Why does lung cancer cause hemoptysis

Unexplained coughing up blood is always a cause for concern and a reason to contact your doctor. If your cough is accompanied by dizziness or severe shortness of breath or your cough produces large volumes of blood more than a few teaspoons , immediately seek emergency medical care.

Coughing up blood from your respiratory tract hemoptysis is a common symptom of lung cancer. Lung cancer can affect more than just your lungs. Learn more about its effects on the body. When lung cancer reaches stage 3, it has spread from the lungs to other nearby tissue or far away lymph nodes. Learn about symptoms, treatment, and…. Have you or a loved one been diagnosed with stage 4 lung cancer? Learn what to expect so you can get the best possible treatment and comfort.

Learn how a lung cancer diagnosis may affect your mental well-being and what you can do to protect your mental health. Health Conditions Discover Plan Connect. Lung Cancer and Coughing Up Blood.

Life expectancy Metastatic lung cancer Other conditions When to see your doctor Takeaway Coughing up blood from your respiratory tract is referred to as hemoptysis. Assistance by a cardiothoracic surgeon should be considered because emergency surgical intervention may be needed.

Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Bidwell received his undergraduate and medical degrees from the University of Wisconsin, Madison. He completed his family medicine residency at St.

Pachner graduated from the Medical College of Wisconsin and completed a family practice residency at St. Address correspondence to Jacob L. Bidwell, M. Reprints are not available from the authors.

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New York: McGraw-Hill, —6. The causes of hemoptysis revisited. A review of the etiologies of hemoptysis between and Mo Med. Bond D, Vyas H. Viral pneumonia and hemoptysis. Crit Care Med. Nelson JE, Forman M. Hemoptysis in HIV-infected patients. A reappraisal of the causes of hemoptysis. Arch Intern Med. Hemoptysis: etiology, evaluation, and outcome in a tertiary referral hospital. Pulmonary embolism. In: Black ER, ed. Diagnostic strategies for common medical problems. Philadelphia: American College of Physicians, — Hemoptysis: comparative study of the role of CT and fiberoptic bronchoscopy.

Long-term outcome and lung cancer incidence in patients with hemoptysis of unknown origin. Cryptogenic hemoptysis. Clinical features, bronchoscopic findings, and natural history in 67 patients. Ann Intern Med. Pianosi P, alsadoon H. Hemoptysis in children. Pediatr Rev. Godfrey S. Pediatr Pulmonol Suppl. Corder R. Emerg Med Clin North Am. Mayo Clin Proc. Preventive Services Task Force. Lung cancer screening with sputum cytologic examination, chest radiography, and computed tomography.

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Colice GL. Detecting lung cancer as a cause of hemoptysis in patients with a normal chest radiograph: bronchoscopy vs CT. Jean-Baptiste E. Clinical assessment and management of massive hemoptysis. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.

Contact afpserv aafp. Want to use this article elsewhere? Get Permissions. Read the Issue. Sign Up Now. Previous: Management of Spontaneous Abortion. Oct 1, Issue. Hemoptysis: Diagnosis and Management. Hemoptysis is the spitting of blood that originated in the lungs or bronchial tubes. C 5 Patients with normal chest radiograph, no risk factors for cancer, and findings not suggestive for infection should be considered for bronchoscopy or high-resolution CT.

C 5 After extensive initial investigation, closely follow smokers older than 40 years who have unexplained hemoptysis. Algorithm for diagnosing nonmassive hemoptysis. Diagnosing Nonmassive Hemoptysis Figure 1.

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Purchase Access: See My Options close. Best Value! To see the full article, log in or purchase access. More in Pubmed Citation Related Articles. Email Alerts Don't miss a single issue. Neck veins should be inspected for distention, and the legs and presacral area should be palpated for pitting edema suggesting heart failure.

Heart sounds should be auscultated with notation of any extra heart sounds or murmur that might support a diagnosis of heart failure and elevated pulmonary pressure. The abdominal examination should focus on signs of hepatic congestion or masses, which could suggest either cancer or hematemesis from potential esophageal varices. The skin and mucous membranes should be examined for ecchymoses, petechiae, telangiectasia, gingivitis, or evidence of bleeding from the oral or nasal mucosa.

If the patient can reproduce hemoptysis during examination, the color and amount of blood should be noted. The history and physical examination often suggest a diagnosis and guide further testing see table Some Causes of Hemoptysis Some Causes of Hemoptysis Hemoptysis is coughing up of blood from the respiratory tract. Despite the many possibilities, some generalities can be made.

