Hemoptysis

Hemoptysis in children is rare but can be dramatic, frightening, and potentially life-threatening. The expectoration of blood or blood-tinged sputum presents the clinician with significant diagnostic and therapeutic challenges. An understanding of the etiology, diagnosis, and management of hemoptysis is important for all clinicians.

The blood supply to the lungs is composed of 2 circulatory systems, bronchial and pulmonary. The bronchial system is high pressure but low volume. Bronchial vessels arise from the aorta and its branches, supplying blood to the conducting airways, down to the terminal bronchioles. The pulmonary system is the opposite, low pressure and high volume. Vessels from this system arise from the right ventricle and supply the acini. Hemoptysis results when endothelial damage occurs, causing either low-volume bleeding if originating from the pulmonary circulatory system or profuse bleeding if occurring in the high-pressure bronchial system.

A variety of factors make it difficult to ascertain the incidence of hemoptysis in children: under the age of 6 years, children have a tendency to swallow their sputum; most cases are mild and resolve within 24 hours; and there is no mandatory …