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Hemoptysis
Last reviewed: 23.04.2024
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Detection of blood in the sputum - hemoptysis (cough with blood) - is of the most important clinical significance. Depending on the blood content, sputum may become pink, red, or brown. In the domestic literature to denote hemoptysis you can find the terms "haemoptysis" v "haemoptoe". These terms can not be considered synonymous: in practical terms, it is important to distinguish bloody impurities from sputum (haemoptysis) and the secretion of pure scarlet blood (haemoptae), which, as a rule, has a foamy character. Thus in sputum (usually mucous or mucous-purulent), blood can be detected both in the form of bloody veins, which is characteristic of the length of haemoptysis, and in the form of separate clots or a mass of scarlet color with an alkaline reaction ( haemopoietic bleeding ). The massive haemoptoe is spoken for pulmonary hemorrhage in the volume of more than 200 ml / day. Usually in this case, urgent bronchoscopy and appropriate surgery - occlusion of the bronchial artery or bronchus, resection of the lobe or segment of the lung, ligation of the arteries of the bronchi, etc. Are necessary in this case.
Causes of hemoptysis (cough with blood)
The causes of the appearance of blood in the sputum can be divided into three groups.
- Inflammatory diseases - bronchoectatic disease, bronchitis, pulmonary tuberculosis (involving bronchi or cavernous process), lung abscess, pneumonia (especially caused by Klebsiella ), ARVI.
- Neoplasms are lung cancer (primarily bronchogenic).
- Other states.
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Features of a cough with blood for various diseases
With croupous pneumonia, the presence of blood in the sputum gives it a characteristic rusty shade - "rusty sputum."
- With bronchogenic cancer, hemoptysis is usually mild but persistent; less often sputum in the form of "crimson jelly" (usually with a pronounced tumor lesion). With the constant allocation of small portions of fresh blood for several days, one should suspect bronchogenic carcinoma, the probability of which is highest for a long-term smoking man.
- With bronchoectatic disease due to erosion of the bronchial mucosa in places of inflammation or atrophy, the walls of small vessels are easily damaged.
- Disintegration of the pulmonary tissue (abscess, tuberculous cavern, aseptic necrosis with Wegener's granulomagosis, hemorrhagic alveolitis with systemic vasculitis) is often accompanied by massive bleeding.
- With mitral stenosis, high pressure in the left atrium and. Consequently, high pressure in the pulmonary veins can cause damage to the small veins of the bronchi and hemoptysis. In the case of mitral stenosis hemoptysis serves as a clinical guideline for assessing the degree of pulmonary hypertension.
- In acute left ventricular failure due to acute blood stasis in the vessels of the small circle of blood circulation (including pulmonary capillaries), the lung is developing, in which a large amount of bloody foamy fluid is released from the respiratory tract.
Treatment with anticoagulant drugs causes a decrease in blood clotting capacity.
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Diagnosis of hemoptysis (cough with blood)
First of all, it is necessary to exclude the flow of blood into the sputum from the nose, nasopharynx, ulceration of the larynx, polyps of the upper respiratory tract as well as bleeding from the esophageal esophagus and gastric bleeding. An important diagnostic value is the detection of previous hemoptysis episodes of ARVI or venous thrombosis (especially deep veins of the lower extremities (usually accompanied by swelling of the legs) with PE and pulmonary infarction.
Diagnostic tactics in detecting hemoptysis require the following points to be taken into account.
- When hemoptysis is detected, a thorough examination is necessary to determine its cause.
- The repeated occurrence of hemoptysis in a patient can be caused not only by the disease associated with hemoptysis in the past, therefore, at any episode of the appearance of blood in sputum, a complete complete examination is necessary, despite a recent survey on the same issue.