （ 血 液 ） diseases, Wegener’s
granuloma’tosis, Goodpasture’s syndrome.

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Bronchiectasis

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Pulmonary tuberculosis

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Lung cancer

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 Clinical feature
Depending on:
• Age
• The quantity of bleeding
• Underlying diseases
• Accompanied symptoms

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 Clinical feature
1. Age
• Young people: tuberculosis,
brochiaectasis, mitral stenosis
• ≥40 years old: lung cancer (especially
smoking ≥ 20 cigarettes/d and ≥20 years)
• Children: leukemia

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 Clinical feature
2. The quantity of bleeding

⚫ Mild hemoptysis: ≤100ml/24hrs.

⚫ Moderate hemoptysis: 100ml to 500ml/24hrs.

⚫ Massive hemoptysis: ≥500ml/24hrs.

≥100ml/one time

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 Clinical feature
Massive hemoptysis:

leading to as’phyxia
（窒息）

life-threatening

medical emergency
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 Clinical feature
3. Color and character

⚫ Bright red: TB(tuberculosis), bronchiectasis

⚫ Dark red: heart diseases (mitral stenosis)
⚫ Rust-colored: pneumococcal pneumonia
⚫ ‘Foamy and pink-colored: heart failure
⚫ Blood streak: lung cancer
⚫ Currant jelly: Klebsiellar pneumonia

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 Clinical feature
4. Accompanied symptoms

⚫ Chest pain: pneumonia, lung cancer involved

pleura or ribs
⚫ Fever: infectious diseases
⚫ Purulent sputum: bronchiectasis, lung abscess
⚫ Systemic Bleeding: hematologic diseases

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 Diagnosis

➢ Confirmation of hemoptysis

Diagnostic ➢ Assessing the severity of

procedures hemoptysis

➢ Determining the causes and

location

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 1. Diagnosis & differential diag
hemoptysis hematemesis

TB, Bronchiectasis, gastroin’testinal and

Causes lung cancer, liver diseases
(medical history) pneumonia, heart
disease etc.
Bleeding by coughing up throwing up
Color Bright red Dark brown, dark red,
Mixed with sputum Foods
pH Alkaline Acidity
Me‘lena(黑便) no or rare Last for days
Expectoration for few days no
post-bleeding 24
 Diagnosis
2. Assessment of severity
Amount of hemoptysis
⚫ Mild
⚫ Moderate
⚫ Massive
At high risk?
⚫ Asphyxia(窒息)?
⚫ Shock?
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 Diagnosis
3. Determining the causes and the
location of bleeding.
⚫ Inquiry of medical history
⚫ Sputum examination
⚫ Radiograph
⚫ CT scan
⚫ Bronchoscopy
⚫ Angiography
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key points of inquiry
◼ Hemoptysis or hematemesis: history, color,
melena, cough, vomiting and so on
◼ Characteristic and amount of hemoptysis
◼ Accompanied symptoms : cough, chest pain,
purulent sputum and so on.
◼ Accompanied systemic symptoms: systemic
bleeding, jaundice

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 Cases
⚫ Bronchiectasis

⚫ Middle age man

⚫ Massive hemoptysis
⚫ Repeating cough &
Chronic purulent sputum
⚫ CT: Dilation of bronchus
or/and thickened bronchial
walls
.

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 Cases
⚫ Tuberculosis

⚫ Young man
⚫ Moderate hemoptysis
⚫ Low-grade fever
& Chronic cough
& Weight loss
⚫ Radiography: Cavities

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 Cases

⚫ Tuberculosis

Sputum eaxms:
acid-fast bacilli

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 Cases

⚫ Lung cancer

⚫ aged man
⚫ Heavy smoking
⚫ Blood-streak sputum
⚫ CT: mass

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 Cases
⚫ Lung cancer

Bronchoscopy:
An active bleeding due
to tumor in the left
bronchus

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 Cases

⚫ Lung cancer

Sputum eaxms:
lung cancer cell

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 Treatment
Depends on the cause and amount of bleeding.
◼ Drugs for stopping bleeding
◼ Stopping bleeding under bronchoscopy
◼ Bronchial artery embolization
◼ Surgical resection
◼ Very important ：to determine and treat the
underlying diseases.

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drugs

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Stopping bleeding under
bronchoscopy

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 Bronchial artery embolization
(支气管动脉栓塞术)

Pre-operation Post-operation 37
 Review
• Many diseases may lead to hemoptysis
• To make diagnosis based on the colour, amount
& accompanied symptoms of bleeding,
investigation and medical history and so on.
• Massive hemoptysis is on emergence. Keeping
patient away from asphyxia and shock.

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Living freely, breathing freely！

Thanks
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