lung and airway disorders
Coughing Up Blood
Evaluation of Coughing Up Blood
The following information can help people decide whether a doctor's evaluation is needed and help them know what to expect during the evaluation. In people with hemoptysis, the following symptoms are of particular concern: Large amounts of blood coughed up Shortness of breath Signs of significant blood loss (weakness, dizziness when standing up, thirst, sweating, and a rapid heart rate) Weakness or fatigue Having a tracheostomy People with warning signs should go the hospital immediately. People without warning signs who have risk factors for serious disorders and those with more than just blood-streaked sputum should see a doctor in a day or two. If people have only blood-streaked sputum (which is usually caused by an upper respiratory infection), a doctor's evaluation is not as urgent. People can call a doctor, who can decide whether and how rapidly they need to be seen based on their symptoms, medical history, and other factors. Typically, a delay of a few days or so is not harmful. Doctors first ask questions about the person's symptoms and medical history and then do a physical examination. What doctors find during the history and physical examination often suggests a cause and the tests that may need to be done (see table). Doctors ask When the person started coughing up blood How long the coughing has been going on Whether anything specific triggers it (such as cold, exertion, or lying down) About how much blood is coughed up (such as streaks, a teaspoonful, or a cupful) Whether the person has other symptoms, such as fever, weight loss, chest pain, or leg pain Doctors determine whether blood was actually coughed (and not vomited or dripped down the back of the throat from a nosebleed). Doctors ask people about their medical history (if not already known) and their risk factors for causes. A history of frequent nosebleeds, easy bruising, or liver disease suggests a possible Overview of Blood Clotting Disorders . Doctors review the medications the person is taking to check for those that inhibit clotting (anticoagulants). During the physical examination, doctors review vital signs to check for fever, rapid heart or breathing rate, and test for a low oxygen level in the blood. They do a full heart and lung examination, inspect the neck veins for signs of fullness such as bulging, and check the legs for puffiness ( Swelling ). Puffiness in one leg may indicate a blood clot ( Clues from the history and examination help doctors determine the cause. A sensation of postnasal drip or any bleeding from the nose, particularly without coughing, may mean that the blood being coughed up has dripped down the back of the throat from the nose. Nausea and vomiting of black, brown, or coffee-ground–colored material usually means that the blood is from the stomach or intestine and is being vomited and not coughed. Frothy sputum, bright red blood, and, if the amount is massive, a sensation of choking usually mean that the blood is from the trachea or lungs (called true hemoptysis). If cough has just begun and if the person is otherwise in good health and has no risk factors for tuberculosis, fungal infection, or pulmonary embolism, the cause is usually an acute respiratory infection, such as Acute Bronchitis . If coughing up blood is caused by a heart or lung disorder, the person has almost always already been diagnosed with that heart or lung disorder. That is, coughing up blood is usually not the first symptom of a heart or lung disorder. If hemoptysis is severe, persistent, or unexplained, testing is needed. If people have coughed up massive amounts of blood, they are treated and their condition is stabilized before testing is done. A Chest Imaging is taken typically. If the chest x-ray is abnormal or if the person has symptoms of or risk factors for a particular disorder, computed tomography (CT) and bronchoscopy are done. In bronchoscopy, a flexible viewing tube is inserted into the windpipe and bronchi to identify the bleeding site. Occasionally, bronchoscopy is necessary to confirm that blood is being coughed up from the lower airways and not from the nose, stomach, or intestine. If pulmonary embolism seems possible, doctors do CT using a radiopaque contrast to show blood vessels (called CT angiography ) or a scan using a radioactive marker (called a Doctors often check for Lung Cancer , especially in people older than age 40 years who smoke (and even in younger people who smoke if they started smoking during adolescence), even if the sputum is only blood-streaked. In many people, a complete blood count and blood tests that assess the blood's ability to clot are done to detect blood clotting problems. Despite testing, the cause of hemoptysis is not identified in 30 to 40% of people. However, when hemoptysis is severe, the cause is usually identified. 