Hemoptysis – Hematemesis – Hemophtoe
Often, hemoptysis is preceded by a sensation of heat or slight itching in the retrosternal area, with a desire to cough.
These characteristics allow us to distinguish true hemoptysis from false hemoptysis – caused by small lesions of the oral cavity – and from hematemesis , in which there is often digested blood (the color of coffee grounds ) in the vomited material . The latter condition is also accompanied by melena – that is, 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 hemophtoe , a term generally used as a synonym for hemoptysis.
Oral blood loss is a frequent clinical problem, which must be carefully evaluated because it is potentially serious. Hemoptysis can in fact represent the simple consequence of small lesions of the upper airways, produced by the efforts associated with coughing, or a sign of bacterial pneumonia , carcinomas or bronchial adenomas .
In young patients – in good health and non-smokers – the presence of blood in the saliva is generally caused by transient infections of the upper airways ( sinusitis , laryngitis or pharyngitis ), gum hemorrhages or epistaxis ( nosebleeds ).
A common cause of hemoptysis is mitral stenosis , because it often causes rupture of small vessels in the pulmonary circulation. This symptom may also be associated with: pulmonary tuberculosis , coagulopathies, use of anticoagulants or cocaine, pulmonary endometriosis , embolism or pulmonary infarction (and in this case it is accompanied by chest pain), lung abscess , lung infections ( bronchitis , pneumonia, bronchiectasis ) and usually due to pulmonary hypertension .
What To Do
It is therefore clear that any patient with haemoptysis 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 must be requested when the haemoptysis is due to thoracic trauma (possible lung injury, especially if associated with dyspnoea and cyanosis ).
The basic diagnostic investigations include, in addition to the medical history and physical examination (very important to exclude cases of “false” hemoptysis), chest x-ray or CT scan and possibly blood chemistry tests including coagulation tests. Further investigations may include performing bronchoscopies and pulmonary angiographies.
|Homogeneous catarrh, with a color ranging from pink to rusty red, due to the simultaneous presence of blood and purulent material||Bacterial pneumonia|
|Putrid sputum with traces of blood||Lung abscess, bronchiectasis|
|Asymptomatic hemoptysis||Bronchial adenoma, “false hemoptysis” (blood coming from the upper airways)|
|Hemoptysis mixed with corpuscular material and associated with cough||Bronchitis, COPD , lung cancer|
|Frankly bloody hemoptysis associated with chest pain, tachycardia , tachypnea , dyspnea||Pulmonary embolism or infarction, chest trauma|
|Orthopnea (breathing difficulties in a lying position), paroxysmal nocturnal dyspnea (shortness of breath that occurs suddenly during night rest)||Mitral stenosis|
The treatment of hemoptysis varies in relation to the causes that generated it; in addition to treating the underlying disease, symptomatic therapies can be prescribed to eliminate or reduce the cough symptom (antitussives, such as codeine and noscarpine) and the risk of bleeding (antihemorrhagic).