What is Hemoptysis?
Hemoptysis is the emission of blood, coming from the respiratory tract, orally, generally following coughing; the blood is alkaline, bright red in color and foaming, because it is mixed with air.
Hemoptysis - Hematemesis - Hemoftoe
Often, hemoptysis is preceded by a feeling of warmth or slight itching in the retrosternal area, with a desire to cough.
These characteristics allow to distinguish true hemoptysis from false hemoptysis - caused by small lesions of the oral cavity - and from hematemesis, in which there is the presence of often digested blood (coffee background color) in the vomited material. This last condition is also accompanied by melaena - ie the emission of blackish, tarry stools - and is caused by gastroesophageal haemorrhages of various kinds (peptic ulcer, gastritis, esophagitis, tumors or gastroesophageal varices).
If the blood traces are mixed with phlegm or sputum, it is more correct to speak of haemophtoe, a term generally used as a synonym for hemoptysis.
Causes
Oral bleeding is a frequent clinical problem that needs to be carefully evaluated as it is potentially serious. Hemoptysis can in fact represent the simple consequence of small lesions of the upper airways, produced with the efforts connected to cough, or indicator of bacterial pneumonia, carcinomas or bronchial adenomas.
In young patients - in good health and non-smokers - the presence of blood in the saliva is usually caused by transient infections of the upper airways (sinusitis, laryngitis or pharyngitis), gum bleeding or epistaxis (nosebleeds).
A common cause of hemoptysis is mitral stenosis, because it often results in the rupture of small vessels in the pulmonary circulation. This symptom can also be associated with: pulmonary tuberculosis, coagulopathies, use of anticoagulants or cocaine, pulmonary endometriosis, pulmonary embolism or infarction (and in this case is accompanied by chest pain), lung abscess, lung infections (bronchitis, pneumonia, bronchiectasis) and typically to pulmonary hypertension.
What to do
It is therefore evident that any patient with hemoptysis should report their condition to the doctor without delay, especially if repeated over time or associated with other symptoms, such as weight loss, fever and sweating. Immediate medical assistance should be requested when hemoptysis is due to thoracic trauma (possible lung injury, especially if associated with dyspnoea and cyanosis).
The basic diagnostic investigations include, in addition to the anamnesis and the physical examination (very important to exclude cases of "false" hemoptysis), chest radiography or CT and possibly blood chemistry tests including coagulation tests. Further investigations may include performing bronchoscopy and pulmonary angiography.
Associated Symptoms
Homogeneous phlegm, with a color ranging from pink to rusty red, due to the simultaneous presence of blood and purulent material
Bronchial adenoma, "false hemoptysis" (blood from the upper airways)
Hemoptysis mixed with corpuscle material and associated with cough
Bronchitis, COPD, lung cancer
Hemoptysis therapy varies in relation to the causes that generated it; in addition to treating the underlying disease, symptomatic therapies may be prescribed to eliminate or reduce the symptom of cough (antitussives, such as codeine and noscarpine) and the risk of bleeding (anti-haemorrhagics).
