Batra and Holinger reported conditions associated with hemoptysis in pediatric patients. Pediatric hemoptysis may range from a minor to life-threatening event and it is essential to identify the cause. The authors are from Children's Memorial Hospital and Northwestern University in Chicago.


Life-threatening hemoptysis is defined as > 8 mL per kg every 24 hours. Massive bleeding can cause hypoxemia by obstructing the airway or filling the alveoli.


Common causes of hemoptysis:

(1) pulmonary infection (tuberculosis, pneumonia, etc)

(2) foreign body aspiration

(3) tracheostomy-related


Causes of massive hemorrhage:

(1) congenital heart disease

(2) an aberrant or anomalous artery (vascular malformation)


Other conditions to consider:

(1) cystic fibrosis

(2) factitious, usually from bite injury of the oral mucosa in a child with psychiatric problems

(3) esophagitis

(4) pulmonary hemosiderosis

(5) bronchial or lung tumor (bronchial carcinoid, bronchial adenoma, mediastinal teratoma, metastasis, primary lung carcinoma)


In almost 20% of patients the cause of the bleeding was not identified during the workup.


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