Hemoptysis - Differential Diagnosis Framework

Massive Hemoptysis: >150-300 mL in 24h

Airway disease: 

 • Bronchitis, Bronchiectasis, Malignancy (Bronchogenic carcinoma, Bronchial carcinoid, Mets), COPD, Cystic fibrosis, Bronchovascular fistula, Foreign body

Parenchyma:

 • Infection: Bacterial (TB, Necrotizing PNA, Abscess), Viral (Influenza, Ebola, Dengue), Fungal (Aspergillosis, Mycetoma, Mucor), Parasitic (Paragonimus, Strongy) 

 • Malignancy: Primary lung, Mets, Kaposi's sarcoma

 • Rheumatologic / Autoimmune: ANCA-Assoc vasculitis (GPA > EGPA, MPA), Cryoglobulinemia, Goodpasture's, SLE

Cardiac: 

 • Valvular (Mitral stenosis or regurgitation, Tricuspid endocarditis), Heart failure

Vascular: 

 • Diffuse alveolar hemorrhage (DAH), AVM, Thoracic aortic aneurysm

Misc / Other:

 • Idiopathic

 • Coagulopathy: DIC, vWD

 • Endometriosis: Catamenial, hemoptysis

 • Trauma: Postprocedural, Lung contusion

 • Drugs / Toxins: Cocaine, Vaping, Bevacizumab

Mimics:

 • GI bleed: esophageal varices, PUD, gastritis

 • Nasopharyngeal bleeding



By Dr. Kristen Carroll via @NUIM_Chiefs



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