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Une expectoration mousseuse, de sang rouge vif, et (si massive) une sensation de suffocation sont caractéristiques de l'hémoptysie vraie.
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Hémoptysie - Troubles pulmonaires - Édition professionnelle du Manuel MSD
nt des narines sans toux est évocatrice de pseudo-hémoptysie. Des nausées et des vomissements concomitants de sang de couleur noire, brun ou marc de café sont caractéristiques d'une hématémèse. <span>Une expectoration mousseuse, de sang rouge vif, et (si massive) une sensation de suffocation sont caractéristiques de l'hémoptysie vraie. La revue des systèmes doit rechercher des symptômes suggérant des causes possibles, dont une fièvre et une expectoration (pneumonie); des sueurs nocturnes, une perte de poids et une fat




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La revue des systèmes doit rechercher des symptômes suggérant des causes possibles, dont une fièvre et une expectoration (pneumonie); des sueurs nocturnes, une perte de poids et une fatigue (cancer, tuberculose); des douleurs thoraciques et une dyspnée (pneumonie, embolie pulmonaire); des douleurs et un gonflement des jambes (embolie pulmonaire); une hématurie (syndrome de Goodpasture); et un écoulement nasal sanglant (granulomatose avec polyangéïte).

Il faut interroger les patients sur les facteurs de risque étiologiques. Ces facteurs de risque comprennent l'infection par le VIH, la prise d'immunodépresseurs (tuberculose, infection fongique); une exposition à la tuberculose; un tabagisme ancien (cancer); et une immobilisation ou opération récente, un cancer connu, des antécédents personnels ou familiaux de thrombose, une grossesse, une prise d'œstrogènes et des voyages lointains récents (embolie pulmonaire)

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Hémoptysie - Troubles pulmonaires - Édition professionnelle du Manuel MSD
ou marc de café sont caractéristiques d'une hématémèse. Une expectoration mousseuse, de sang rouge vif, et (si massive) une sensation de suffocation sont caractéristiques de l'hémoptysie vraie. <span>La revue des systèmes doit rechercher des symptômes suggérant des causes possibles, dont une fièvre et une expectoration (pneumonie); des sueurs nocturnes, une perte de poids et une fatigue (cancer, tuberculose); des douleurs thoraciques et une dyspnée (pneumonie, embolie pulmonaire); des douleurs et un gonflement des jambes (embolie pulmonaire); une hématurie (syndrome de Goodpasture); et un écoulement nasal sanglant (granulomatose avec polyangéïte). Il faut interroger les patients sur les facteurs de risque étiologiques. Ces facteurs de risque comprennent l'infection par le VIH, la prise d'immunodépresseurs (tuberculose, infection fongique); une exposition à la tuberculose; un tabagisme ancien (cancer); et une immobilisation ou opération récente, un cancer connu, des antécédents personnels ou familiaux de thrombose, une grossesse, une prise d'œstrogènes et des voyages lointains récents (embolie pulmonaire). La recherche des antécédents médicaux doit couvrir les troubles connus cause d'hémoptysie, dont une pneumopathie chronique (p. ex.,bronchopneumopathie chronique obstructive [BPCO], bro




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Une anamnèse d'épistaxis fréquentes, de formation facile d'ecchymoses, ou de maladie du foie évoque une possible coagulopathie. On doit rechercher la prise d'anticoagulants et d'antiplaquettaires.
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Hémoptysie - Troubles pulmonaires - Édition professionnelle du Manuel MSD
ose avec polyangéïte [anciennement appelée maladie de Wegener]). L'exposition à la tuberculose est importante, en particulier en cas d'infection par le VIH ou en cas d'autres immunodépressions. <span>Une anamnèse d'épistaxis fréquentes, de formation facile d'ecchymoses, ou de maladie du foie évoque une possible coagulopathie. On doit rechercher la prise d'anticoagulants et d'antiplaquettaires. Examen clinique Les signes vitaux sont recherchés, notamment une fièvre, une tachycardie, une tachypnée et une saturation en oxygène basse. Les symptômes constitutionnels (p. ex., cache




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Plusieurs signes spécifiques sont importants.

  • Une insuffisance rénale ou une hématurie connues évoquent un syndrome réno-pulmonaire (p. ex., syndrome de Goodpasture, granulomatose avec polyangéïte [anciennement appelée maladie de Wegener]).

  • La granulomatose avec polyangéïte (anciennement appelée granulomatose de Wegener) peut provoquer des lésions des muqueuses nasales.

  • Des télangiectasies visibles évoquent une malformation artérioveineuse.

  • Les patients qui présentent une hémoptysie due à un trouble de la coagulation sanguine ont habituellement des symptômes cutanés (pétéchies et/ou purpura) ou des antécédents de prise d'anticoagulant ou d'un traitement médicamenteux antiplaquettaire.

  • Une hémoptysie récurrente coïncidant avec les règles évoque fortement une endométriose pulmonaire.

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Hémoptysie - Troubles pulmonaires - Édition professionnelle du Manuel MSD
trouble identifié un cancer ou une tuberculose doivent être évoqués, bien que l'hémoptysie puisse être la première manifestation du cancer du poumon chez un patient par ailleurs asymptomatique. <span>Plusieurs signes spécifiques sont importants. Une insuffisance rénale ou une hématurie connues évoquent un syndrome réno-pulmonaire (p. ex., syndrome de Goodpasture, granulomatose avec polyangéïte [anciennement appelée maladie de Wegener]). La granulomatose avec polyangéïte (anciennement appelée granulomatose de Wegener) peut provoquer des lésions des muqueuses nasales. Des télangiectasies visibles évoquent une malformation artérioveineuse. Les patients qui présentent une hémoptysie due à un trouble de la coagulation sanguine ont habituellement des symptômes cutanés (pétéchies et/ou purpura) ou des antécédents de prise d'anticoagulant ou d'un traitement médicamenteux antiplaquettaire. Une hémoptysie récurrente coïncidant avec les règles évoque fortement une endométriose pulmonaire. Examens complémentaires En cas d'hémoptysie massive, le patient doit être traité et stabilisé, généralement en USI, avant de débuter les examens. En cas d'hémoptysie mineure, le patient




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Hémoptysies cryptogénétiques

L'étiologie des hémoptysies reste méconnue dans 30 à 40% des cas, mais le pronostic des hémoptysies cryptogénétiques est généralement favorable, avec habituellement guérison du saignement dans les 6 mois du bilan

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Hémoptysie - Troubles pulmonaires - Édition professionnelle du Manuel MSD
essité d'induire des expectorations ou de pratiquer une bronchoscopie pour obtenir des prélèvements et rechercher des bacilles acido-résistants si un autre diagnostic n'est pas mis en évidence. <span>Hémoptysies cryptogénétiques L'étiologie des hémoptysies reste méconnue dans 30 à 40% des cas, mais le pronostic des hémoptysies cryptogénétiques est généralement favorable, avec habituellement guérison du saignement dans les 6 mois du bilan. Traitement Hémoptysies massives Le traitement initial des hémoptysies massives a deux objectifs: Éviter l'inhalation de sang dans le poumon non atteint (ce qui peut provoquer une asphy




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L'hémoptysie massive est l'une des rares indications de la bronchoscopie rigide (par opposition à la bronchoscopie flexible), qui permet le contrôle des voies respiratoires, permet un champ visuel plus large qu'une bronchoscopie souple, de meilleures possibilités d'aspiration et est plus adaptée aux interventions thérapeutiques, telles que le traitement par laser.
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Hémoptysie - Troubles pulmonaires - Édition professionnelle du Manuel MSD
ue de plus en plus utilisé pour favoriser l'hémostase. Le traitement par le laser, la cautérisation ou l'injection directe d'adrénaline ou de vasopressine peut être effectué sous bronchoscopie. <span>L'hémoptysie massive est l'une des rares indications de la bronchoscopie rigide (par opposition à la bronchoscopie flexible), qui permet le contrôle des voies respiratoires, permet un champ visuel plus large qu'une bronchoscopie souple, de meilleures possibilités d'aspiration et est plus adaptée aux interventions thérapeutiques, telles que le traitement par laser. L'embolisation par angiographie de l'artère bronchique devient la méthode préférée d'arrêt d'une hémoptysie massive, avec des taux de succès rapportés allant jusqu'à 90% (1). L'interven




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La bronchite, la bronchectasie, la tuberculose et la pneumonie nécrosante ou l'abcès du poumon sont les causes les plus fréquentes chez l'adulte.
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Hémoptysie - Troubles pulmonaires - Édition professionnelle du Manuel MSD
anagement of massive hemoptysis. Critical Care Medicine 28(5): 1642–1647, 2000. Points clés L'hémoptysie doit être distinguée de l'hématémèse et des hémorragies nasopharyngées ou oropharyngées. <span>La bronchite, la bronchectasie, la tuberculose et la pneumonie nécrosante ou l'abcès du poumon sont les causes les plus fréquentes chez l'adulte. Les infections des voies respiratoires inférieures et l'inhalation de corps étrangers sont les causes les plus fréquentes chez l'enfant. En cas d'hémoptysie massive, le patient doit êtr




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Les infections des voies respiratoires inférieures et l'inhalation de corps étrangers sont les causes les plus fréquentes chez l'enfant.
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Hémoptysie - Troubles pulmonaires - Édition professionnelle du Manuel MSD
es hémorragies nasopharyngées ou oropharyngées. La bronchite, la bronchectasie, la tuberculose et la pneumonie nécrosante ou l'abcès du poumon sont les causes les plus fréquentes chez l'adulte. <span>Les infections des voies respiratoires inférieures et l'inhalation de corps étrangers sont les causes les plus fréquentes chez l'enfant. En cas d'hémoptysie massive, le patient doit être traité et stabilisé, généralement en service de réanimation, avant de débuter les examens. En cas d'hémoptysie massive, lorsque le côté




Criteria for the definition of massive/life-threatening haemoptysis should be better defined.
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Pathophysiology and causes of haemoptysis - Oxford Medicine
for personal use (for details see Privacy Policy and Legal Notice). date: 20 December 2020 Top Key points ◆ Haemoptysis varies in intensity from a minor event to a life-threatening condition. ◆ <span>Criteria for the definition of massive/life-threatening haemoptysis should be better defined. ◆ The epidemiology of haemoptysis has changed over time, particularly in industrialized countries, where bronchiectasis and lung cancer have surpassed tuberculosis as the most frequent




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The epidemiology of haemoptysis has changed over time, particularly in industrialized countries, where bronchiectasis and lung cancer have surpassed tuberculosis as the most frequent causes.
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Pathophysiology and causes of haemoptysis - Oxford Medicine
ey points ◆ Haemoptysis varies in intensity from a minor event to a life-threatening condition. ◆ Criteria for the definition of massive/life-threatening haemoptysis should be better defined. ◆ <span>The epidemiology of haemoptysis has changed over time, particularly in industrialized countries, where bronchiectasis and lung cancer have surpassed tuberculosis as the most frequent causes. ◆ The lungs are furnished with a dual blood supply, the bronchial arteries and the pulmonary arteries. Although the former account for only about 1% of arterial supply to the lung, bron




