Coughing Up Blood (Hemoptysis)

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Introduction

What is coughing up blood (hemoptysis)?

Coughing up blood is the production of blood or bloody mucus from the lower respiratory tract. This includes the lungs and bronchial tubes—the main airway passages. Hemoptysis is the medical term for this symptom. It is different from spitting up blood from the mouth, throat or stomach.

Common causes of coughing blood include bronchitis, pneumonia, tuberculosis, and bronchiectasis (inflammation of the airways). Other causes include lung abscess, lung cancer, and PE (pulmonary embolism). Medical tests and procedures, such as bronchoscopy and respiratory tract biopsy, can lead to coughing up blood as well.

A bloody cough may appear pink and frothy when it mixes with air and mucus from the lungs. It can also be bright or rusty red. Hemoptysis may involve large amounts of blood or mucus may appear streaked with blood.

The first step in diagnosing hemoptysis is to determine if you are truly coughing up blood from the lungs. Doctors need to confirm it is actually blood while ruling out the possibility of blood coming from the digestive tract, throat, or nasal passages.

Is coughing up blood an emergency?

Contact your doctor or seek prompt medical care if you are coughing up blood. Seek immediate medical care (call 911) if you are coughing up large amounts of blood, the bleeding won’t stop, or you have any of the following symptoms:

  • Chest pain

  • Dizziness

  • Fever

  • Lightheadedness

  • Shortness of breath

Contact your doctor any time you are concerned about the color, consistency or amount of liquid or mucus a cough produces.

Symptoms

What other symptoms might occur with coughing up blood (hemoptysis)?

You may experience other symptoms, depending on the underlying cause. These symptoms can affect other body systems, such as the circulatory system and the digestive tract.

Other symptoms that may occur along with hemoptysis

Coughing blood may occur with other symptoms including:

Serious symptoms that might indicate a life-threatening condition

In some cases, coughing up blood can occur with other symptoms that might indicate a serious or life-threatening condition that needs evaluation in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms:

Causes

What causes coughing up blood (hemoptysis)?

A number of different respiratory diseases, disorders and conditions can cause hemoptysis, many of which are serious, life-threatening situations. However, it can be difficult to find the source of the blood in some cases. Blood that is not coming from the lungs may be spit up from the throat or nose. You can also swallow blood and regurgitate it from the stomach.

Possible causes of coughing up blood

Reasons for coughing up blood are varied. It is most commonly due to bronchitis, pneumonia, tuberculosis, and bronchiectasis (inflammation of the airways). Medical tests and procedures can also cause hemoptysis. This includes bronchoscopy and respiratory tract biopsy. Other possible causes, some of which are potentially life threatening include:

  • Aortic aneurysm, mitral valve stenosis, and heart failure

  • Chest trauma or foreign body

  • COPD (chronic obstructive pulmonary disease) and cystic fibrosis

  • Crack cocaine use

  • Legionnaires’ disease

  • Lung abscess and lung cancer

  • Pulmonary aspiration (inhaling food or other substances into lungs) and pulmonary embolism (blood clot in the lung)

  • Taking blood thinner medications

In about one-third of patients, doctors can’t identify a cause. Close monitoring is necessary to make sure lung cancer or another condition is not the cause.

Conditions that can mimic coughing up blood

Some medical conditions can lead to blood coming from the mouth and mimic coughing blood. These include:

If you are coughing up blood, your doctor will look for a treatable cause. The first step is taking a medical history and doing a physical exam. Doctors will want to know about your symptoms, chronic medical conditions, travel history, and tobacco and alcohol use.

If your doctor suspects the blood is coming from your lungs, testing is necessary to find the cause. This can include:

  • Chest X-ray to look for a mass or other lung disease

  • CT scan if X-ray findings are abnormal

  • Bronchoscopy to view the inside of the lungs and confirm the source of bleeding or diagnosis, and treat the cause if possible

  • Lab tests, such as blood clotting time, complete blood counts, and urinalysis, to support and further define the diagnosis

  • Lung perfusion scan or CT angiography if pulmonary embolism or lung inflammation is possible

  • Sputum sample for culture if infection is suspected

The results of these hemoptysis tests will help your doctor design a treatment plan. Treatment will depend on the underlying cause. The goal is to stop the bleeding and treat the underlying cause. Some treatments to stop bleeding, such as cauterizing tissue, may be performed during bronchoscopy or may require surgery. Doctors can also administer medicine directly to the area.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Aug 12
  1. Bidwell JL, Pachner RW. Hemoptysis: Diagnosis and Management. Am Fam Physician. 2005;72(7):1253-1260.
  2. Coughing Up Blood. Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/symptoms/coughing-up-blood/basics/definition/sym-20050934 
  3. Coughing Up Blood. MedlinePlus, U.S. National Library of Medicine. https://medlineplus.gov/ency/article/003073.htm 
  4. Earwood JS, Thompson TD. Hemoptysis: Evaluation and management. Am Fam Physician. 2015;91(4):243-249.
  5. Hemoptysis. Merck Manual Professional Version. https://www.merckmanuals.com/professional/pulmonary-disorders/symptoms-of-pulmonary-disorders/hemoptysis#v911355 
  6. Wilkins T, Khan N, Nabh A, et al. Diagnosis and management of upper gastrointestinal bleeding. Am Fam Physician. 2012;85(5):469-476.


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