Hemoptysis in children

Hemoptysis is rare in children, yet is one of the most frightening manifestations of cardiopulmonary disease. A wide spectrum of diseases has been reported to cause hemoptysis in children, but the search for a specific cause can be tedious and unrewarding. Early diagnosis and interventions of hemoptysis are extremely important for the successful management of this potentially lethal process in children.

From July 1994 to June 1996, 15 pediatric patients ranging from 1 month to 15 years of age were admitted to the Pulmonology division for the investigation of hemoptysis. We retrospectively reviewed the clinical records and diagnostic evaluations of these patients.

Six (40%) of the patients investigated were infectious in origin, only one patient had tuberculous infection. Three patients had a traumatic cause and 2 patients had foreign bodies in the airway. Two cases had no obvious contributing cause of hemoptysis despite extensive investigations. One patient had hematemesis because bleeding from esophageal ulcerations was misinterpreted as hemoptysis. One patient had varicosed tracheal and bronchial collaterals causing massive hemoptysis due to portal vein obstruction and hypertension.

Pulmonary infection was the leading cause of hemoptysis in the 15 children we studied, but Mycobacterium tuberculosis is an uncommon causative agent. Bronchoscopy is an extremely useful tool for the diagnosis and localization of hemoptysis. Hematemesis may be misinterpreted as hemoptysis, particularly when an accurate history is not possible in children, therefore, bleeding from the upper aerodigestive tract should be studied meticulously and excluded adequately using endoscopy.