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Haemoptysis is defined as the expectoration of blood or blood-streaked sputum from the lower respiratory tract. The term derives from the ancient Greek words haima, meaning blood, and ptysis, meaning spitting
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Pathophysiology and causes of haemoptysis - Oxford Medicine
mmatory conditions, where release of angiogenic growth factors leads to neovascularization with thin-walled fragile new vessels that are prone to rupture into the airways. Top Next Introduction <span>Haemoptysis is defined as the expectoration of blood or blood-streaked sputum from the lower respiratory tract. The term derives from the ancient Greek words haima, meaning blood, and ptysis, meaning spitting. The presence of haemoptysis, even in the case of minor events, is a frightening symptom for the patient. The clinical spectrum may vary from minor blood-stained sputum to major bleedin




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There is a lack of universal consensus on the quantification and severity of haemoptysis events. Haemoptysis is considered scant when involving <5 mL, mild when <20 mL, and moderate when >20 mL
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Pathophysiology and causes of haemoptysis - Oxford Medicine
ained sputum to major bleeding causing respiratory failure and haemodynamic instability. Underlying causes may vary from benign, self-limiting conditions to severe, potentially lethal diseases. <span>There is a lack of universal consensus on the quantification and severity of haemoptysis events. Haemoptysis is considered scant when involving <5 mL, mild when <20 mL, and moderate when >20 mL. Massive haemoptysis has been varyingly defined as 100 mL/24 hours to more than 1000 mL/24 hours. Most authors apply the term massive haemoptysis to bleeding >600 mL/24 hours or >




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Most authors apply the term massive haemoptysis to bleeding >600 mL/24 hours or >25 mL/hour.
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Pathophysiology and causes of haemoptysis - Oxford Medicine
s is considered scant when involving <5 mL, mild when <20 mL, and moderate when >20 mL. Massive haemoptysis has been varyingly defined as 100 mL/24 hours to more than 1000 mL/24 hours. <span>Most authors apply the term massive haemoptysis to bleeding >600 mL/24 hours or >25 mL/hour. The term exsanguinating haemoptysis refers to blood loss >1000 mL/24 hours (>150 mL/hour) or >300 mL for a single expectoration event [1]‌. Given the unreliability in both the




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Given the unreliability in both the patient’s and physician’s estimates of expectorated volume, and lack of consensus cut-off volume definition, other authors define haemoptysis as massive in the presence of clinical consequences, such as respiratory failure due to airway obstruction or haemodynamic instability [2].
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Pathophysiology and causes of haemoptysis - Oxford Medicine
eding >600 mL/24 hours or >25 mL/hour. The term exsanguinating haemoptysis refers to blood loss >1000 mL/24 hours (>150 mL/hour) or >300 mL for a single expectoration event [1]‌. <span>Given the unreliability in both the patient’s and physician’s estimates of expectorated volume, and lack of consensus cut-off volume definition, other authors define haemoptysis as massive in the presence of clinical consequences, such as respiratory failure due to airway obstruction or haemodynamic instability [2]. It has been estimated that volumes of blood in the alveoli above 400 mL are sufficient to significantly alter gas exchange. However, it must be considered than, in many situations, haem




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t has been estimated that volumes of blood in the alveoli above 400 mL are sufficient to significantly alter gas exchange. However, it must be considered than, in many situations, haemoptysis arises in patients with underlying cardiorespiratory disease. These subjects may suffer considerable worsening of gaseous exchange even for smaller quantities of blood.
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Pathophysiology and causes of haemoptysis - Oxford Medicine
volume definition, other authors define haemoptysis as massive in the presence of clinical consequences, such as respiratory failure due to airway obstruction or haemodynamic instability [2]. I<span>t has been estimated that volumes of blood in the alveoli above 400 mL are sufficient to significantly alter gas exchange. However, it must be considered than, in many situations, haemoptysis arises in patients with underlying cardiorespiratory disease. These subjects may suffer considerable worsening of gaseous exchange even for smaller quantities of blood. It has been proposed that the term ‘massive’ haemoptysis be substituted with ‘life-threatening.’ Life-threatening haemoptysis may be defined as any haemoptysis that: ◆ Is >100 mL in




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Life-threatening haemoptysis may be defined as any haemoptysis that:

  • ◆ Is >100 mL in 24 hours.

  • ◆ Causes abnormal gas exchange/airway obstruction.

  • ◆ Causes haemodynamic instability.

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Pathophysiology and causes of haemoptysis - Oxford Medicine
ects may suffer considerable worsening of gaseous exchange even for smaller quantities of blood. It has been proposed that the term ‘massive’ haemoptysis be substituted with ‘life-threatening.’ <span>Life-threatening haemoptysis may be defined as any haemoptysis that: ◆ Is >100 mL in 24 hours. ◆ Causes abnormal gas exchange/airway obstruction. ◆ Causes haemodynamic instability. Independent of its definition, massive/life-threatening haemoptysis involves only a minority of clinical events (generally 5–10%), but related mortality may exceed 50% [1,2]. Mortality




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Independent of its definition, massive/life-threatening haemoptysis involves only a minority of clinical events (generally 5–10%), but related mortality may exceed 50% [1,2]. Mortality is generally more the result of airway compromise with asphyxiation, rather than exsanguination.

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Pathophysiology and causes of haemoptysis - Oxford Medicine
atening.’ Life-threatening haemoptysis may be defined as any haemoptysis that: ◆ Is >100 mL in 24 hours. ◆ Causes abnormal gas exchange/airway obstruction. ◆ Causes haemodynamic instability. <span>Independent of its definition, massive/life-threatening haemoptysis involves only a minority of clinical events (generally 5–10%), but related mortality may exceed 50% [1,2]. Mortality is generally more the result of airway compromise with asphyxiation, rather than exsanguination. Top Previous Next Causes Haemoptysis may derive from a variety of very different conditions, such as infections, pulmonary diseases, neoplastic conditions, cardiovascular alterations, vasculitis, traumat




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The relative importance of different causes of haemoptysis has changed over time. For centuries, haemoptysis was considered virtually pathognomonic for pulmonary tuberculosis. The following Hippocratic aphorism: ‘The spitting of pus follows that spitting of blood, consumption follows the spitting of this and death follows consumption’ shows how far rooted in history is the association between haemoptysis and tuberculosis
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Pathophysiology and causes of haemoptysis - Oxford Medicine
ections, pulmonary diseases, neoplastic conditions, cardiovascular alterations, vasculitis, traumatic events, haematological derangements, and iatrogenic or drug-induced events (see Box 126.1). <span>The relative importance of different causes of haemoptysis has changed over time. For centuries, haemoptysis was considered virtually pathognomonic for pulmonary tuberculosis. The following Hippocratic aphorism: ‘The spitting of pus follows that spitting of blood, consumption follows the spitting of this and death follows consumption’ shows how far rooted in history is the association between haemoptysis and tuberculosis. During the course of the last century, however, effective antimycobacterial treatment and the rise in prevalence of cigarette smoking have changed the epidemiology of haemoptysis. TB c




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Box 126.1 Causes of haemoptysis

Infection

  • ◆ Mycobacterial (tuberculosis and atypical mycobacteria).

  • ◆ Fungal infections (including mycetoma).

  • ◆ Necrotizing pneumonia.

  • ◆ Lung abscess.

  • ◆ Parasitic.

  • ◆ Septic emboli.

Pulmonary

  • ◆ Acute bronchitis.

  • ◆ Chronic obstructive pulmonary disease.

  • ◆ Bronchiectasis (including cystic fibrosis).

  • ◆ Alveolar haemorrhage.

  • ◆ Lymphangioleiomiomatosis.

  • ◆ Sarcoidosis.

  • ◆ Lung transplantation.

Neoplastic

  • ◆ Bronchogenic carcinoma.

  • ◆ Metastatic lung cancer.

  • ◆ Endobronchial tumours (bronchial adenoma, carcinoid).

Cardiovascular

  • ◆ Pulmonary embolism (lung infarct).

  • ◆ Pulmonary hypertension.

  • ◆ Pulmonary artery aneurysm.

  • ◆ Bronchial artery aneurysm.

  • ◆ Left ventricular heart failure.

  • ◆ Mitral stenosis.

  • ◆ Arteriovenous malformations.

Vasculitic

  • ◆ Wegener’s granulomatosis.

  • ◆ Behçet’s disease.

  • ◆ Goodpasture syndrome.

  • ◆ Systemic lupus erythematosus.

  • ◆ Antiphospholipid syndrome.

Traumatic

  • ◆ Foreign body aspiration.

  • ◆ Blunt or penetrating chest injury.

  • ◆ Aortic aneurysm.

Iatrogenic

  • ◆ Bronchoscopy.

  • ◆ Endobronchial procedures (brachytherapy, dilation, stent placement, laser).

  • ◆ Lung biopsy.

  • ◆ Pulmonary artery catheterization.

Drugs and toxins

  • ◆ Bevacizumab.

  • ◆ Solvents.

  • ◆ Crack cocaine.

  • ◆ Penicillamine.

Haematological

  • ◆ Coagulopathy (congenital, acquired, or iatrogenic).

  • ◆ Thrombocytopenia.

  • ◆ Platelet dysfunction.

Miscellaneous

  • ◆ Cryptogenetic.

  • ◆ Endometriosis.

