Chapter 034. Cough and Hemoptysis (Part 4)

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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) ...

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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.