Factitious hemoptysis is considered in the differential diagnosis if no etiology. Hemoptysis, a characteristic feature of ph is rare as children tend to swallow the blood. Epidemiology and etiology causes of hemoptysis in children are listed in table 1. Hemoptysis and bronchiolitis obliterans in children with. Because children younger than 6 years of age tend to swallow their sputum, they rarely present with hemoptysis, unless the bleeding is substantial. Hemoptysis in an asthmatic child in the course of varicella. Ats reading list american thoracic society hemoptysis. Pdf 6 academic content and language evaluation of this article.
Hemoptysis is an uncommon but distressing symptom in children. Although this is the first report on the etiology of hemoptysis in korean children, selection bias should be considered, because the results were obtained from a single, tertiary medical institution. Lower respiratory tract infection and foreign body aspiration are the most common causes in children. With massive hemoptysis, if the side of bleeding is known, patients should be positioned with the affected lung in the dependent position. Massive hemoptysis is a complication commonly reported in patients with cystic fibrosis cf.
Isolated pulmonary arteritis can lead to massive hemoptysis in children 27. Hemoptysis american academy of pediatrics textbook of. In children, the most common causes of hemoptysis are infection and tracheostomyrelated complications. Nov 08, 20 hemoptysis is an uncommon but distressing symptom in children. Here we present the case of a pediatric patient who had an undiagnosed mass with lifethreatening hemoptysis. Pulmonary hemorrhagehemoptysis in children godfrey 2004. Hemoptysis in children is extremely rare and usually due to trauma, exacerbations of chronic pulmonary conditions, e.
A retrospective analysis was done, checking clinical files of patients admitted for hemoptysis, between 1 st january 2004 and 31 st december 2008. Coughing up blood, also known as hemoptysis, can be a sign of a serious medical condition. Hemoptysis might be the presenting symptom in numerous diseases with an associated mortality 730%. Massive hemoptysis, defined as the expectoration of blood volumes 100 ml per day in different studies is a potentially fatal complication mainly due to obstruction of the airways, as the anatomical dead space of the major airways is approximately 100200ml. Although common in adults, hemoptysis is a rare presentingsymptom in children. Hemoptysis is defined as the expectoration of blood derived from the lungs or bronchial tubes as a result of pulmonary or bronchial hemorrhage. Extrapulmonary tb disease may cause symptoms related to the part of the body that is affected table 4. Approach to pediatric hemoptysis general presentation hemoptysis, defined as coughing up blood or presenting with blood in sputum, arises from the lungs. Hemoptysis is the coughing up of blood or bloodstained mucus from the bronchi, larynx, trachea, or lungs. Therefore, multicenter studies are warranted to obtain more accurate information regarding the common etiology of hemoptysis in korean children. Other causes of hemoptysis are far less common, such as bleeding from localized lesions in the upper airway or tracheobronchial tree. The diagnosis is challenging as it is difficultto elicit a clear history and perform thorough physical examination in a child. It poses a diagnostic challenge as it is difficult to elicit a clear history and perform thorough physical examination in a child.
A focused physical examination can lead to the diagnosis of hemoptysis in most of the cases. The etiologies resulting in hemoptysis in children are similar to that in adults, including infections, cardiovascular diseases, foreign body aspiration, cystic fibrosis, respiratory neoplasm. The major cause of hemoptysis in children is lower respiratory tract infection. In children, lower respiratory tract infection and foreign body aspiration are common causes. Results the 19 children ranged in age from 7 weeks to 18 years mean age, 5. Hemoptysis in children is a rare but potentiallylifethreatening conditionof various underlying respiratory tract abnormalities. The second most common cause is foreign body aspiration, with most cases occurring in children younger than four. Citations 0 references 16 researchgate has not been able to resolve any citations for this publication. Indeed, the most common cause of hemoptysis is the least serious a ruptured small blood vessel caused by coughing andor a bronchitic infection in patients with a history of smoking or who are otherwise at risk for lung disease, however, hemoptysis is often a sign of serious illness, including cancer 11. Pneumothorax and hemoptysis guidelines cf foundation. Antifibrinolytic agents for hemoptysis management in.
Patients nineteen consecutive children presenting with hemoptysis to the otolaryngology service. Young adults who present with hemoptysis are assumed to be at lower risk for serious medical conditions when compared with older individuals, and there is little published research. Assessment of haemoptysis differential diagnosis of. The annualized hemoptysis admission rate prior to and following enrollment on the antifibrinolytic treatment pathway was calculated for each patient by dividing the number of hospital admissions with hemoptysis as the primary indication for admission by the total duration of time elapsed in years. The cause of hemoptysis in children can vary with the childs age. Recurrent pallor and hemoptysis in a child patra et al.