  • ◆ Broncholitiasis

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Pathophysiology and causes of haemoptysis - Oxford Medicine
f haemoptysis. TB continues to be a leading cause of haemoptysis in the developing world, but in industrialized countries bronchial carcinoma and bronchiectasis are more commonly reported [3]‌. <span>Box 126.1 Causes of haemoptysis Infection ◆ Mycobacterial (tuberculosis and atypical mycobacteria). ◆ Fungal infections (including mycetoma). ◆ Necrotizing pneumonia. ◆ Lung abscess. ◆ Parasitic. ◆ Septic emboli. Pulmonary ◆ Acute bronchitis. ◆ Chronic obstructive pulmonary disease. ◆ Bronchiectasis (including cystic fibrosis). ◆ Alveolar haemorrhage. ◆ Lymphangioleiomiomatosis. ◆ Sarcoidosis. ◆ Lung transplantation. Neoplastic ◆ Bronchogenic carcinoma. ◆ Metastatic lung cancer. ◆ Endobronchial tumours (bronchial adenoma, carcinoid). Cardiovascular ◆ Pulmonary embolism (lung infarct). ◆ Pulmonary hypertension. ◆ Pulmonary artery aneurysm. ◆ Bronchial artery aneurysm. ◆ Left ventricular heart failure. ◆ Mitral stenosis. ◆ Arteriovenous malformations. Vasculitic ◆ Wegener’s granulomatosis. ◆ Behçet’s disease. ◆ Goodpasture syndrome. ◆ Systemic lupus erythematosus. ◆ Antiphospholipid syndrome. Traumatic ◆ Foreign body aspiration. ◆ Blunt or penetrating chest injury. ◆ Aortic aneurysm. Iatrogenic ◆ Bronchoscopy. ◆ Endobronchial procedures (brachytherapy, dilation, stent placement, laser). ◆ Lung biopsy. ◆ Pulmonary artery catheterization. Drugs and toxins ◆ Bevacizumab. ◆ Solvents. ◆ Crack cocaine. ◆ Penicillamine. Haematological ◆ Coagulopathy (congenital, acquired, or iatrogenic). ◆ Thrombocytopenia. ◆ Platelet dysfunction. Miscellaneous ◆ Cryptogenetic. ◆ Endometriosis. ◆ Broncholitiasis. It has been estimated that in bronchogenic carcinoma, haemoptysis presents at some point in the natural history of the disease in up to 20% of patients. Conversely, haemoptysis may be




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It has been estimated that in bronchogenic carcinoma, haemoptysis presents at some point in the natural history of the disease in up to 20% of patients. Conversely, haemoptysis may be the presenting symptom in only 7% of patients with lung malignancy [4]‌. Haemoptysis is more likely to occur, and may manifest earlier in (p. 585) the disease course, when carcinoma originates in a major bronchus compared with more peripheral sites
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Pathophysiology and causes of haemoptysis - Oxford Medicine
enicillamine. Haematological ◆ Coagulopathy (congenital, acquired, or iatrogenic). ◆ Thrombocytopenia. ◆ Platelet dysfunction. Miscellaneous ◆ Cryptogenetic. ◆ Endometriosis. ◆ Broncholitiasis. <span>It has been estimated that in bronchogenic carcinoma, haemoptysis presents at some point in the natural history of the disease in up to 20% of patients. Conversely, haemoptysis may be the presenting symptom in only 7% of patients with lung malignancy [4]‌. Haemoptysis is more likely to occur, and may manifest earlier in (p. 585) the disease course, when carcinoma originates in a major bronchus compared with more peripheral sites. Among mycobacteria, haemoptysis is mainly related to Mycobacterium tuberculosis, with few reports on the involvement of non-tuberculous mycobacteria. Haemoptysis may be the result of a




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Haemoptysis may be the result of active tuberculosis, generally with small and chronic bouts of blood, although massive haemoptysis has also been described in this context. Inactive mycobacterial disease may be associated with bleeding arising from post-tuberculous thick-walled cavities or bronchiectasis. Rarely, peri-bronchial calcified lymph node may erode into or distort an adjacent bronchus. This condition is known as broncholithiasis and may be associated with symptoms such as cough, recurrent episodes of fever and purulent sputum, and sometimes massive haemoptysis [5]
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Pathophysiology and causes of haemoptysis - Oxford Medicine
onchus compared with more peripheral sites. Among mycobacteria, haemoptysis is mainly related to Mycobacterium tuberculosis, with few reports on the involvement of non-tuberculous mycobacteria. <span>Haemoptysis may be the result of active tuberculosis, generally with small and chronic bouts of blood, although massive haemoptysis has also been described in this context. Inactive mycobacterial disease may be associated with bleeding arising from post-tuberculous thick-walled cavities or bronchiectasis. Rarely, peri-bronchial calcified lymph node may erode into or distort an adjacent bronchus. This condition is known as broncholithiasis and may be associated with symptoms such as cough, recurrent episodes of fever and purulent sputum, and sometimes massive haemoptysis [5]‌. Aspergilloma is a mycotic colonization of a pre-existing lung cavity or cyst. Post-tuberculous cavities or idiopathic pulmonary fibrosis cavities are examples of pre-existing lung dis




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The reported incidence of haemoptysis in patients with aspergilloma ranges from 54 to 87.5%. Most patients will experience mild and recurrent episodes of haemoptysis, although roughly 10% may develop massive events [6]‌. Invasive pulmonary aspergillosis in immunocompromised subjects is also associated with haemoptysis events, although rarely fatal
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Pathophysiology and causes of haemoptysis - Oxford Medicine
is cavities are examples of pre-existing lung disease conditions that may be prone to fungal colonization. Aspergillus fumigatus and Aspergillus niger are the most commonly encountered species. <span>The reported incidence of haemoptysis in patients with aspergilloma ranges from 54 to 87.5%. Most patients will experience mild and recurrent episodes of haemoptysis, although roughly 10% may develop massive events [6]‌. Invasive pulmonary aspergillosis in immunocompromised subjects is also associated with haemoptysis events, although rarely fatal. Cystic fibrosis, usually in the context of extensive bronchiectasis, has become an increasingly common aetiology of haemoptysis, probably due to the longer survival of affected patient




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Cystic fibrosis, usually in the context of extensive bronchiectasis, has become an increasingly common aetiology of haemoptysis, probably due to the longer survival of affected patients into adulthood. Approximately 40% of patients with cystic fibrosis will develop an episode of haemoptysis during the course of their life, with an average annual incidence of 0.87% [7]‌.
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Pathophysiology and causes of haemoptysis - Oxford Medicine
moptysis, although roughly 10% may develop massive events [6]‌. Invasive pulmonary aspergillosis in immunocompromised subjects is also associated with haemoptysis events, although rarely fatal. <span>Cystic fibrosis, usually in the context of extensive bronchiectasis, has become an increasingly common aetiology of haemoptysis, probably due to the longer survival of affected patients into adulthood. Approximately 40% of patients with cystic fibrosis will develop an episode of haemoptysis during the course of their life, with an average annual incidence of 0.87% [7]‌. Necrotizing pneumonia, lung abscess, and lung gangrene caused by bacteria, such as Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus pneumoniae, other




#GarjoHemoptysie
Necrotizing pneumonia, lung abscess, and lung gangrene caused by bacteria, such as Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus pneumoniae, other Streptococcus spp. and Actinomyces spp. may be associated with haemoptysis in up to 15% of cases [8]‌
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Pathophysiology and causes of haemoptysis - Oxford Medicine
tients into adulthood. Approximately 40% of patients with cystic fibrosis will develop an episode of haemoptysis during the course of their life, with an average annual incidence of 0.87% [7]‌. <span>Necrotizing pneumonia, lung abscess, and lung gangrene caused by bacteria, such as Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus pneumoniae, other Streptococcus spp. and Actinomyces spp. may be associated with haemoptysis in up to 15% of cases [8]‌. (p. 586) Bevacizumab is a monoclonal antibody that targets angiogenic factors and has been shown to be effective in the treatment of various forms of cancer. The use of this drug in pa




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Pulmonary hypertension is reported as the underlying cause of haemoptysis in 0.2–4% of cases [11]. Conversely, in patients with Eisenmenger syndrome, haemoptysis is a more common finding
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Pathophysiology and causes of haemoptysis - Oxford Medicine
r 70%. Rupture may be due either to the catheter tip being directed into the vessel wall, or to catheter migration to a smaller calibre branch and subsequent rupturing during balloon inflation. <span>Pulmonary hypertension is reported as the underlying cause of haemoptysis in 0.2–4% of cases [11]. Conversely, in patients with Eisenmenger syndrome, haemoptysis is a more common finding. In female patients with thoracic endometriosis haemoptysis represents an early clinical manifestation, occurring at an earlier age, whereas pneumothorax tends to manifest in more advan




#GarjoHemoptysie
In female patients with thoracic endometriosis haemoptysis represents an early clinical manifestation, occurring at an earlier age, whereas pneumothorax tends to manifest in more advanced disease. In over 80% of cases the right hemithorax is involved [12]
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Pathophysiology and causes of haemoptysis - Oxford Medicine
tion. Pulmonary hypertension is reported as the underlying cause of haemoptysis in 0.2–4% of cases [11]. Conversely, in patients with Eisenmenger syndrome, haemoptysis is a more common finding. <span>In female patients with thoracic endometriosis haemoptysis represents an early clinical manifestation, occurring at an earlier age, whereas pneumothorax tends to manifest in more advanced disease. In over 80% of cases the right hemithorax is involved [12]. Diffuse alveolar haemorrhage is a rare cause of haemoptysis associated with disruption of the alveolar–capillary barrier. It should be suspected in case of haemoptysis, anaemia and bil




#GarjoHemoptysie
Diffuse alveolar haemorrhage is a rare cause of haemoptysis associated with disruption of the alveolar–capillary barrier. It should be suspected in case of haemoptysis, anaemia and bilateral infiltrates on the chest radiograph. The infiltrates are the result of distal inhalation of blood.
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Pathophysiology and causes of haemoptysis - Oxford Medicine
esents an early clinical manifestation, occurring at an earlier age, whereas pneumothorax tends to manifest in more advanced disease. In over 80% of cases the right hemithorax is involved [12]. <span>Diffuse alveolar haemorrhage is a rare cause of haemoptysis associated with disruption of the alveolar–capillary barrier. It should be suspected in case of haemoptysis, anaemia and bilateral infiltrates on the chest radiograph. The infiltrates are the result of distal inhalation of blood. Diffuse alveolar haemorrhage may be associated with Goodpasture’s syndrome, where antibodies to type IV collagen are deposited along the alveolar and glomerular basement membranes, givi




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Diffuse alveolar haemorrhage may be associated with Goodpasture’s syndrome, where antibodies to type IV collagen are deposited along the alveolar and glomerular basement membranes, giving rise to haemoptysis. Diffuse alveolar haemorrhage is also associated with systemic vasculitis, such as Wegener’s granulomatosis or microscopic polyangiitis. Less commonly, diffuse alveolar haemorrhage may be associated with other immunological conditions, such as systemic lupus erythematosus, Henoch–Schönlein purpura, IgA nephropathy, rheumatoid arthritis, Behçet’s syndrome, and cryoglobulinaemia. Infectious processes, such as leptospirosis, malaria, and cytomegalovirus infection may present alveolar haemorrhage. A number of drugs are also associated with diffuse alveolar haemorrhage, such as propylthiouracil, carbimazole, and crack cocaine [ 13]
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Pathophysiology and causes of haemoptysis - Oxford Medicine
veolar–capillary barrier. It should be suspected in case of haemoptysis, anaemia and bilateral infiltrates on the chest radiograph. The infiltrates are the result of distal inhalation of blood. <span>Diffuse alveolar haemorrhage may be associated with Goodpasture’s syndrome, where antibodies to type IV collagen are deposited along the alveolar and glomerular basement membranes, giving rise to haemoptysis. Diffuse alveolar haemorrhage is also associated with systemic vasculitis, such as Wegener’s granulomatosis or microscopic polyangiitis. Less commonly, diffuse alveolar haemorrhage may be associated with other immunological conditions, such as systemic lupus erythematosus, Henoch–Schönlein purpura, IgA nephropathy, rheumatoid arthritis, Behçet’s syndrome, and cryoglobulinaemia. Infectious processes, such as leptospirosis, malaria, and cytomegalovirus infection may present alveolar haemorrhage. A number of drugs are also associated with diffuse alveolar haemorrhage, such as propylthiouracil, carbimazole, and crack cocaine [13]. In a sizable number of cases, even after extensive diagnostic work-up, a definitive cause for haemoptosyis is not found. These cases are termed as cryptogentic haemoptysis. The inciden




