Haemoptysis

Hemoptysis is coughing up blood from the lungs or tracheobronchial tree. The majority of presentations are non-massive and patients can be managed without hospital admission. The most common causes are idiopathic, infective and neoplastic. A small number of presentations are with massive hemoptysis, which can be rapidly fatal. Investigation of hemoptysis is with chest x-ray and high resolution CT chest studies with further investigation dependent on initial imaging findings and clinical features of the presentation. The role of bronchoscopy is becoming controversial as CT technology improves, but offers tissue diagnoses and organism samples for culture. It also offers direct access to bronchial lesions to manage bleeding. Management depends on investigation findings, antibiotics or other microbial agents may be appropriate for some, treatment of malignancy or vasculitides for others. Massive hemoptysis management is with supportive therapy such as oxygen, intubation and ventilation and requires complex decision-making about the type of endotracheal tube to place. Tranexamic acid may have a role. Once intubated, endovascular procedures offer the opportunity to temporarily stabilise patients prior to making decisions about the appropriateness of thoracic surgery or other management.