Hemoptysis Causes, Treatment & Symptoms | What Is Hemoptysis?

Keta Bhakta, Danielle Haak
  • Author
    Keta Bhakta

    Keta Bhakta graduated from University of Minnesota with a B.S. in Neuroscience and then with a D.D.S. as a dentist. She has tutored many students in various math and science subjects. She began working as a professor at the University of Minnesota School of Dentistry in 2013.

  • Instructor
    Danielle Haak

    Danielle has a PhD in Natural Resource Sciences and a MSc in Biological Sciences

What does the medical term hemoptysis mean? Learn causes, symptoms, and treatments. Read about massive hemoptysis and how hemoptysis differs from hematemesis. Updated: 08/05/2021

What Is Hemoptysis?

Hemoptysis is the act of expulsion of blood from the lungs via the respiratory tract and out through the mouth and/or nose. This medical term is derived from the words hem-, meaning blood, and -ptysis, meaning spitting. The areas affected by this abnormality include

  • nose
  • mouth
  • pharynx
  • larynx
  • bronchi
  • bronchioles
  • alveoli and
  • lungs.

Coughing up Blood

In some cases, chronic infections of the lung that only partially resolve or do not resolve at all after treatment with antibiotics can lead to hemoptysis. A few examples of these conditions are

  • cystic fibrosis
  • bronchiectasis
  • chronic obstructive pulmonary disease or COPD
  • emphysema
  • pneumonia.

Two of the most common chronic lung infections are asthma and COPD. Some infections such as pneumonia lead to hemoptysis due to a prolonged state of inflammation. If an infection is severe or remains untreated, the underlying inflammatory response from the body to the cause of the infection will lead to accumulation of inflammatory fluids, which can cause swelling. This swelling in tissues can lead to destruction of nearby tissues and rupture of blood vessels, leading to bleeding from those vessels into tissues such as the lung. This blood is then removed by the body via hemoptysis.

Definition of Hemoptysis

We've all had bad winter colds that make us feel like we are 'coughing up a lung,' but what happens when that cough begins to produce blood? Hemoptysis is a condition that causes someone to cough up blood from the lungs. It can be caused by bleeding within the lungs or after a severe nosebleed. The person may cough up only blood or blood mixed with phlegm (sputum). Symptoms can be confused with blood that is actually coughed up from the stomach rather than from the respiratory system.

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  • 0:00 Definition of Hemoptysis
  • 0:32 Causes of Hemoptysis
  • 1:42 Symptoms of Hemoptysis
  • 2:10 Diagnosis of Hemoptysis
  • 2:50 Treatment of Hemoptysis
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Causes of Hemoptysis

Hemoptysis can have many causes in the human body. Infectious causes include

  • bronchitis
  • tuberculosis
  • lung abscess
  • pneumonia

Non-infectious hemoptysis causes include

  • lung cancer
  • benign growth in the lungs
  • trauma or injury
  • taking pain medications without following proper instructions
  • illegal drugs such as cocaine
  • smoking
  • heart conditions such as congestive heart failure and mitral valve stenosis

Symptoms of Hemoptysis

There are many symptoms that accompany hemoptysis with disease processes such as:

  • Fever
  • Coughing without blood
  • Purulent or pus-filled sputum
  • Jaundice (rare)
  • Chest pain
  • Bleeding in other areas of the respiratory tract
  • Difficulty with breathing
  • Wheezing (rare)
  • Fatigue

It is important to note that blood loss is not the major concern with hemoptysis. The risk of choking on the bloody sputum poses a greater risk to the patient.

Diagnosis of Hemoptysis

The diagnosis of hemoptysis is achieved with a variety of tools, such as

  • chest x-ray
  • CT scan
  • 3D CT scan
  • bronchoscopy
  • bronchial angiography

Lab tests can also be done on the blood in order to determine the root cause of the hemoptysis. These tests include WBC, or white blood cell count. The sputum that is expelled by the affected patient is also observed under the microscope closely, and culture tests can be performed to determine infectious causes.

Treatment of Hemoptysis

Treatment for hemoptysis is focused on the root cause. Topical treatments for causes like injury include iced saline and taking vasoconstrictors such as adrenaline or vasopressin. The vasoconstrictors work by constricting or narrowing the blood vessels in the lungs and throughout the respiratory tract, which reduces the amount of blood that can leak and be expelled by the patient.

A treatment that works by creating physical obstruction to the bleeding is known as endobronchial tamponade. A device, such as a tampon, is used to block the bronchus in the lung that is the source of the bleeding. Another physical barrier method is known as bronchial intubation. A tube is placed inside the lung that is bleeding in order to collapse that lung, reduce its function, and in turn reduce the bleeding that is occurring from it.