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In a sizable number of cases, even after extensive diagnostic work-up, a definitive cause for haemoptosyis is not found. These cases are termed as cryptogentic haemoptysis. The incidence of cryptogenetic haemoptysis varies between different reports, with most being between 15 and 30% [14]. Most of these studies have, however, not systematically used CT evaluation on all patients
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Pathophysiology and causes of haemoptysis - Oxford Medicine
tomegalovirus infection may present alveolar haemorrhage. A number of drugs are also associated with diffuse alveolar haemorrhage, such as propylthiouracil, carbimazole, and crack cocaine [13]. <span>In a sizable number of cases, even after extensive diagnostic work-up, a definitive cause for haemoptosyis is not found. These cases are termed as cryptogentic haemoptysis. The incidence of cryptogenetic haemoptysis varies between different reports, with most being between 15 and 30% [14]. Most of these studies have, however, not systematically used CT evaluation on all patients. Wider availability and technical developments in CT imaging will likely result in reduced prevalence of unknown origin cases of haemoptysis in the future. Top Previous Pathophysiology




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The lungs are furnished with a dual blood supply, the bronchial arteries and the pulmonary arteries. The former account for only about 1% of arterial supply to the lung and bring nutrients to the lung parenchyma, the bronchi, and vasa vasorum of the pulmonary arteries and veins
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Pathophysiology and causes of haemoptysis - Oxford Medicine
patients. Wider availability and technical developments in CT imaging will likely result in reduced prevalence of unknown origin cases of haemoptysis in the future. Top Previous Pathophysiology <span>The lungs are furnished with a dual blood supply, the bronchial arteries and the pulmonary arteries. The former account for only about 1% of arterial supply to the lung and bring nutrients to the lung parenchyma, the bronchi, and vasa vasorum of the pulmonary arteries and veins. The bronchial arteries are a high-pressure circulation system. They have a variable anatomy in terms of origin and branching distribution. They generally originate from the descending




#GarjoHemoptysie
The bronchial arteries are a high-pressure circulation system. They have a variable anatomy in terms of origin and branching distribution. They generally originate from the descending thoracic aorta, at the level of the 3rd–8th thoracic vertebral body, more commonly between T5 and T6 (70–83.3% of cases) [ 15]. The right bronchial artery often arises together with the first aortic intercostal artery to form the intercostobronchial (ICBT) trunk, which usually branches off from the right lateral surface of the descending thoracic aorta. The left bronchial arteries conversely tend to arise from the more anterior surface of the descending thoracic aorta.
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Pathophysiology and causes of haemoptysis - Oxford Medicine
nary arteries. The former account for only about 1% of arterial supply to the lung and bring nutrients to the lung parenchyma, the bronchi, and vasa vasorum of the pulmonary arteries and veins. <span>The bronchial arteries are a high-pressure circulation system. They have a variable anatomy in terms of origin and branching distribution. They generally originate from the descending thoracic aorta, at the level of the 3rd–8th thoracic vertebral body, more commonly between T5 and T6 (70–83.3% of cases) [15]. The right bronchial artery often arises together with the first aortic intercostal artery to form the intercostobronchial (ICBT) trunk, which usually branches off from the right lateral surface of the descending thoracic aorta. The left bronchial arteries conversely tend to arise from the more anterior surface of the descending thoracic aorta. The four most common bronchial artery branching patterns include type I with one right bronchial artery (rising from the ICBT) and two left bronchial arteries (present in 40.6% of cases




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In approximately 20–30% of cases aberrant bronchial arteries branch off from other systemic arteries, such as the aortic arch, brachiocephalic artery, subclavian artery, internal mammary artery, inferior phrenic artery, or abdominal aorta. In addition, during chronic inflammatory processes collateral blood supply may be recruited from non-bronchial systemic arteries through transpleural vessels. These collateral non-bronchial vessels may derive from ramifications of subclavian, axillary, internal mammary arteries, as well as from subdiaphragmatic arteries. True bronchial arteries (both normal variants and aberrant) can be distinguished from these non-bronchial systemic arteries in that their trajectory into the pulmonary parenchyma parallels the bronchovascular axes. In contrast, non-bronchial systemic collateral vessels do not run parallel to the airways and have a more unpredictable origin from infradiaphragmatic arteries or from the supra-aortic great vessels or their branches, and enter the parenchyma through the inferior pulmonary ligament or through the adherent pleura; their course is not parallel to that of the bronchi
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Pathophysiology and causes of haemoptysis - Oxford Medicine
wo right (only one rising from the ICBT), and two left bronchial arteries (20.6%), and type 4 with two right (only one rising from the ICBT), and one left bronchial artery (9.7% of cases) [15]. <span>In approximately 20–30% of cases aberrant bronchial arteries branch off from other systemic arteries, such as the aortic arch, brachiocephalic artery, subclavian artery, internal mammary artery, inferior phrenic artery, or abdominal aorta. In addition, during chronic inflammatory processes collateral blood supply may be recruited from non-bronchial systemic arteries through transpleural vessels. These collateral non-bronchial vessels may derive from ramifications of subclavian, axillary, internal mammary arteries, as well as from subdiaphragmatic arteries. True bronchial arteries (both normal variants and aberrant) can be distinguished from these non-bronchial systemic arteries in that their trajectory into the pulmonary parenchyma parallels the bronchovascular axes. In contrast, non-bronchial systemic collateral vessels do not run parallel to the airways and have a more unpredictable origin from infradiaphragmatic arteries or from the supra-aortic great vessels or their branches, and enter the parenchyma through the inferior pulmonary ligament or through the adherent pleura; their course is not parallel to that of the bronchi. The pulmonary arteries are a low-pressure circulation system that account for 99% of the arterial supply to the lungs and are responsible for gas exchange. The bronchial and pulmonary




#GarjoHemoptysie
The pulmonary arteries are a low-pressure circulation system that account for 99% of the arterial supply to the lungs and are responsible for gas exchange. The bronchial and pulmonary systems are in close proximity at the level of the vasa vasorum where they are interconnected by numerous anastomoses. These communications cause a physiological right-to-left shunt that involves approximately 5% of the total cardiac output
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Pathophysiology and causes of haemoptysis - Oxford Medicine
pra-aortic great vessels or their branches, and enter the parenchyma through the inferior pulmonary ligament or through the adherent pleura; their course is not parallel to that of the bronchi. <span>The pulmonary arteries are a low-pressure circulation system that account for 99% of the arterial supply to the lungs and are responsible for gas exchange. The bronchial and pulmonary systems are in close proximity at the level of the vasa vasorum where they are interconnected by numerous anastomoses. These communications cause a physiological right-to-left shunt that involves approximately 5% of the total cardiac output. Bleeding in the lungs may originate from bronchial arteries, pulmonary arteries, bronchial capillaries, and alveolar capillaries. Bronchial arteries are the most common site of bleedin




#GarjoHemoptysie
Bleeding in the lungs may originate from bronchial arteries, pulmonary arteries, bronchial capillaries, and alveolar capillaries. Bronchial arteries are the most common site of bleeding causing haemoptysis, being involved in approximately 90% of cases [16]. In only 5% of cases does haemoptysis origin from the pulmonary vessels. In the remaining 5% of cases bleeding arises from ectopic bronchial arteries or other non-bronchial systemic arteries (including the aorta)
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Pathophysiology and causes of haemoptysis - Oxford Medicine
he vasa vasorum where they are interconnected by numerous anastomoses. These communications cause a physiological right-to-left shunt that involves approximately 5% of the total cardiac output. <span>Bleeding in the lungs may originate from bronchial arteries, pulmonary arteries, bronchial capillaries, and alveolar capillaries. Bronchial arteries are the most common site of bleeding causing haemoptysis, being involved in approximately 90% of cases [16]. In only 5% of cases does haemoptysis origin from the pulmonary vessels. In the remaining 5% of cases bleeding arises from ectopic bronchial arteries or other non-bronchial systemic arteries (including the aorta). Bleeding from the pulmonary artery circulation may be found in disease processes, such as tuberculosis, mycetoma, cavitating lung carcinoma, lymphoma, Behçet disease, pulmonary arterio




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The most common cause of bleeding from the pulmonary circulation is Rasmussens’s aneurysm. In the walls of cavitary lesions, bronchial or pulmonary arteries may be subject to deformation causing pear-shaped dilatations, which are, in truth, pseudo-aneurysmatic lesions, which may be eroded due to chronic inflammatory derangement. These aneurysms are traditionally considered responsible for haemoptysis in TB patients. However, the development of hypervascularized, dilated, tortuous bronchial vessels, often anastomotic with the pulmonary circulation, in the absence of true aneurysms, may be equally involved in these patients.
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Pathophysiology and causes of haemoptysis - Oxford Medicine
in disease processes, such as tuberculosis, mycetoma, cavitating lung carcinoma, lymphoma, Behçet disease, pulmonary arteriovenous malformations, and trauma during right heart catheterization. <span>The most common cause of bleeding from the pulmonary circulation is Rasmussens’s aneurysm. In the walls of cavitary lesions, bronchial or pulmonary arteries may be subject to deformation causing pear-shaped dilatations, which are, in truth, pseudo-aneurysmatic lesions, which may be eroded due to chronic inflammatory derangement. These aneurysms are traditionally considered responsible for haemoptysis in TB patients. However, the development of hypervascularized, dilated, tortuous bronchial vessels, often anastomotic with the pulmonary circulation, in the absence of true aneurysms, may be equally involved in these patients. (p. 587) In certain situations, the thin-walled capillary communications between the high-pressure systemic bronchial arterial system, and the lower pressure pulmonary arterial system c




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In certain situations, the thin-walled capillary communications between the high-pressure systemic bronchial arterial system, and the lower pressure pulmonary arterial system can vasodilate and enlarge. Conditions causing reduced pulmonary arterial perfusion, such as chronic thromboembolic disease and vasculitic disorders, in which there is a reduction in pulmonary arterial supply distal to the emboli, can lead to a gradual increase in the bronchial arterial contribution [3]‌, thereby increasing the importance of bronchial-to-pulmonary artery anastomoses in regions of the lung that are deprived of their pulmonary arterial blood flow. Experimental studies have suggested that the increased bronchial arterial blood flow is due to neovascularization [3]. The anastomotic vessels, which are subjected to increased systemic arterial pressure, are often thin-walled, and prone to rupture into the alveoli or bronchial airways, giving rise to haemoptysis
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Pathophysiology and causes of haemoptysis - Oxford Medicine
f hypervascularized, dilated, tortuous bronchial vessels, often anastomotic with the pulmonary circulation, in the absence of true aneurysms, may be equally involved in these patients. (p. 587) <span>In certain situations, the thin-walled capillary communications between the high-pressure systemic bronchial arterial system, and the lower pressure pulmonary arterial system can vasodilate and enlarge. Conditions causing reduced pulmonary arterial perfusion, such as chronic thromboembolic disease and vasculitic disorders, in which there is a reduction in pulmonary arterial supply distal to the emboli, can lead to a gradual increase in the bronchial arterial contribution [3]‌, thereby increasing the importance of bronchial-to-pulmonary artery anastomoses in regions of the lung that are deprived of their pulmonary arterial blood flow. Experimental studies have suggested that the increased bronchial arterial blood flow is due to neovascularization [3]. The anastomotic vessels, which are subjected to increased systemic arterial pressure, are often thin-walled, and prone to rupture into the alveoli or bronchial airways, giving rise to haemoptysis. During acute or chronic tracheobronchitic events, inflammation of the mucosa with vascular engorgement, desquamation, atrophy, and erosion, may lead to bleeding. Infective agents, such