Pneumothorax and hemoptysis clinical care guidelines. The cause of hemoptysis in children can vary with the child s. Pulmonary hemorrhagehemoptysis in children godfrey. Methods the clinical, laboratory, and imaging data of 39 children with recurrent hemoptysis between. In pediatric population, the main etiologies of hemoptysis bronchiectasis and congenital cardiopathies are in accordance with other studies.
Upper gastrointestinal ugi bleeding arising proximal to the ligament of treitz in the distal duodenum commonly presents with hematemesis vomiting of red blood or coffee groundlike material andor melena black, tarry stools. Massive hemoptysis in a patient with pulmonary embolism, a. An understanding of the pathophysiology of this complication and its consequences is important for the management of patients with cf. The diagnosis is challenging as it is difficult to elicit a clear history and perform thorough physical examination in a child. Massive hemoptysis is defined as bleeding that exceeds 8 mlkg per 24 hours. Studies on hemoptysis is rare because hemoptysis is an uncommon symptom in children. Pulmonary hemorrhage and hemoptysis are uncommon in childhood, and the frequency with which they are encountered by the pediatrician depends largely on the special interests of the center to which the child is referred. Hemoptysis, defined as coughing up blood or presenting with blood in sputum, arises from the lungs. The annualized hemoptysis admission rate prior to and following enrollment on the antifibrinolytic treatment pathway was calculated for each patient by dividing the number of hospital admissions with hemoptysis as the primary indication for admission by. Finding the cause and treatment of the hemoptysis in pediatric patients is largely dependent on the history. This document reflects the cystic fibrosis foundation s pulmonary therapies committee recommendations for the treatment of hemoptysis and pneumothorax. Hemoptysis and pneumothorax are complications reported in people with cystic fibrosis. Despite haemoptysis being regarded as an alarm symptom, no identifiable cause is found in 1520% of cases and these are termed idiopathic or cryptogenic haemoptysis.
Hemoptysis in children a single institutional experience. Hemoptysis, the spitting or coughing of blood that originates within the thorax, can vary from flecks of blood in the sputum to massive, lifethreatening bleeding. Baishideng publishing group inc, 7041 koll center parkway, suite 160, pleasanton, ca 94566, usa. Hemoptysis, the spitting or coughing of blood that originates within the thorax, can vary from flecks of blood in the sputum to massive, lifethreatening bleeding that can lead to respiratory distress or death. Antifibrinolytic agents for hemoptysis management in adults. Appropriate management, ranging from antibiotics to emergency embolization, resulted in control of hemoptysis in all patients. We report this case to discuss hemoptysis in pediatric hydatid disease and to emphasize that lifethreatening he. Hemoptysis american academy of pediatrics textbook of pediatric. The diagnosis of pediatric hemoptysis can be challenging. General presentation hemoptysis, defined as coughing up blood or presenting with blood in sputum, arises from the lungs.
Design retrospective analysis of patients evaluated between january 1, 1995, and august 31, 1999. If romancing were permissible in medicine, we might indulge in an interesting consideration of the sharp turns hemoptysis has wrought in the lives of important personages and in the history of the world. Learn more about the causes, diagnostic tests, and treatments for hemoptysis. Epidemiology and etiology causes of hemoptysis in children. Pulmonary hemorrhage ph, defined as extravasation of blood into airways andor lung parenchyma, is uncommon in children. There are scarce reports in the literature on hemoptysis in children in the course of varicella pneumonitis. It often precipitates a psychological panic through the fear of. The aim of this study was to identify the causes of hemoptysis in children. Hemoptysis in children is a rare but potentially lifethreatening condition of various underlying respiratory tract abnormalities. In those centers caring for children with cystic fibrosis or congenital heart disease, these will be by far the most common causes of hemoptysis. Hemoptysis is considered massive at 300 ml 11 imp fl oz. To provide prevalence rates for the most common causes of hemoptysis in children.
Advances in endoscopic techniques have led to different new therapeutic approaches. Original article etiology and management of pediatric. Haemoptysis is the coughing of blood from a source below the glottis. Massive hemoptysis occurred with an average annual incidence of 0.