A previously healthy person with a normal examination and no risk factors eg, for TB, pulmonary embolism who presents with acute-onset cough and fever most likely has hemoptysis due to an acute respiratory illness; chronic disorders are much lower on the list of possibilities.

However, if risk factors are present, those specific disorders must be strongly suspected. Clinical prediction can help estimate the risk of pulmonary embolism Pulmonary Embolism PE Pulmonary embolism PE is the occlusion of pulmonary arteries by thrombi that originate elsewhere, typically in the large veins of the legs or pelvis.

A normal oxygen saturation does not exclude pulmonary embolism. Patients whose hemoptysis is due to a lung disorder eg, COPD, cystic fibrosis, bronchiectasis or heart disease eg, heart failure typically have a clear history of those disorders.

Hemoptysis is not an initial manifestation. Patients with symptoms or signs of chronic illness but no known disorders should be suspected of having cancer or TB, although hemoptysis can be the initial manifestation of lung cancer in a patient who is otherwise asymptomatic. Known renal failure or hematuria suggests a pulmonary-renal syndrome eg, Goodpasture syndrome, granulomatosis with polyangiitis.

Patients with hemoptysis due to a bleeding disorder usually have cutaneous findings petechiae, purpura, or both or a history of anticoagulant or antiplatelet drug use. Patients with massive hemoptysis require treatment and stabilization, usually in an intensive care unit, before testing. Patients with minor hemoptysis can undergo outpatient testing. Imaging is always done, typically chest x-ray, although sometimes eg, with known bronchiectasis CT is the initial test. Patients with normal results, a consistent history, and nonmassive hemoptysis can undergo empiric treatment for bronchitis.

Patients with abnormal results and patients without a supporting history should undergo CT and bronchoscopy. CT may reveal pulmonary lesions that are not apparent on the chest x-ray and can help locate lesions in anticipation of bronchoscopy and biopsy.

CT and pulmonary angiography can also detect pulmonary arteriovenous fistulas. Fiberoptic inspection of the pharynx, larynx, and airways may be indicated along with esophagogastric endoscopy when the etiology is obscure to distinguish hemoptysis from hematemesis and from nasopharyngeal or oropharyngeal bleeding. Laboratory testing is also done.

Patients usually should have a complete blood count, a platelet count, and measurement of PT prothrombin time and PTT partial thromboplastin time. Anti-factor Xa testing can be used to detect supratherapeutic anticoagulation in patients receiving low molecular weight heparin.

Urinalysis should be done to look for signs of glomerulonephritis hematuria, proteinuria, casts. TB skin testing and sputum culture should be done as the initial tests for active TB, but negative results do not preclude the need to induce sputum or do fiberoptic bronchoscopy to obtain samples for further acid-fast bacillus testing if an alternative diagnosis is not found.

It can be difficult to protect the uninvolved lung because it is often initially unclear which side is bleeding. Prevention of exsanguination involves reversal of any bleeding diathesis and direct efforts to stop the bleeding. Clotting deficiencies can be reversed with fresh frozen plasma and factor-specific or platelet transfusions.

Desmopressin is used to reverse platelet dysfunction associated with uremia and kidney disease. Tranexamic acid is an antifibrinolytic drug being increasingly used to promote hemostasis.

Laser therapy, cauterization, or direct injection with epinephrine or vasopressin can be done bronchoscopically. Massive hemoptysis is one of the few indications for rigid as opposed to flexible bronchoscopy Bronchoscopy Bronchoscopy is the introduction of an endoscope into the airways. Flexible fiberoptic bronchoscopy is used for virtually all diagnostic, and most therapeutic, indications. Flexible bronchoscopes Emergency surgery is indicated for massive hemoptysis not controlled by rigid bronchoscopy or embolization and is generally considered a last resort.

Once a diagnosis is made, further treatment is directed at the cause 2, 3 Treatment references Hemoptysis is coughing up of blood from the respiratory tract. Early resection may be indicated for bronchial adenoma or carcinoma. Broncholithiasis erosion of a calcified lymph node into an adjacent bronchus may require pulmonary resection if the stone cannot be removed via rigid bronchoscopy.

Bleeding secondary to heart failure or mitral stenosis usually responds to specific therapy for heart failure. In rare cases, emergency mitral valvulotomy is necessary for life-threatening hemoptysis due to mitral stenosis.