#GarjoHemoptysie
During acute or chronic tracheobronchitic events, inflammation of the mucosa with vascular engorgement, desquamation, atrophy, and erosion, may lead to bleeding. Infective agents, such as Aspergillus spp. may release fungal endotoxins that exert haemolytic activity. Inflammatory processes release angiogenic growth factors, thus promoting neo-angiogenesis and recruitment of collateral supplies from adjacent vessels and increased anastomoses between bronchial and pulmonary arterial systems [17]
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Pathophysiology and causes of haemoptysis - Oxford Medicine
anastomotic vessels, which are subjected to increased systemic arterial pressure, are often thin-walled, and prone to rupture into the alveoli or bronchial airways, giving rise to haemoptysis. <span>During acute or chronic tracheobronchitic events, inflammation of the mucosa with vascular engorgement, desquamation, atrophy, and erosion, may lead to bleeding. Infective agents, such as Aspergillus spp. may release fungal endotoxins that exert haemolytic activity. Inflammatory processes release angiogenic growth factors, thus promoting neo-angiogenesis and recruitment of collateral supplies from adjacent vessels and increased anastomoses between bronchial and pulmonary arterial systems [17]. Similar mechanisms are in play in haemoptysis caused by lung cancer. Cancer growth requires new vessel formation derived from pro-angiogenic tumour-secreted cytokines becoming dominant




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The hypoxic micro-environment associated with tumour growth causes cellular activation of hypoxia-inducible factor (HIF). HIF up-regulation promotes transcription of pro-angiogenic cytokines [20]. Hypoxaemia-induced angiopoietin 2 release plays an important role in initiating vessel sprouting in concert with VEGF. In contrast with angiopoietin-1, which stabilizes blood vessels, angiopoietin 2 destabilizes blood vessels, thus favouring bleeding. The new vessels associated with chronic inflammatory or tumoural pro-angiogenesis are usually thin-walled and fragile, and thus prone to rupture into the airways, therefore causing haemoptysis
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Pathophysiology and causes of haemoptysis - Oxford Medicine
sis factor-α‎, and interleukin-8 [18]. Furthermore, there is evidence that VEGF elevation correlates significantly with the presence of haemoptysis in patients with pulmonary aspergilloma [19]. <span>The hypoxic micro-environment associated with tumour growth causes cellular activation of hypoxia-inducible factor (HIF). HIF up-regulation promotes transcription of pro-angiogenic cytokines [20]. Hypoxaemia-induced angiopoietin 2 release plays an important role in initiating vessel sprouting in concert with VEGF. In contrast with angiopoietin-1, which stabilizes blood vessels, angiopoietin 2 destabilizes blood vessels, thus favouring bleeding. The new vessels associated with chronic inflammatory or tumoural pro-angiogenesis are usually thin-walled and fragile, and thus prone to rupture into the airways, therefore causing haemoptysis. Other specific mechanisms may be involved in generating haemoptysis, in particular disease conditions. In patients with depressed left ventricular ejection fraction or mitral stenosis




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Furthermore, a large volume of expectorated blood alone should not define massive hemoptysis, but rather an amount of blood sufficient to cause a condition that threatens the patient’s life can be a more correct and functional definition of severe hemoptysis (4, 5).
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Diagnosis and management of hemoptysis
e of a cutoff value is controversial (3). Volumes of 100 to 1000 mL of blood (4–9) have been described as indicative of massive hemoptysis, but no specific volume has been universally accepted. <span>Furthermore, a large volume of expectorated blood alone should not define massive hemoptysis, but rather an amount of blood sufficient to cause a condition that threatens the patient’s life can be a more correct and functional definition of severe hemoptysis (4, 5). Asphyxia due to the flooding of the airways rather than exsanguination is usually the cause of death, and it is commonly accompanied by cardiovascular collapse. The mortality rate from




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Asphyxia due to the flooding of the airways rather than exsanguination is usually the cause of death, and it is commonly accompanied by cardiovascular collapse. The mortality rate from untreated massive hemoptysis is more than 50% (6).
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Diagnosis and management of hemoptysis
massive hemoptysis, but rather an amount of blood sufficient to cause a condition that threatens the patient’s life can be a more correct and functional definition of severe hemoptysis (4, 5). <span>Asphyxia due to the flooding of the airways rather than exsanguination is usually the cause of death, and it is commonly accompanied by cardiovascular collapse. The mortality rate from untreated massive hemoptysis is more than 50% (6). Therefore, prompt recognition of severe hemoptysis and identification of its causes are mandatory to initiate an adequate treatment and to avoid fatal complications (6). Imaging plays a




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Hemoptysis has multiple causes usually categorized under parenchymal diseases, airway diseases, and vascular diseases.
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Diagnosis and management of hemoptysis
s of the various diagnostic modalities will be analyzed and a guide for managing hemoptysis, according to the most recent medical literature, will be proposed. Go to: Causes and pathophysiology <span>Hemoptysis has multiple causes usually categorized under parenchymal diseases, airway diseases, and vascular diseases. Bleeding may originate from small or large lung vessels (10). Bleeding from the small vessels usually causes a focal or diffuse alveolar hemorrhage and is mainly due to immunologic, vas




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Bleeding from the small vessels usually causes a focal or diffuse alveolar hemorrhage and is mainly due to immunologic, vasculitic, cardiovascular, and coagulatory causes ( Table 1 ). Causes of bleeding from the large vessels include infectious, cardiovascular, congenital, neoplastic, and vasculitic diseases ( Table 2 )

tabl 1 : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4463269/table/t1-dir-20-4-299/
tabl 2 : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4463269/table/t2-dir-20-4-299/

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Diagnosis and management of hemoptysis
hophysiology Hemoptysis has multiple causes usually categorized under parenchymal diseases, airway diseases, and vascular diseases. Bleeding may originate from small or large lung vessels (10). <span>Bleeding from the small vessels usually causes a focal or diffuse alveolar hemorrhage and is mainly due to immunologic, vasculitic, cardiovascular, and coagulatory causes (Table 1). Causes of bleeding from the large vessels include infectious, cardiovascular, congenital, neoplastic, and vasculitic diseases (Table 2). However, the most frequent diseases causing hemoptysis are bronchiectasis, tuberculosis, fungal infections, and cancer (4, 7). Table 1. Causes of hemoptysis from small vessels Immunolo




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Complex capillary anastomoses exist between the pulmonary arteries and the systemic bronchial arteries (9). When pulmonary circulation is compromised (e.g., in thromboembolic disease, vasculitic disorders, or in hypoxic vasoconstriction), the bronchial supply gradually increases causing a hyperflow in the anastomotic vessels, which become hypertrophic with thin walls and tend to break into the alveoli and bronchi, giving rise to hemoptysis
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Diagnosis and management of hemoptysis
involved in the gas exchange (8). Mediastinal lymph nodes and nerves, visceral pleura, esophagus, vasa vasorum of the aorta, and pulmonary veins are also provided by the bronchial arteries (4). <span>Complex capillary anastomoses exist between the pulmonary arteries and the systemic bronchial arteries (9). When pulmonary circulation is compromised (e.g., in thromboembolic disease, vasculitic disorders, or in hypoxic vasoconstriction), the bronchial supply gradually increases causing a hyperflow in the anastomotic vessels, which become hypertrophic with thin walls and tend to break into the alveoli and bronchi, giving rise to hemoptysis. Likewise, in chronic inflammatory disorders, such as bronchiectasis, chronic bronchitis, tuberculosis, mycotic lung diseases, and lung abscess, as well as in neoplastic diseases, the r




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Bronchial arteries are the principal sources of hemoptysis amenable to treatment (5). Searching the bronchial arteries origin before treatment is helpful, because over 30% have an abnormal origin that may lead to endovascular treatment failure. The bronchial arteries commonly originate from the upper portion of the descending thoracic aorta. The origin is defined orthotopic if the arteries arise from the descending aorta at the level of the vertebral bodies of T5–T6 (or at the carina). When the bronchial arteries originate at other levels, including aortic branches, they are referred to as ectopic (18)
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Diagnosis and management of hemoptysis
ed tomography (CT), particularly multidetector CT (MDCT), a decrease in the prevalence of hemoptysis without known cause might be expected (17). Go to: Anatomy of the lung arterial blood supply <span>Bronchial arteries are the principal sources of hemoptysis amenable to treatment (5). Searching the bronchial arteries origin before treatment is helpful, because over 30% have an abnormal origin that may lead to endovascular treatment failure. The bronchial arteries commonly originate from the upper portion of the descending thoracic aorta. The origin is defined orthotopic if the arteries arise from the descending aorta at the level of the vertebral bodies of T5–T6 (or at the carina). When the bronchial arteries originate at other levels, including aortic branches, they are referred to as ectopic (18). Ectopic bronchial arteries commonly arise from the inferior aspect of the aortic arch, subclavian artery, brachiocephalic trunk, thyrocervical trunk, internal mammary artery, costocerv




[unknown IMAGE 6073907285260] #GarjoHemoptysie #has-images

Cauldwell et al. (19) reported the most frequent types of origin of orthotopic bronchial arteries in a population of 150 adult cadavers ( Fig. 1 ). Usually, two or three branches of the bronchial arteries run parallel with the major bronchi and generate a peribronchial plexus by anastomosing with each other (20). Arterioles from this plexus perforate the muscular layer and create a parallel plexus in the bronchial submucosa. In normal conditions the diameter of bronchial arteries is less than 1.5 mm at the origin and less than 0.5 mm more distally (21). They are usually considered hypertrophic and a potential source of hemoptysis when larger than 2 mm at the origin (22).

