Behind hemoptysis, there may be "early warning signs" of these diseases

Author: Jiang Guanchao, Chief Physician, Peking University People's Hospital

Reviewer: Zhi Xiuyi, Chief Physician, Xuanwu Hospital, Capital Medical University

Hemoptysis, as one of the common clinical symptoms of thoracic surgery and respiratory department, is often accompanied by the patient's tension and anxiety. From a professional medical perspective, hemoptysis refers to the phenomenon of bleeding in the respiratory tract or lungs, which is discharged from the mouth through coughing. This phenomenon is not an isolated symptom, and there may be multiple causes behind it.

Hemoptysis is closely associated with bronchiectasis and tumors, especially lung cancer. In lung cancer, hemoptysis is particularly common in large airway tumors or central lung cancer. These tumors grow near the openings of the trachea, bronchi, or segmental bronchus, and hemoptysis is caused by rupture of blood vessels on the surface of the tumor or erosion of surrounding blood vessels. It is worth noting that peripheral lung cancer often does not have any symptoms in the early stages, including hemoptysis, chest pain, and dyspnea. Its early detection mostly depends on health examinations and chest CT screening.

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Hemoptysis caused by lung cancer indicates that the disease has developed to an advanced stage, but for tumors in the large airways, hemoptysis may occur when the tumor is still small. Therefore, patients with hemoptysis symptoms should undergo detailed medical examinations as soon as possible to determine the cause and take appropriate treatment measures.

However, hemoptysis is not an exclusive symptom of lung cancer, and its causes are actually complex and diverse. Bleeding from multiple parts of the respiratory tract to the digestive tract may be discharged from the mouth through coughing or vomiting, and thus be mistaken for hemoptysis. Therefore, when doctors see patients with hemoptysis, they first need to determine the source of the bleeding.

Respiratory bleeding is the main cause of hemoptysis, which is usually accompanied by coughing. Gastrointestinal bleeding is often accompanied by symptoms such as nausea and vomiting, and the amount of bleeding is large. In addition, nasopharyngeal bleeding and oral mucosal bleeding are also common false signs of hemoptysis. This type of bleeding is mostly caused by dry air, deviated nasal septum, etc., and manifests as blood or black sputum in the sputum without coughing symptoms.

In terms of differential diagnosis, in addition to detailed medical history and physical examination, imaging examinations such as CT scans and bronchoscopy are also indispensable means. CT scans can visually display lung lesions, such as masses, bronchiectasis, etc. Bronchoscopy can directly enter the airway, observe the bleeding site, and perform necessary biopsies or treatment operations.

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Patients with hemoptysis often have other symptoms, which are of great reference value for diagnosing the cause of hemoptysis. For example, hemoptysis accompanied by a large amount of purulent sputum indicates the possible presence of bronchiectasis. Bronchiectasis is a chronic respiratory disease with repeated coughing, purulent sputum and hemoptysis as the main manifestations. Its pathogenesis is related to chronic inflammation and fibrosis of the bronchial wall, which leads to the destruction of the muscle and elastic tissue of the bronchial wall, and the expansion and deformation of the lumen.

In addition, when hemoptysis is accompanied by low-grade fever, night sweats, fatigue and other symptoms, the possibility of pulmonary tuberculosis should be highly suspected. Pulmonary tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis, which mainly invades the lungs and causes respiratory symptoms such as hemoptysis, cough, and sputum. At the same time, pulmonary tuberculosis can also cause systemic symptoms such as low-grade fever, night sweats, fatigue and weight loss, which are manifestations of tuberculosis toxicity.

Timely medical examination and diagnosis are essential for patients with hemoptysis. By comprehensively analyzing the patient's symptoms, signs, and imaging test results, the cause of hemoptysis can be determined and appropriate treatment measures can be taken. For hemoptysis caused by tumors, an individualized treatment plan should be developed based on the type and stage of the tumor; for hemoptysis caused by benign diseases such as bronchiectasis and tuberculosis, appropriate treatment methods should be selected based on the severity of the disease and the patient's physical condition.