Differential diagnosis of hemoptysis

1. Big picture

Hemoptysis = coughing up blood from the lower respiratory tract. In the exam, the first question is not “what is the cause?” but:

Is this true hemoptysis, is it massive/life-threatening, and can the patient protect the airway?

The dangerous causes to exclude early are:

• Lung cancer
• Tuberculosis
• Bronchiectasis
• Pulmonary embolism with infarction
• Diffuse alveolar hemorrhage
• Goodpasture syndrome / ANCA vasculitis
• Severe pneumonia or lung abscess
• Anticoagulant-related bleeding
• Aspergilloma
• Mitral stenosis / pulmonary venous hypertension

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