Fig : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4463269/figure/f1-dir-20-4-299/

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Diagnosis and management of hemoptysis
, brachiocephalic trunk, thyrocervical trunk, internal mammary artery, costocervical trunk, pericardiophrenic artery, inferior phrenic artery, abdominal aorta, and coronary arteries (4, 6, 18). <span>Cauldwell et al. (19) reported the most frequent types of origin of orthotopic bronchial arteries in a population of 150 adult cadavers (Fig. 1). Usually, two or three branches of the bronchial arteries run parallel with the major bronchi and generate a peribronchial plexus by anastomosing with each other (20). Arterioles from this plexus perforate the muscular layer and create a parallel plexus in the bronchial submucosa. In normal conditions the diameter of bronchial arteries is less than 1.5 mm at the origin and less than 0.5 mm more distally (21). They are usually considered hypertrophic and a potential source of hemoptysis when larger than 2 mm at the origin (22). Open in a separate window Figure 1. Four most frequent origins and branching types of the orthotopic bronchial arteries at the level of tracheal bifurcation as described by Cauldwell et




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Hemoptysis may also arise from nonbronchial systemic arteries, which enter the pulmonary parenchyma through transpleural adhesions due to chronic inflammatory processes (tuberculosis, mycosis) or through pulmonary ligaments (20) and anastomose with the pulmonary arterial circulation (8)
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isconti, MD, from Yoon W, Kim JK, Kim YH, et al. Bronchial and nonbronchial systemic artery embolization for life-threatening hemoptysis: A comprehensive review. RadiGraphics 2002;22:1395–1409. <span>Hemoptysis may also arise from nonbronchial systemic arteries, which enter the pulmonary parenchyma through transpleural adhesions due to chronic inflammatory processes (tuberculosis, mycosis) or through pulmonary ligaments (20) and anastomose with the pulmonary arterial circulation (8). Nonbronchial arteries most commonly originate from inferior phrenic arteries, musculophrenic and pericardiodiaphragmatic arteries, posterior intercostal arteries, thyrocervical trunk,




#GarjoHemoptysie
Pulmonary arterial origin of hemoptysis is possible (23). Persistent hemoptysis despite appropriate embolization of the systemic arteries suggests a pulmonary arterial source of bleeding. Khalil et al. (24) investigated the potential causes of pulmonary arterial hemoptysis, including diseases causing necrosis (active tuberculosis, pulmonary abscess, aspergillosis, and necrotic lung carcinoma), vasculitis (Behçet disease or Hughes-Stovin syndrome), trauma by Swan-Ganz catheter, and pulmonary arteriovenous malformation (PAVM)
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from inferior phrenic arteries, musculophrenic and pericardiodiaphragmatic arteries, posterior intercostal arteries, thyrocervical trunk, internal mammary arteries, and subclavian arteries (4). <span>Pulmonary arterial origin of hemoptysis is possible (23). Persistent hemoptysis despite appropriate embolization of the systemic arteries suggests a pulmonary arterial source of bleeding. Khalil et al. (24) investigated the potential causes of pulmonary arterial hemoptysis, including diseases causing necrosis (active tuberculosis, pulmonary abscess, aspergillosis, and necrotic lung carcinoma), vasculitis (Behçet disease or Hughes-Stovin syndrome), trauma by Swan-Ganz catheter, and pulmonary arteriovenous malformation (PAVM). Go to: Diagnostic modalities Diagnostic modalities for studying hemoptysis include chest radiography (CXR), bronchoscopy, MDCT, MDCT angiography (MDCTA) and digital subtraction angiogr




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Nevertheless, the sensitivity of CXR in this context is not high. Hirshberg et al. (28) reported only 50% positive diagnostic yield for CXR. Revel et al. (29) demonstrated that CXR may identify the bleeding site in 46% of cases and the bleeding cause in 35% only. In a study by Herth et al. (30), nearly a quarter of patients presenting with hemoptysis due to malignancy showed normal CXR. Therefore, in patients presenting with hemoptysis, a negative CXR warrants other diagnostic studies, including bronchoscopy and/or MDCTA
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ease, atelectasis, cavitary lesion, and alveolar opacities due to alveolar hemorrhage (10). A localized finding may guide further evaluation better than a diffuse or bilateral lung involvement. <span>Nevertheless, the sensitivity of CXR in this context is not high. Hirshberg et al. (28) reported only 50% positive diagnostic yield for CXR. Revel et al. (29) demonstrated that CXR may identify the bleeding site in 46% of cases and the bleeding cause in 35% only. In a study by Herth et al. (30), nearly a quarter of patients presenting with hemoptysis due to malignancy showed normal CXR. Therefore, in patients presenting with hemoptysis, a negative CXR warrants other diagnostic studies, including bronchoscopy and/or MDCTA. Bronchoscopy For many years bronchoscopy has been considered the primary method for diagnosing and localizing hemoptysis, especially if massive (31). Bronchoscopy, performed with eithe




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Although rigid bronchoscopy may have a role in massive hemoptysis due to its ability to maintain airway patency (6), flexible fiberoptic bronchoscopy has the advantage of being carried out at the patient’s bedside without anesthesia and in the intensive care unit, and is therefore more frequently used (10).
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if massive (31). Bronchoscopy, performed with either a rigid or flexible endoscope, is helpful for identifying active bleeding and for checking the airways in patients with massive hemoptysis. <span>Although rigid bronchoscopy may have a role in massive hemoptysis due to its ability to maintain airway patency (6), flexible fiberoptic bronchoscopy has the advantage of being carried out at the patient’s bedside without anesthesia and in the intensive care unit, and is therefore more frequently used (10). The capability and success of bronchoscopy in localizing the bleeding site may vary according to the rate and severity of the hemorrhage (Fig. 2). Hirshberg et al. (28) found that bronc




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Bronchoscopy has an overall lower sensitivity than MDCT in detecting the underlying causes of bleeding (8, 2527, 29). In a study by Revel et al. (29), the cause of bleeding was identified in 8% of the patients, with bronchoscopy and in 77%, with MDCT. Nevertheless, bronchoscopy yields additional information on endobronchial lesions and allows samples for tissue diagnosis and microbial cultures (10). Moreover, with bronchoscopy cold saline solution can be instilled directly into the airways at the level of the bleeding source, if identified, and balloon inflation or laser coagulation may be used to control hemorrhage, even though the efficacy of these procedures is not proved and depends mostly on the practitioner’s skill (32)
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g (b) demonstrates a soft tissue in the right hilum, abrupting into the lumen of distal main bronchus (arrow) and representing a squamous cell carcinoma. Right pleural effusion is also evident. <span>Bronchoscopy has an overall lower sensitivity than MDCT in detecting the underlying causes of bleeding (8, 25–27, 29). In a study by Revel et al. (29), the cause of bleeding was identified in 8% of the patients, with bronchoscopy and in 77%, with MDCT. Nevertheless, bronchoscopy yields additional information on endobronchial lesions and allows samples for tissue diagnosis and microbial cultures (10). Moreover, with bronchoscopy cold saline solution can be instilled directly into the airways at the level of the bleeding source, if identified, and balloon inflation or laser coagulation may be used to control hemorrhage, even though the efficacy of these procedures is not proved and depends mostly on the practitioner’s skill (32). A recent study by Lee et al. (33) demonstrated that bronchoscopy has a relevant role mainly in patients with hemoptysis and no explainable lesions on MDCT. Multidetector CT MDCT repres




#GarjoHemoptysie
MDCT may identify the bleeding site in 63% to 100% of patients with hemoptysis (25, 34) and has the ability to uncover the potential underlying causes of bleeding, such as bronchiectasis, pulmonary infections, lung cancer, etc., being superior to bronchoscopy in this respect. MDCT also has the advantage of showing distal airways beyond the level of the bronchoscope (25, 26, 28, 33), and it has a sensitivity of more than 90% in identifying endobronchial lesions (10)
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Diagnosis and management of hemoptysis
sive and highly useful imaging tool in the clinical context of hemoptysis and allows a comprehensive evaluation of the lung parenchyma, airways, and thoracic vessels by using contrast material. <span>MDCT may identify the bleeding site in 63% to 100% of patients with hemoptysis (25, 34) and has the ability to uncover the potential underlying causes of bleeding, such as bronchiectasis, pulmonary infections, lung cancer, etc., being superior to bronchoscopy in this respect. MDCT also has the advantage of showing distal airways beyond the level of the bronchoscope (25, 26, 28, 33), and it has a sensitivity of more than 90% in identifying endobronchial lesions (10). Nevertheless, there are some limitations in characterizing lesions such as endobronchial blood clots that may mimic a tumor and visualizing an endobronchial process in the presence of




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Nevertheless, there are some limitations in characterizing lesions such as endobronchial blood clots that may mimic a tumor and visualizing an endobronchial process in the presence of acute bleeding filling the bronchial lumen (35). In these cases bronchoscopy remains an important complementary diagnostic tool (10). It has been affirmed that the combined use of MDCT and bronchoscopy provides the best accuracy in assessing patients with hemoptysis (34). Numerous authors have suggested that MDCT should be carried out before eventual bronchoscopy in all patients with hemoptysis (5, 27).
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MDCT also has the advantage of showing distal airways beyond the level of the bronchoscope (25, 26, 28, 33), and it has a sensitivity of more than 90% in identifying endobronchial lesions (10). <span>Nevertheless, there are some limitations in characterizing lesions such as endobronchial blood clots that may mimic a tumor and visualizing an endobronchial process in the presence of acute bleeding filling the bronchial lumen (35). In these cases bronchoscopy remains an important complementary diagnostic tool (10). It has been affirmed that the combined use of MDCT and bronchoscopy provides the best accuracy in assessing patients with hemoptysis (34). Numerous authors have suggested that MDCT should be carried out before eventual bronchoscopy in all patients with hemoptysis (5, 27). MDCTA is useful to create a detailed and accurate map of the thoracic vasculature that may guide further treatment. Remy-Jardin et al. (36) demonstrated that MDCTA provides more detaile




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In cases of hemoptysis, vessel analysis should include the bronchial and nonbronchial arteries and the pulmonary arterial circulation. A MDCTA of the chest performed before treatment is of value because the number and the origin of bronchial arteries may be carefully evaluated and the coexistence of an additional nonbronchial arterial supply may be easily depicted to determine the optimal angiographic approach (4, 36). Recognition of more than one arterial supply before endovascular treatment in patients presenting with massive hemoptysis, will assist in choosing ectopic vessels amenable to embolization and in preventing recurrences of hemoptysis after initial successful embolization (15)
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thoracic vasculature that may guide further treatment. Remy-Jardin et al. (36) demonstrated that MDCTA provides more detailed depiction of bronchial and nonbronchial systemic arteries than DSA. <span>In cases of hemoptysis, vessel analysis should include the bronchial and nonbronchial arteries and the pulmonary arterial circulation. A MDCTA of the chest performed before treatment is of value because the number and the origin of bronchial arteries may be carefully evaluated and the coexistence of an additional nonbronchial arterial supply may be easily depicted to determine the optimal angiographic approach (4, 36). Recognition of more than one arterial supply before endovascular treatment in patients presenting with massive hemoptysis, will assist in choosing ectopic vessels amenable to embolization and in preventing recurrences of hemoptysis after initial successful embolization (15). The availability of this information before patient’s arrival in the angiographic suite reduces the procedure time and potential iatrogenic risks of searching for abnormal vessels, whi




