Recurrent hemoptoic sputum

Specialty: Respiratory.

• expectoration with streaks of blood
• sputum with recurrent threads of blood

Why it occurs

• Acute or exacerbated chronic bronchitis (persistent and intense inflammation of the bronchial mucosa damages the superficial capillaries, causing small blood leaks mixed with mucus)
• Uninfected or colonized bronchiectasis (neovascularization from the bronchial arteries, which handle systemic pressures, generates fragile vessels prone to repeated bleeding)
• Small cell or non-small cell lung cancer located endobronchially (progressive erosion of the bronchial mucosa due to invasive tumor growth)
• Mitral stenosis or left heart failure (increased pulmonary venous pressure is transmitted to the bronchial veins, causing bronchial varicose veins that rupture intermittently with the effort of coughing)
• Inactive pulmonary tuberculosis with cavitary sequelae (bleeding from dilated bronchial arteries within the walls of the cavern, such as Rasmussen's aneurysm).

Initial workup

Digital chest x-ray in two projections; Chest multidetector computed tomography (CT) with contrast; Flexible bronchoscopy (essential for exact localization of the source of bleeding and taking bronchial biopsies); Microbiological and cytological analysis of sputum.

Standard management

• Tranexamic acid — antifibrinolytic, administered at doses of 500-1000 mg orally or intravenously every 8 hours to reduce active capillary bleeding
• Codeine (antitussive, 15-30 mg orally every 6-8 hours to suppress cough that perpetuates vascular rupture, taking care not to retain secretions in patients with COPD or severe bronchiectasis).