Frank Hemoptysis (Blood in Sputum)

CLINICAL DIAGNOSTIC MANUAL

Frank hemoptysis refers to the expectoration of blood originating from the respiratory tract. It is an alarming symptom that can indicate a variety of underlying pathologies, ranging from infections to malignancies.

The amount of blood can vary from small traces to large volumes, which may pose a life-threatening risk if not properly managed. A thorough evaluation is crucial to identify the underlying cause and provide appropriate treatment.

Pathology	Clinical Symptoms and Signs	Suspected Diagnosis	Confirmatory Diagnosis
Acute bronchitis	Cough, fever, blood in sputum, chest pain	Clinical history, physical examination, chest X-ray	Sputum culture, chest X-ray
Pulmonary embolism	Sudden dyspnoea, pleuritic chest pain, hemoptysis, tachycardia	Clinical history, physical examination, chest X-ray, ECG	Pulmonary angiography, contrast-enhanced CT
Lung carcinoma	Chronic cough, weight loss, blood in sputum, chest pain, dyspnoea	Clinical history, chest X-ray, computed tomography (CT)	Lung biopsy, bronchoscopy, sputum cytology
Pulmonary tuberculosis	Chronic cough, fever, night sweats, weight loss, hemoptysis	Clinical history, chest X-ray	Sputum culture, tuberculin test, PCR for Mycobacterium tuberculosis
Upper respiratory tract infection	Fever, cough, sore throat, blood in sputum	Clinical history, physical examination	Sputum culture, chest X-ray
Lung abscess	Fever, night sweats, weight loss, foul-smelling blood-stained sputum, chest pain	Clinical history, chest X-ray	Computed tomography (CT), sputum culture
Bronchiectasis	Chronic cough with purulent sputum, hemoptysis, dyspnoea, recurrent respiratory infections	Clinical history, chest X-ray, computed tomography (CT)	High-resolution CT (HRCT), sputum culture
Wegener’s granulomatosis	Sinusitis, hemoptysis, dyspnoea, fever, weight loss, arthralgias	Clinical history, blood tests (ANCA), chest X-ray	Biopsy of affected tissue, computed tomography (CT)
Pneumonia	Fever, productive cough, chest pain, dyspnoea, hemoptysis	Clinical history, physical examination, chest X-ray	Sputum culture, blood cultures, chest X-ray
Pulmonary arteriovenous malformation	Dyspnoea, hemoptysis, cyanosis, vascular bruits	Clinical history, chest X-ray, echocardiogram	Pulmonary angiography, computed tomography (CT)
Others	Varies depending on the specific pathology but may include cough, fever, chest pain, dyspnoea, hemoptysis	Clinical history, physical examination, imaging and lab tests as indicated	Specific tests such as biopsies, cultures, pulmonary function tests, etc.