The term hemoptysis refers to expectoration of blood originating from the lower respiratory tract (ie, from below the vocal cords). Pseudohemoptysis, expectoration of blood that comes from the upper respiratory tract and/or the upper gastrointestinal tract, can mimic hemoptysis
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opics are updated as new evidence becomes available and our peer review process is complete. Literature review current through: Nov 2020. | This topic last updated: Jan 02, 2020. INTRODUCTION — <span>The term hemoptysis refers to expectoration of blood originating from the lower respiratory tract (ie, from below the vocal cords). Pseudohemoptysis, expectoration of blood that comes from the upper respiratory tract and/or the upper gastrointestinal tract, can mimic hemoptysis. There are several sources of bleeding within the lung and endobronchial tree that can be responsible for hemoptysis. Causes of life-threatening and non-life-threatening hemoptysis are




The most common causes of non-life-threatening hemoptysis in developed countries are acute bronchitis, bronchiectasis, and bronchial neoplasms (primary or secondary) [1-6]. In contrast, in developing countries, infections due to Mycobacterium tuberculosis and Paragonimus westermani and non-cystic fibrosis (CF)-related bronchiectasis are more common causes [1,7-9]
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SIS — Most episodes of hemoptysis are non-life-threatening. There are numerous causes of non-life-threatening bleeding from the lower respiratory tract, which are listed in the table (table 1). <span>The most common causes of non-life-threatening hemoptysis in developed countries are acute bronchitis, bronchiectasis, and bronchial neoplasms (primary or secondary) [1-6]. In contrast, in developing countries, infections due to Mycobacterium tuberculosis and Paragonimus westermani and non-cystic fibrosis (CF)-related bronchiectasis are more common causes [1,7-9]. Airways diseases — Hemoptysis is not an uncommon symptom of pathologic airway processes due to the proximal location of bronchi and their bronchial arterial supply. Bronchitis and bron




In bronchitis, minor amounts of hemoptysis may be seen during an acute flare but hemoptysis is unusual during the chronic phase. Life-threatening hemoptysis from acute bronchitis is unusual
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ronchitis and bronchiectasis — Inflammatory diseases, such as bronchitis and bronchiectasis (eg, due to cystic fibrosis, immunodeficiency, and prior pneumonia) are common causes of hemoptysis. ●<span>In bronchitis, minor amounts of hemoptysis may be seen during an acute flare but hemoptysis is unusual during the chronic phase. Life-threatening hemoptysis from acute bronchitis is unusual. (See "Acute bronchitis in adults" and "Chronic obstructive pulmonary disease: Definition, clinical manifestations, diagnosis, and staging".) ●In bronchiectasis, minor amounts of blood




In bronchiectasis, minor amounts of blood that are mixed with expectorated phlegm (“streaky” in appearance) are commonplace during the chronic phase. Less commonly, larger amounts that appear as bright red blood and clots may occur during an acute flare. In contrast to acute bronchitis, bronchiectasis is a common cause of life-threatening hemoptysis. Non-life-threatening hemoptysis is likely due to the chronic airway inflammation that is characteristic of bronchiectasis, while life-threatening hemoptysis is likely due to rapid bleeding from a ruptured tortuous bronchial artery or from hypertrophied submucosal and peribronchial blood vessels
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tening hemoptysis from acute bronchitis is unusual. (See "Acute bronchitis in adults" and "Chronic obstructive pulmonary disease: Definition, clinical manifestations, diagnosis, and staging".) ●<span>In bronchiectasis, minor amounts of blood that are mixed with expectorated phlegm (“streaky” in appearance) are commonplace during the chronic phase. Less commonly, larger amounts that appear as bright red blood and clots may occur during an acute flare. In contrast to acute bronchitis, bronchiectasis is a common cause of life-threatening hemoptysis. Non-life-threatening hemoptysis is likely due to the chronic airway inflammation that is characteristic of bronchiectasis, while life-threatening hemoptysis is likely due to rapid bleeding from a ruptured tortuous bronchial artery or from hypertrophied submucosal and peribronchial blood vessels. Because more patients with CF now survive into adulthood, recurrent hemoptysis in CF patients with bronchiectasis is occurring more frequently. (See "Clinical manifestations and diagno




The most common clinical pattern of hemoptysis due to lung cancer is intermittent small amounts of hemoptysis lasting more than two weeks. Less commonly, bronchogenic carcinoma causes life-threatening hemoptysis.
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g hemoptysis occurs in 7 to 10 percent of patients with lung cancer at the time of presentation and in approximately 20 percent of patients at some time during the course of their illness [10]. <span>The most common clinical pattern of hemoptysis due to lung cancer is intermittent small amounts of hemoptysis lasting more than two weeks. Less commonly, bronchogenic carcinoma causes life-threatening hemoptysis. (See 'Bronchogenic carcinoma' below.) Bronchial carcinoid, a highly vascular tumor that is unrelated to smoking, should be considered in a young or middle-aged nonsmoker with recurrent




Non-life-threatening hemoptysis occurs in 7 to 10 percent of patients with lung cancer at the time of presentation and in approximately 20 percent of patients at some time during the course of their illness [10].
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rimary bronchogenic carcinoma, endobronchial metastatic carcinoma (most commonly from melanoma or from breast, colon, or renal cell carcinoma), and bronchial carcinoid can all cause hemoptysis. <span>Non-life-threatening hemoptysis occurs in 7 to 10 percent of patients with lung cancer at the time of presentation and in approximately 20 percent of patients at some time during the course of their illness [10]. The most common clinical pattern of hemoptysis due to lung cancer is intermittent small amounts of hemoptysis lasting more than two weeks. Less commonly, bronchogenic carcinoma causes l




Fistulas – Fistula formation between a blood vessel and the tracheobronchial tree can occur when there is chronic vascular inflammation (eg, aortic aneurysm, aortic surgery such as stent placement, aortic infection, or an indwelling vascular device) or airway inflammation (eg, tracheobronchial medical device such as an airway stent). Vascular fistulas are at high risk of causing life-threatening hemoptysis, which is often heralded by smaller non-life threatening episodes of bleeding
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m old histoplasma infection. ●Airway infections – Airway mucosal infection with herpes virus [13-15] or fungal species [16-18] can cause hemoptysis, particularly in immunocompromised patients. ●<span>Fistulas – Fistula formation between a blood vessel and the tracheobronchial tree can occur when there is chronic vascular inflammation (eg, aortic aneurysm, aortic surgery such as stent placement, aortic infection, or an indwelling vascular device) or airway inflammation (eg, tracheobronchial medical device such as an airway stent). Vascular fistulas are at high risk of causing life-threatening hemoptysis, which is often heralded by smaller non-life threatening episodes of bleeding.(See 'Uncommon etiologies' below.) ●Dieulafoy lesion – A Dieulafoy lesion is a dilated aberrant submucosal vessel (superficial, subepithelial bronchial artery lesions contiguous with th




Infection — A number of lung parenchymal infections, especially tuberculosis, mycetoma, lung abscess, and necrotizing pneumonia can cause hemoptysis, most often due to erosion into blood vessels. Hemoptysis from infection can be life-threatening, particularly among patients with an aspergilloma and tuberculosis [25,26]. Among those with aspergilloma, hemoptysis is relatively common, occurring in up to 40 percent of patients in some series. In the developing world, P. westermani is a common cause of hemoptysis, and hemorrhagic dengue fever is associated with hemoptysis in about one-fourth of patients [27]. Hemoptysis is a late manifestation of Ebola virus. Other infections are listed in the table (table 1).
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ding in adults", section on 'Dieulafoy's lesion'.) Pulmonary parenchymal diseases — Causes of bleeding originating from the pulmonary parenchyma fall into several major categories listed below. <span>Infection — A number of lung parenchymal infections, especially tuberculosis, mycetoma, lung abscess, and necrotizing pneumonia can cause hemoptysis, most often due to erosion into blood vessels. Hemoptysis from infection can be life-threatening, particularly among patients with an aspergilloma and tuberculosis [25,26]. Among those with aspergilloma, hemoptysis is relatively common, occurring in up to 40 percent of patients in some series. In the developing world, P. westermani is a common cause of hemoptysis, and hemorrhagic dengue fever is associated with hemoptysis in about one-fourth of patients [27]. Hemoptysis is a late manifestation of Ebola virus. Other infections are listed in the table (table 1). (See "Clinical manifestations and complications of pulmonary tuberculosis", section on 'Hemoptysis' and "Clinical manifestations and diagnosis of chronic pulmonary aspergillosis" and "L




Pulmonary artery pseudoaneurysms – Pulmonary artery pseudoaneurysms (Rasmussen aneurysm), which are usually caused by infection, neoplasms, or trauma, have a predilection for peripheral pulmonary arteries and may be single or multiple [32]. Active tuberculosis and paragonimiasis may cause sudden rupture of a Rasmussen aneurysm [33,34]. Bleeding is more likely to be life-threatening
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haracterized by the presence of multiple pulmonary and/or bronchial aneurysms that can cause life-threatening hemoptysis [31]. (See "Clinical manifestations and diagnosis of Behçet syndrome".) ●<span>Pulmonary artery pseudoaneurysms – Pulmonary artery pseudoaneurysms (Rasmussen aneurysm), which are usually caused by infection, neoplasms, or trauma, have a predilection for peripheral pulmonary arteries and may be single or multiple [32]. Active tuberculosis and paragonimiasis may cause sudden rupture of a Rasmussen aneurysm [33,34]. Bleeding is more likely to be life-threatening. ●Pulmonary embolism (thrombotic, fat, septic) – Hemoptysis is a rare presenting manifestation of pulmonary embolism and is usually non-life-threatening unless the patient is receiving




Pulmonary or bronchial artery aneurysms – Hughes-Stovin syndrome, which may be a variant of Behçet syndrome, is characterized by the presence of multiple pulmonary and/or bronchial aneurysms that can cause life-threatening hemoptysis [31].
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angiectasia) and may be life-threatening (eg, during pregnancy). (See "Pulmonary arteriovenous malformations: Epidemiology, etiology, and pathology in adults" and 'Uncommon etiologies' below.) ●<span>Pulmonary or bronchial artery aneurysms – Hughes-Stovin syndrome, which may be a variant of Behçet syndrome, is characterized by the presence of multiple pulmonary and/or bronchial aneurysms that can cause life-threatening hemoptysis [31]. (See "Clinical manifestations and diagnosis of Behçet syndrome".) ●Pulmonary artery pseudoaneurysms – Pulmonary artery pseudoaneurysms (Rasmussen aneurysm), which are usually caused by




