Hemoptysis and pseudohemoptysis: the patient expectorating blood

Patients expectorating blood seek evaluation and treatment from a variety of clinicians. Although the bleeding may arise either from the lungs (hemoptysis) or from the upper aerodigestive tract (pseudohemoptysis), the evaluation commonly focuses on exclusion of a pulmonary neoplastic source. Likewise, most literary reviews only focus on hemoptysis as it relates to pulmonary malignancies. The present retrospective review identifies 471 patients with the diagnosis of hemoptysis over a six-year period, and 10% were ultimately found to have UAT etiologies for their bleeding. UAT cancers were identified as the source in 2.1% of all patients, either due to primary lesions or via metastases. The majority of UAT cancers had been previously diagnosed prior to this episode of hemoptysis. This review indicates that a thorough UAT history and exam is warranted in the hemoptysis patient because of the significant occurrence of UAT causes. However, the likelihood of finding an occult UAT cancer in this patient population is very low with the only risk factor being a previous history of a UAT neoplasm.