HEMOPTYSIS is defined as coughing of blood derived from bleeding in the lungs and bronchial tubes. This symptom should be taken seriously however small the amount is.
Coughing of blood must be differentiated from vomiting of blood. Blood from the lungs is usually bright red and mixed with frothy (foamy) or purulent sputum, while blood from the stomach is dark red and mixed with food materials. Hemoptysis must be differentiated also from pseudo-hemoptysis or blood from the nose, lips, gums, tongue, mouth or throat. Inspection on these areas will easily reveal the source of bleeding.
Hemoptysis occurs from a variety of diseases of the respiratory tract. They are classified into: infections, trauma, retained foreign body, tumors and congenital malformations.
Infection is the most common cause of hemoptysis in children. Included are pneumonias, pulmonary abscess, infected bronchiectasis (chronic inflammatory condition of one or more bronchi marked by dilatation or loss of elasticity of the wall), and tuberculosis. Fungi and parasitic infections are less common causes of hemoptysis in this age group.
The infection process usually erodes the wall of blood vessel(s) producing bleeding. Lung abscess may erode large blood vessel(s) leading to massive hemoptysis. Hemoptysis in children with tuberculosis is rarely encountered.
Even in the advanced stage of tuberculosis hemoptysis is unusual. However, if tuberculosis is associated or complicated with bronchiectasis, hemoptysis becomes a common symptom. The incidence of hemoptysis in adolescent tuberculosis is similar in adults.
Trauma such as pulmonary compression injury may cause hemoptysis in any age group. This may occur from exposure to blast, from a fall, or from automobile crash. Sudden violent compression pressure on the chest will result in severe internal tissue disruption. Extensive bleeding into the lungs will occur producing the hemoptysis.
Aspirated foreign body retained in the airway is another cause of hemoptysis in children. Wheezing after foreign body aspiration may lead one to believe that the child has asthma.
The foreign body may have been overlooked or forgotten and the child is treated for asthma every time he has an attack of wheezing. It is worth remembering that uncomplicated asthma is not a cause of hemoptysis. When it occurs foreign body should be considered.
Tumors in the respiratory tract as a cause of hemoptysis are rare in children. However some benign bronchial tumors are highly vascular and hemoptysis is an alarming symptom in 50% of cases. Most benign tumors produce more of compression and obstructive symptoms rather than bleeding. Primary cancer of the lungs is very rare in children.
The goals of treatment of hemoptysis include aspiration precaution, treatment of the underlying cause of bleeding and to stop the bleeding. Initial management depends on the amount of blood loss.
A child with massive hemoptysis, a blood loss of more than 100 milliliters (ml) per day represents a life-threatening situation. The child should be hospitalized and an aggressive emergency measures should be instituted at once.
Diagnostic evaluation and management must be done simultaneously. Airway maintenance is important because the primary mechanism of death in these cases is asphyxiation not exanguination. Blood may not be coughed out fast enough that large amount of clotted blood will occlude a major airway.
A child with frank hemoptysis (blood loss of more than 10 ml.) should be closely monitored. Treatment is directed at the underlying cause. Most are due to infection and an appropriate antibiotic should be given. Non-sedative anti-tussive (cough syrup) will be helpful in trying to stop the bleeding.
Gentle cough is advised, not the forceful coughing which will aggravate the bleeding. Rest is important allowing only necessary activities.
Failed resolution of the problem after initial treatment needs further evaluation and if bleeding persists other methods to stop bleeding should be instituted. (PVI)
