Hemoptysis: Definition, Causes, Tests, Risk Factors and Treatments

What does it consist of?

It consists in coughing up blood. And its appearance can be a sign of a severe medical condition. Infections, cancer, and lung blood vessel problems may be responsible. A cough with blood usually requires a medical evaluation unless the hemoptysis is due to bronchitis.

Causes of hemoptysis

There are many potential reasons to cough up blood. Causes for coughing up blood include:

  • Bronchitis (acute or chronic) is the most common cause of coughing up blood. Hemoptysis due to bronchitis is rarely fatal.
  • Bronchiectasis
  • Lung cancer or non-malignant lung tumors
  • Use of anticoagulants (anticoagulation)
  • Pneumonia
  • Pulmonary embolism
  • Congestive heart failure, especially mitral stenosis
  • Tuberculosis
  • Inflammatory or autoimmune conditions (lupus, Wegener’s granulomatosis, microscopic polyangiitis, Churg-Strauss syndrome, and many others).
  • Pulmonary arteriovenous malformations (AVM)
  • Consumption of Cocaine and crack.
  • Trauma, such as a gunshot wound or car accident
  • Dieulafoy’s disease

Hemoptysis can also come from bleeding outside of the lungs and airways. Severe nosebleeds or vomiting blood from the stomach can cause blood drainage into the windpipe (trachea).

Then the blood coughs up, appearing as hemoptysis. In many people with hemoptysis, no cause is ever identified. Most people with unexplained hemoptysis will no longer cough up blood six months later.


In people coughing up blood, the test focuses on determining the rate of bleeding and any risk of breathing. The cause of the hemoptysis must then be identified. Tests for coughing up blood include:

History and physical examination: When talking and examining someone coughing up blood, a doctor gathers clues that help identify the cause.


Chest x-ray: This test may show a mass in the chest, areas of fluid or congestion in the lungs, or be completely normal.

Computed tomography (CT) scan: A CT scan can reveal some causes of coughing up blood by producing detailed images of structures in the chest.

Bronchoscopy: A doctor inserts an endoscope (flexible tube with a camera at its end) through the nose or mouth into the trachea and airways. Through bronchoscopy, a doctor may be able to identify the cause of the hemoptysis.

Complete blood count: A test of the number of white and red blood cells in the blood and platelets (cells that help the blood clot).

Urinalysis: Certain hemoptysis also causes abnormalities in a simple urine test.

Blood chemistry profile: This test measures electrolytes and kidney function, which may be abnormal in some causes of hemoptysis.

Coagulation assays: Alterations in the blood’s ability to clot can contribute to bleeding and coughing up blood.

Massive hemoptysis in summary

When a patient presents with massive hemoptysis, the initial steps are to correctly position the patient, establish a patent airway, ensure adequate gas exchange and cardiovascular function, and control bleeding.

The source of massive hemoptysis can be identified during initial efforts to control bleeding or later during a diagnostic evaluation once the patient has been stabilized.

It is essential to identify the cause of massive hemoptysis even if the bleeding has stopped since the reason determines the proper definitive treatment and the risk of recurrence.

Diagnostic evaluation and definitive treatment of massive hemoptysis

Arterial blood gas consists of a test of the levels of oxygen and carbon dioxide in the blood. Oxygen levels may be low in people who cough up blood.

Pulse oximetry. It is a probe (usually on a finger) that tests the oxygen level in the blood.


For people coughing up blood, the treatments try to stop the bleeding and treat the underlying cause of the hemoptysis.

The treatments include:

Embolization of the bronchial artery

It is a procedure in which a doctor inserts a catheter through the leg into an artery that supplies blood to the lungs.

The doctor identifies the source of bleeding by injecting dye and visualizing the arteries on a video screen. That artery is then blocked using metal coils or another substance. Bleeding usually stops, and other streets compensate for the newly blocked artery.


The tools at the end of the endoscope can be used to treat some causes of coughing up blood. For example, an inflated balloon inside the airway can help stop bleeding.

Risk factors for hemoptysis in idiopathic and hereditary pulmonary arterial hypertension

When hemoptysis complicates pulmonary arterial hypertension (PAH), it is assumed to result from bronchial artery hypertrophy.

In hereditary PAH, the most common mutation in the BMPR2 gene regulates mesenchymal cell growth, differentiation, and apoptosis.

This study aims to determine the relationship in PAH between the onset of hemoptysis, the progression of the disease, bronchial artery hypertrophy, pulmonary artery dilation, and BMPR2 mutations.

Detection methods:

Twenty-nine patients underwent a basal pulmonary image and repeated right heart catheterization. Genetic mutations were evaluated in a subset of patients.


Hemoptysis was associated with a more significant presence of hypertrophic bronchial arteries and faster hemodynamic deterioration.

A BMPR2 mutation did not predispose to the development of hemoptysis but was associated with a more significant number of hypertrophic bronchial arteries and a worse baseline hemodynamic profile.


Hemoptysis in pulmonary arterial hypertension is associated with bronchial artery hypertrophy and faster disease progression.

Although a BMPR2 mutation did not correlate with a higher incidence of hemoptysis in our patient cohort, its association with worse hemodynamics and a tendency to more significant bronchial arterial hypertrophy may increase the risk of hemoptysis.