Chapter 034. Cough and Hemoptysis (Part 4)

Table 34-1 Differential Diagnosis of HemoptysisSource other than the lower respiratory tractUpper airway (nasopharyngeal) bleedingGastrointestinal bleedingTracheobronchial sourceNeoplasm (bronchogenic carcinoma, endobronchial metastatic tumor, Kaposis sarcoma, bronchial carcinoid)Bronchitis (acute or chronic)BronchiectasisBroncholithiasisAirway traumaForeign bodyPulmonary parenchymal sourceLung abscessPneumoniaTuberculosisMycetoma ("fungus ball")Goodpastures syndromeIdiopathic pulmonary hemosiderosisWegeners granulomatosisLupus pneumonitisLung contusionPrimary vascular sourceArteriovenous malformationPulmonary embolismElevated pulmonary venous pressure (esp. mitral stenosis) ...
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Chapter 034. Cough and Hemoptysis (Part 4) Chapter 034. Cough and Hemoptysis (Part 4)Table 34-1 Differential Diagnosis of HemoptysisSource other than the lower respiratory tract Upper airway (nasopharyngeal) bleeding Gastrointestinal bleeding Tracheobronchial source Neoplasm (bronchogenic carcinoma, endobronchial metastatic tumor,Kaposis sarcoma, bronchial carcinoid) Bronchitis (acute or chronic) Bronchiectasis Broncholithiasis Airway trauma Foreign body Pulmonary parenchymal source Lung abscess Pneumonia Tuberculosis Mycetoma (fungus ball) Goodpastures syndrome Idiopathic pulmonary hemosiderosis Wegeners granulomatosis Lupus pneumonitis Lung contusionPrimary vascular source Arteriovenous malformation Pulmonary embolism Elevated pulmonary venous pressure (esp. mitral stenosis) Pulmonary artery rupture secondary to balloon-tip pulmonary arterycatheter 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 hemoptysisvaries from series to series, most recent studies indicate that bronchitis andbronchogenic carcinoma are the two most common causes in the United States.Despite the lower frequency of tuberculosis and bronchiectasis seen in recentcompared to older series, these two disorders still represent the most commoncauses of massive hemoptysis in several series, especially worldwide. Even afterextensive evaluation, a sizable proportion of patients (up to 30% in some series)have no identifiable etiology for their hemoptysis. These patients are classified ashaving idiopathic or cryptogenic hemoptysis, and subtle airway or parenchymaldisease is presumably responsible for the bleeding.