Pulmonary embolism (thrombotic, fat, septic) – Hemoptysis is a rare presenting manifestation of pulmonary embolism and is usually non-life-threatening unless the patient is receiving anticoagulant therapy. The presumed mechanism is pulmonary infarction, which usually occurs with smaller, more distal thromboembolism
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ry arteries and may be single or multiple [32]. Active tuberculosis and paragonimiasis may cause sudden rupture of a Rasmussen aneurysm [33,34]. Bleeding is more likely to be life-threatening. ●<span>Pulmonary embolism (thrombotic, fat, septic) – Hemoptysis is a rare presenting manifestation of pulmonary embolism and is usually non-life-threatening unless the patient is receiving anticoagulant therapy. The presumed mechanism is pulmonary infarction, which usually occurs with smaller, more distal thromboembolism. (See "Overview of acute pulmonary embolism in adults", section on 'Clinical presentation, evaluation, and diagnosis' and "Clinical presentation, evaluation, and diagnosis of the nonpre




Any etiology associated with non-life-threatening hemoptysis (table 1) can also cause life-threatening hemoptysis, but a few etiologies account for most episodes of the latter. While comprehensive epidemiologic data are lacking, common causes of life-threatening hemoptysis in developed countries include bronchiectasis (most often cystic fibrosis [CF]-related), tuberculosis (TB), airway neoplasms (primary and metastatic), and fungal infections (particularly aspergilloma) [54-56]
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-hour period or bleeding at a rate ≥100 mL/hour [50]. For practical purposes, more than 150 mL is easily quantifiable by patients as roughly a half cup of blood in 24 hours. Common etiologies — <span>Any etiology associated with non-life-threatening hemoptysis (table 1) can also cause life-threatening hemoptysis, but a few etiologies account for most episodes of the latter. While comprehensive epidemiologic data are lacking, common causes of life-threatening hemoptysis in developed countries include bronchiectasis (most often cystic fibrosis [CF]-related), tuberculosis (TB), airway neoplasms (primary and metastatic), and fungal infections (particularly aspergilloma) [54-56]. In a series of 58 patients undergoing arterial embolization for hemoptysis, underlying causes included CF-related bronchiectasis (40 percent), lung metastasis (14 percent), lung cancer




Active TB – Life-threatening hemoptysis due to active TB can occur in the setting of cavitary or noncavitary disease. The cause of the bleeding is usually due to bronchial arterial vessel ulceration [10]. Less often, active TB may cause sudden rupture of a Rasmussen aneurysm (ie, pseudoaneurysm) of the pulmonary artery [33]. There is some uncertainty about whether similar pseudoaneurysms can also arise from TB-infected bronchial arteries
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is. (See "Clinical manifestations and diagnosis of bronchiectasis in adults", section on 'Etiologies'.) Tuberculosis — Life-threatening hemoptysis can be due to either active or prior TB [51]. ●<span>Active TB – Life-threatening hemoptysis due to active TB can occur in the setting of cavitary or noncavitary disease. The cause of the bleeding is usually due to bronchial arterial vessel ulceration [10]. Less often, active TB may cause sudden rupture of a Rasmussen aneurysm (ie, pseudoaneurysm) of the pulmonary artery [33]. There is some uncertainty about whether similar pseudoaneurysms can also arise from TB-infected bronchial arteries. (See "Clinical manifestations and complications of pulmonary tuberculosis", section on 'Hemoptysis'.) ●Prior TB – There are multiple causes of hemoptysis due to inactive prior TB. Thes




Prior TB – There are multiple causes of hemoptysis due to inactive prior TB. These include the erosion of a healed calcified lymph node (ie, broncholith) through a bronchial artery and into an airway, bronchiectasis due to structural lung damage from prior TB, a mycetoma in an old TB lung cavity, and scar carcinoma in areas of healed TB. Late rupture of a Rasmussen aneurysm also may occur in patients with prior TB [61]
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about whether similar pseudoaneurysms can also arise from TB-infected bronchial arteries. (See "Clinical manifestations and complications of pulmonary tuberculosis", section on 'Hemoptysis'.) ●<span>Prior TB – There are multiple causes of hemoptysis due to inactive prior TB. These include the erosion of a healed calcified lymph node (ie, broncholith) through a bronchial artery and into an airway, bronchiectasis due to structural lung damage from prior TB, a mycetoma in an old TB lung cavity, and scar carcinoma in areas of healed TB. Late rupture of a Rasmussen aneurysm also may occur in patients with prior TB [61]. Fungal infections — Fungal infections in the lung have increased in frequency, especially among patients with pre-existing cavitary disease and in immunocompromised patients (eg, hemat




In many patients, aspergillomas (and mycetomas) are asymptomatic and non-progressive for prolonged periods of time. However, hemoptysis occurs in 50 to 90 percent of patients, at some point in their life [10,25,26]. Hemoptysis is generally non-life-threatening but in rare cases, can be life-threatening. The exact cause of bleeding due to an aspergilloma is uncertain.
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vity may derive from various causes, such as chronic pulmonary sarcoidosis, emphysematous bullae, septic emboli, or hydatid cyst [25,62,63]. A mycetoma, can also be due to other fungal species. <span>In many patients, aspergillomas (and mycetomas) are asymptomatic and non-progressive for prolonged periods of time. However, hemoptysis occurs in 50 to 90 percent of patients, at some point in their life [10,25,26]. Hemoptysis is generally non-life-threatening but in rare cases, can be life-threatening. The exact cause of bleeding due to an aspergilloma is uncertain. (See "Clinical manifestations and diagnosis of chronic pulmonary aspergillosis".) ●Invasive parenchymal fungal infections – Invasive parenchymal fungal infections may also cause hemopty




Invasive parenchymal fungal infections – Invasive parenchymal fungal infections may also cause hemoptysis, particularly infections caused by the angioinvasive fungi including Aspergillus (acute or chronic necrotizing aspergillosis) and Mucor [10,64]. The fungi destroy parenchymal and vascular structures, thereby inducing hemorrhage
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g but in rare cases, can be life-threatening. The exact cause of bleeding due to an aspergilloma is uncertain. (See "Clinical manifestations and diagnosis of chronic pulmonary aspergillosis".) ●<span>Invasive parenchymal fungal infections – Invasive parenchymal fungal infections may also cause hemoptysis, particularly infections caused by the angioinvasive fungi including Aspergillus (acute or chronic necrotizing aspergillosis) and Mucor [10,64]. The fungi destroy parenchymal and vascular structures, thereby inducing hemorrhage. There is increasing recognition of subacute progressive aspergillus infection in patients with chronic underlying lung disease, including severe chronic obstructive pulmonary disease (




There is increasing recognition of subacute progressive aspergillus infection in patients with chronic underlying lung disease, including severe chronic obstructive pulmonary disease (COPD). When invasive parenchymal fungal infection occurs after hemopoietic stem cell transplantation, bleeding may be more likely when bone marrow production of neutrophils returns (about day 100), since local inflammation may increase [65].
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the angioinvasive fungi including Aspergillus (acute or chronic necrotizing aspergillosis) and Mucor [10,64]. The fungi destroy parenchymal and vascular structures, thereby inducing hemorrhage. <span>There is increasing recognition of subacute progressive aspergillus infection in patients with chronic underlying lung disease, including severe chronic obstructive pulmonary disease (COPD). When invasive parenchymal fungal infection occurs after hemopoietic stem cell transplantation, bleeding may be more likely when bone marrow production of neutrophils returns (about day 100), since local inflammation may increase [65]. (See "Clinical manifestations and diagnosis of chronic pulmonary aspergillosis" and "Epidemiology and clinical manifestations of invasive aspergillosis" and "Mucormycosis (zygomycosis)"




Acute dimorphic fungal infections (eg, histoplasmosis, blastomycosis) rarely cause hemoptysis and, when they do, it is likely a consequence of mucosal erosion. Prior histoplasmosis has been reported as a potential cause of hemoptysis, either due to the erosion of a calcified lymph node through an airway and vessel, or the effects of fibrosing mediastinitis.
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[65]. (See "Clinical manifestations and diagnosis of chronic pulmonary aspergillosis" and "Epidemiology and clinical manifestations of invasive aspergillosis" and "Mucormycosis (zygomycosis)".) <span>Acute dimorphic fungal infections (eg, histoplasmosis, blastomycosis) rarely cause hemoptysis and, when they do, it is likely a consequence of mucosal erosion. Prior histoplasmosis has been reported as a potential cause of hemoptysis, either due to the erosion of a calcified lymph node through an airway and vessel, or the effects of fibrosing mediastinitis. (See "Pathogenesis and clinical features of pulmonary histoplasmosis" and "Clinical manifestations and diagnosis of blastomycosis", section on 'Pulmonary involvement'.) Bronchogenic car




Bronchogenic cancer accounts for approximately 5 to 30 percent of cases of life-threatening hemoptysis, depending on the report [66-68]. In many cases, life-threatening bleeding may be heralded by smaller, sentinel bleeding events during the prior weeks [69]. Patients typically have large, centrally located tumors, especially squamous cell carcinoma. In a case series of 125 patients with life-threatening hemoptysis related to non-small cell lung cancer, bleeding was due to bronchial artery involvement in 82 percent, while bleeding due to involvement of the main pulmonary artery was rare (6 percent) [70]. Approximately half these patients had squamous cell carcinoma
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(See "Pathogenesis and clinical features of pulmonary histoplasmosis" and "Clinical manifestations and diagnosis of blastomycosis", section on 'Pulmonary involvement'.) Bronchogenic carcinoma — <span>Bronchogenic cancer accounts for approximately 5 to 30 percent of cases of life-threatening hemoptysis, depending on the report [66-68]. In many cases, life-threatening bleeding may be heralded by smaller, sentinel bleeding events during the prior weeks [69]. Patients typically have large, centrally located tumors, especially squamous cell carcinoma. In a case series of 125 patients with life-threatening hemoptysis related to non-small cell lung cancer, bleeding was due to bronchial artery involvement in 82 percent, while bleeding due to involvement of the main pulmonary artery was rare (6 percent) [70]. Approximately half these patients had squamous cell carcinoma. Carcinoid tumors and endobronchial hemangiomas are highly vascular and are rare causes of life-threatening hemoptysis. (See "Lung neuroendocrine (carcinoid) tumors: Epidemiology, risk




Flashcard 6074392513804

Question
Gesicherte Risikofaktoren für Mammakarzinom
Answer

frühere und längere Östrogenexposition sowie eine genetische Belastung:

- frühe Menarche vor 12. Lebensjahr

- späte Menopause

- späte erste Gravidität (nach dem 30. Lebensjahr)

- Positive Familienanamnese


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Flashcard 6074397494540

Question
Aus welchen Zellen entsteht das Mammakarzinom?
Answer
Das Mammakarzinom entsteht hormonabhängig aus den Epithelien des ductulo- lobulären Übergangs unter dem Einfluss von Keimbahn- (ca. 10%) und somatischen Mutationen.

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Flashcard 6075350387980

Question
For stenotic lesions
Answer
[default - edit me]

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Flashcard 6075351436556

Question
[default - edit me]
Answer
key measurements are maximum velocity, mean gradient, and valve area.

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