Hemoptysis

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Other Causes

Other causes for hemoptysis include pulmonary infarction or embolism, various heart problems, vascular disorders, pulmonary AVM , and trauma.

Pulmonary infarction or embolism
A pulmonary embolism is the sudden closure of a pulmonary artery due to a blood clot or presence of foreign material. Pulmonary infarction is the death of lung tissue due to the lack of oxygen resulting from a single embolism or several recurrent embolisms. Pulmonary embolism can be massive, resulting in death or severe shock; or it can be relatively mild.

Infarction is a relatively uncommon cause of hemoptysis. Associated symptoms include chest pain (pleuritic chest pain in particular, meaning the pain is felt as the patient breathes in and out), cough, low-grade fever, tachypnea (rapid breathing), tachycardia (rapid heartbeat), and dyspnea (shortness of breath, even without exertion).

The chest x-ray of a patient with a pulmonary infarction or embolism is usually normal, but there may be a couple of distinguishing features.

Heart problems
Mitral stenosis (a narrowing of the mitral valve that leads into the left ventricle) can lead to very mild hemoptysis—pink, frothy sputum with mild traces of blood. Other symptoms associated with left ventricular failure include orthopnea (difficulty breathing when lying down), paroxysmal nocturnal dyspnea (PND; a shortness of breath that appears suddenly at night, usually waking a person from sleep), and shortness of breath while exercising.

Coagulopathy
A coagulopathy (also known as a hypercoagulable state) is any disease that affects coagulability—the ability to of the blood to clot. In a patient with coagulopathy, clots cannot form after even mild trauma to the mucosal lining of the respiratory airways, leading to mild hemoptysis.

Other signs of coagulopathy include epistaxis (nosebleed), purpura (appearance of lesions, or bruises, on the skin due to broken blood vessels), menorrhagia (excessively long or heavy periods), and hematuria (blood in the urine).

Anticoagulants
Anticoagulants are drugs commonly prescribed to prevent the formation of blood clots. They are often used to treat thromboembolic disorders (blood clot disorders; a thrombus is a clot and an embolism is the sudden closure of an artery due to a clot). Hemoptysis sometimes develops in people who take anticoagulant medication.

Drug use
In addition to anticoagulants, a variety of other drugs including aspirin, cocaine, and penicillamine (a drug used to treat lead poisoning and other disorders) are known to cause hemoptysis.

Catamenial hemoptysis
Catamenial hemoptysis is menstrual-related hemoptysis. It is also known as pulmonary endometriosis. Endometriosis is the development of cells outside of the uterus that normally grow only inside the uterus—the same cells that are shed monthly during menstruation. Researchers do not know how or why endometriosis occurs.

Usually the abnormal cell growth occurs in other areas of the reproductive tract, but sometimes it occurs in the liver, lung, and even the brain. Endometriosis in the lungs results in catamenial hemoptysis. It is very rare and usually treated using hormones.

Cryptogenic hemoptysis
About 15% to 30% of hemoptysis cases go undiagnosed and the underlying cause is never determined. This is true even after extensive diagnostic tests, including a bronchoscopy. Usually the hemoptysis is mild and attributed to bronchial inflammation, and the prognosis (final outcome) for most patients is good.

Iatrogenic hemoptysis
An iatrogenic condition occurs as a result of the activity of a physician or surgeon. Iatrogenic hemoptysis can occur following a biopsy of lung tissue taken during a bronchoscopy. Usually the bleeding stops on its own, but sometimes it can be severe.

Aspergillosis
Aspergillosis is a lung infection caused by the fungus Aspergillus fumigatus. It is rare, except in patients with compromised immune systems. The fungus usually grows to form a ball (known as an aspergilloma) that can invade the blood vessels in the area, causing massive hemoptysis and major damage. A chest x-ray is usually diagnostic, and treatment usually involves surgically removing the lesion.

Lung abscess
A lung abscess is an accumulation of pus (a fluid product of inflammation and infection) in the lungs that can cause hemoptysis.

Arteriovenous malformation (AVM)
AVM is a congenital (present at birth) childhood disease characterized by the presence of abnormal arteries and veins throughout the lungs. The abnormalities cause internal damage to the lungs and eventually cause loss of function.

Idiopathic pulmonary hemosiderosis
Idiopathic pulmonary hemosiderosis is a rare childhood disease that leads to the deposition of hemosiderin (an iron byproduct of hemoglobin) in the lungs. It is believed to be an autoimmune disease, meaning that the body mistakenly attacks its own healthy tissue, causing damage. Patients suffer repeated sudden attacks of hemoptysis and dyspnea (difficult breathing).

Goodpasture's syndrome
Goodpasture's syndrome also involves an accumulation of iron in the lungs. Goodpasture's also involves the kidneys, and most patients die from kidney failure several months after being diagnosed.

Trauma
Trauma to the chest, such as from a car accident or other injury, can cause hemoptysis immediately following the incident or later.

Wegener's granulomatosis
Wegener's granulomatosis is an autoimmune disease, meaning that the body attacks its own healthy, normal tissue, causing damage. Wegener's is very rare and is characterized by inflammation.

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