Hemoptysis is the expectoration of blood from the lower respiratory tract and has an extensive differential diagnosis that can be divided into pseudohemoptysis, infectious, neoplastic, vascular, autoimmune, and drug-related categories. Pseudohemoptysis is the expectoration of blood from a different source and needs to be ruled out. Clinical and hemodynamic stability must be established first. Chest x-ray is the initial imaging examination for all patients with hemoptysis. However, advanced imaging, such as a computed tomography scan, is helpful for further evaluation. Management aims to ensure patient stabilization. Most diagnoses are self-limited, but bronchoscopy and transarterial bronchial artery embolization can be used to manage massive hemoptysis.

Case 4. ZD is a 72-year-old patient who comes to your office after 4 days of morning cough with blood-tinged sputum. He has a history of smoking and chronic bronchitis, but reports that he stopped smoking 5 years ago. He has no history of recent travel, fever, dyspnea, or night sweats; however, he has experienced a 5-kg (11-lb) weight loss in the past 2 months. Physical examination findings are normal except for bibasilar crackles on lung auscultation. Chest x-ray results are normal.

Definition and Prevalence

Hemoptysis refers to the expulsion of blood from the lower respiratory tract. It can occur with or without expulsion of mucus.¹³⁰ Hemoptysis predominantly affects older individuals with a mean age of 62 years and males more than females in a ratio of 2:1.¹³¹ It occurs in approximately 10% of patients with chronic lung disease and approximately 0.1% and 0.2% of outpatient and inpatient populations, respectively.¹³⁰ On the basis of these statistics, primary care physicians may see approximately 4 to 5 patients/year with hemoptysis.¹³²

Hemoptysis is nonmassive or massive. More than 90% of nonmassive hemoptysis cases are self-limited, whereas massive hemoptysis is a medical emergency.¹³³ Because of the difficulty quantifying the volume of expectorated blood, the definition of massive hemoptysis has shifted from the volume of loss during a specific period to the clinical effects of the bleeding.¹³⁴ Massive hemoptysis is less common than nonmassive hemoptysis, accounting for approximately 5% to 15% of hemoptysis diagnoses.¹³⁵ Despite being less common, massive hemoptysis should always be considered life-threatening and requires immediate intervention and assessment.