Causes of Hemoptysis

There are actually a ton of possible causes for hemoptysis, so doctors have their work cut out for them trying to pinpoint the culprit. In fact, in about 25% of cases, no cause is identified at all! In the United States, the most common cause is acute bronchitis, which is when the bronchi become inflamed or swollen. These cases usually clear on their own but can progress into more serious conditions. In the rest of the world, tuberculosis, a bacterial infection of the lungs, is the most common cause of hemoptysis.

Here is a list of other possible causes:

  • Bronchiectasis
  • Lung cancer
  • Benign tumors in the lungs
  • Parasitic infection
  • Use of blood thinners or other medication
  • Pneumonia
  • Pulmonary embolism
  • Congestive heart failure
  • Chronic inflammatory conditions
  • Autoimmune disorders
  • Use of crack cocaine
  • Cigarette smoking
  • Trauma
  • Foreign body lodged in the lungs
  • Dieulafoy's disease
  • Cystic fibrosis
  • Chronic obstructive pulmonary disease (COPD)

Symptoms of Hemoptysis

Generally, coughing up blood would be alarming enough in itself to prompt one to get medical treatment. However, there are a number of symptoms that may accompany hemoptysis that indicate the possibility of a serious medical emergency. These include hemoptysis lasting longer than a week or recurring over time, chest pains, unexpected weight loss, night sweats, fever, and shortness of breath during activities that would otherwise be non-exerting.

Diagnosis of Hemoptysis

If a patient walks in to your office and is coughing up blood, it's time to get down to business and figure out the underlying cause. A physical exam and review of the patient's medical history can help pinpoint causes, as can imaging scans like X-rays or CT scans. Blood chemistry, blood cell counts (platelets help with blood clotting), and analysis of the material that is being coughed up can also provide clues as to the cause of the blood. There is also a process called a bronchoscopy, in which a small tube with a camera is fed through the mouth down into the windpipe and lungs. The camera can provide 'eyes on the inside' to locate the source of a bleed.

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Video Transcript

Definition of Hemoptysis

We've all had bad winter colds that make us feel like we are 'coughing up a lung,' but what happens when that cough begins to produce blood? Hemoptysis is a condition that causes someone to cough up blood from the lungs. It can be caused by bleeding within the lungs or after a severe nosebleed. The person may cough up only blood or blood mixed with phlegm (sputum). Symptoms can be confused with blood that is actually coughed up from the stomach rather than from the respiratory system.

Causes of Hemoptysis

There are actually a ton of possible causes for hemoptysis, so doctors have their work cut out for them trying to pinpoint the culprit. In fact, in about 25% of cases, no cause is identified at all! In the United States, the most common cause is acute bronchitis, which is when the bronchi become inflamed or swollen. These cases usually clear on their own but can progress into more serious conditions. In the rest of the world, tuberculosis, a bacterial infection of the lungs, is the most common cause of hemoptysis.

Here is a list of other possible causes:

  • Bronchiectasis
  • Lung cancer
  • Benign tumors in the lungs
  • Parasitic infection
  • Use of blood thinners or other medication
  • Pneumonia
  • Pulmonary embolism
  • Congestive heart failure
  • Chronic inflammatory conditions
  • Autoimmune disorders
  • Use of crack cocaine
  • Cigarette smoking
  • Trauma
  • Foreign body lodged in the lungs
  • Dieulafoy's disease
  • Cystic fibrosis
  • Chronic obstructive pulmonary disease (COPD)

Symptoms of Hemoptysis

Generally, coughing up blood would be alarming enough in itself to prompt one to get medical treatment. However, there are a number of symptoms that may accompany hemoptysis that indicate the possibility of a serious medical emergency. These include hemoptysis lasting longer than a week or recurring over time, chest pains, unexpected weight loss, night sweats, fever, and shortness of breath during activities that would otherwise be non-exerting.

Diagnosis of Hemoptysis

If a patient walks in to your office and is coughing up blood, it's time to get down to business and figure out the underlying cause. A physical exam and review of the patient's medical history can help pinpoint causes, as can imaging scans like X-rays or CT scans. Blood chemistry, blood cell counts (platelets help with blood clotting), and analysis of the material that is being coughed up can also provide clues as to the cause of the blood. There is also a process called a bronchoscopy, in which a small tube with a camera is fed through the mouth down into the windpipe and lungs. The camera can provide 'eyes on the inside' to locate the source of a bleed.

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Frequently Asked Questions

What does hemoptysis mean?

Hemoptysis is the expulsion of blood from the lungs by means of coughing. It indicates the presence of a pathological process.

What causes haemoptysis?

Hemoptysis is caused by infection, cancer, lung disease, injury to chest or throat, illegal drugs, smoking, and misuse of pain or anti-inflammatory medications.

How do you treat hemoptysis?

Hemoptysis is treated depending on the cause. Infections are treated with antibiotics. Lung cancer may require chemotherapy or radiation. Discontinuation of illegal drugs or discontinuation of pain medications may be needed to stop the bleeding. Injuries may require stabilization or dressing to prevent further bleeding.

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