Pulmonary Hemorrhage

Chapter 76


Pulmonary Hemorrhage

Karen Z. Voter, MD, FAAP, and Clement L. Ren, MD, MS


Hemoptysis in children is uncommon and is frequently related to a known underlying condition.

Reports of “coughing up blood” can be related to bleeding from the nasopharynx, esophagus, lower airways, or lung parenchyma.

Underlying conditions associated with pulmonary bleeding include


Cystic fibrosis (CF)

Pulmonary hypertension, usually associated with congenital heart disease

Autoimmune diseases, including granulomatosis with polyangiitis (formerly known as Wegener granulomatosis), systemic lupus erythematosus, microscopic polyangiitis, and Goodpasture syndrome

Infection, usually tuberculous or fungal, though it can be bacterial

Endobronchial mass

Foreign body


Mucosal irritation from dry secretions or trauma

Mucosal trauma, especially with a tracheostomy or foreign body

Pulmonary hypertension from congenital heart disease or arteriovenous malformation

Pulmonary embolism

Autoimmune vasculitis

Erosion through pulmonary tissue into bronchial vessels

Can be massive if a bronchial artery is eroded

Occurs in CF

Idiopathic pulmonary hemosiderosis (IPH)

Thought to be immune mediated, but without detectable autoantibodies

Heiner syndrome is a subform of IPH associated with allergy to milk protein

Clinical Features

Coughing or suctioning up blood is the most common presentation.

Anemia (iron deficiency) may be present.

There may be opacities on chest radiographs that are typically more transient than those of pneumonia.

The patient may have multiple episodes of bleeding.

Especially with massive bleeding, patients can often localize the site.

Signs of infection include fever and leukocytosis.

Signs of pulmonary embolism may be present.

Risk factors include therapy with oral contraceptives.

The presence of renal disease or rash suggests an autoimmune disorder.

Differential Diagnosis

Nonpulmonary source of bleeding


Upper airway



Complication of an underlying diagnosis

Congenital heart disease


Aug 8, 2019 | Posted by in PEDIATRICS | Comments Off on Pulmonary Hemorrhage
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