Five patients had concomitant fevers, while 3 also had cough. Etiology and management of pediatric hemoptysis pediatrics. Hemoptysis is a potentially lifethreatening event that necessitates that pediatricians have an understanding of its etiology, management, and prognosis. It is not a common symptom in children and although not. Finding the cause and treatment of the hemoptysis in pediatric patients is largely. Oct 27, 2014 despite haemoptysis being regarded as an alarm symptom, no identifiable cause is found in 1520% of cases and these are termed idiopathic or cryptogenic haemoptysis. Apr 21, 2004 in those centers caring for children with cystic fibrosis or congenital heart disease, these will be by far the most common causes of hemoptysis. Hemoptysis etiology, evaluation and treatment in a. Haemoptysis is rare in children and often only presents where bleeding is substantial, as children tend to swallow rather than expectorate their sputum. Pediatric hemoptysis without bronchiectasis or cardiac. Original article etiology and management of pediatric hemoptysis.
Approach to upper gastrointestinal bleeding in children. Oct 01, 2005 hemoptysis is the spitting of blood that originated in the lungs or bronchial tubes. It can range from a small amount of bloodstreaked sputum to massive bleeding with lifethreatening consequences due to airway obstruction, hypoxaemia, and haemodynamic instability. It often precipitates a psychological panic through the fear of impending dissolution and, then, spurns death in order to condition destiny. Jul 17, 2008 indeed, the most common cause of hemoptysis is the least serious a ruptured small blood vessel caused by coughing andor a bronchitic infection in patients with a history of smoking or who are otherwise at risk for lung disease, however, hemoptysis is often a sign of serious illness, including cancer 11. Hemoptysis is definedas the expectorationof blood or blood tingedsputum from the lower respiratory tract 1. Important causes of massive hemoptysis in children are. Etiology and management of pediatric hemoptysis university of. Hemoptysis in children american academy of pediatrics. Hemoptysis in children hemoptysis in children godfrey, simon 20040201 00. Bloodtinged sputum is a rare finding in the pediatric population.
Sep 25, 2009 although this is the first report on the etiology of hemoptysis in korean children, selection bias should be considered, because the results were obtained from a single, tertiary medical institution. Hemoptysis is a frequent manifestation of a wide variety of diseases, with mild to lifethreatening presentations. It may also be due to very rare conditions such the pulmonaryrenal syndromes and idiopathic pulmonary hemosiderosis iph. The diagnostic workup and the management of severe hemoptysis are often challenging. The patient with scant hemoptysis hemoptysis is a common occurrence in patients with cf, the committee tried to determine the threshold amount of bleeding that should prompt communication with a health care provider. The cause of hemoptysis in children can vary with the child s age. The american thoracic society improves global health by advancing research, patient care, and public health in pulmonary disease, critical illness, and sleep disorders. Recently, catamenial hemoptysis has been described in a 12 year old child and fibreoptic bronchoscopy revealed presence of endobronchial endometriosis28. Cold saline, vasoconstrictive and antifibrinolytic agents, oxidized regenerated cellulose, biocompatible glue. Hemoptysis is defined as the expectoration of blood or bloodtinged sputum.
In children, lower respiratory tract infection and. The cause of hemoptysis in children can vary with the childs. Diagnosis and management of hemoptysis in this age group requires knowledge and skill in the causes and management of this infrequently occurring potentially life. It is unclear which patients benefit most from bronchoscopy as an early component of their evaluation. Hemoptysis is a rare but potentially lifethreatening symptom of underlying respiratory tract abnormality in children. There was no increased occurrence by sex, but it was more prevalent in older patients mean age, 24. Objective to investigate the causes, clinical features, therapy and treatment outcomes of recurrent hemoptysis in children and to improve the skills of pediatricians in the etiological diagnosis and treatment of recurrent hemoptysis in children. Hemoptysis is the spitting of blood that originated in the lungs or bronchial tubes.
The patients history should help determine the amount of blood and differentiate between hemoptysis. This can occur with lung cancer, infections such as tuberculosis, bronchitis, or pneumonia, and certain cardiovascular conditions. Evaluate patients admitted for hemoptysis, its etiology, use of diagnostic tests, treatment and outcome. Approach to pediatric hemoptysis general presentation. Hemoptysis was the sole presenting symptom in patients. Diagnosis and management american family physician. Designretrospective analysis of patients evaluated between january 1. American journal of respiratory and critical care medicine. Unlike in adults, for whom more than 100 different causes of hemoptysis have been described, hemoptysis is a rare occurrence in children.
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