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Following is a list of causes or underlying conditions (see also Misdiagnosis of underlying causes of Lung abscess) that could possibly cause Lung abscess includes:
More causes: see full list of causes for Lung abscess
The follow list shows some of the possible medical causes of Lung abscess that are listed by the Diseases Database:
To research the causes of Lung abscess, consider researching the causes of these these diseases that may be similar, or associated with Lung abscess:
Causes of Broader Categories of Lung abscess: Review the causal information about the various more general categories of medical conditions:
Other conditions that might have Lung abscess as a complication may, potentially, be an underlying cause of Lung abscess. Our database lists the following as having Lung abscess as a complication of that condition:
Conditions listing Lung abscess as a symptom may also be potential underlying causes of Lung abscess. Our database lists the following as having Lung abscess as a symptom of that condition:
The following medical news items are relevant to causes of Lung abscess:
As with all medical conditions, there may be many causal factors. Further relevant information on causes of Lung abscess may be found in:
16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the causes of Lung abscess.
Source: In a Page: Signs and Symptoms, 2004
Source: In A Page: Pediatric Signs and Symptoms, 2007
Bronchial adenoma is an insidious disorder that causes recurring hemoptysis in up to 30% of patients, along with a chronic cough and local wheezing.
Inflamed bronchial surfaces and eroded bronchial blood vessels cause hemoptysis, which can vary from blood-tinged sputum to blood (in about 20% of cases) The patient’s sputum may also be copious, foul-smelling, and purulent
He may exhibit a chronic cough, coarse crackles, clubbing (a late sign), a fever, weight loss, fatigue, weakness, malaise, and dyspnea on exertion.
The first sign of chronic bronchitis is typically a productive cough that lasts at least 3 months Eventually this leads to the production of blood-streaked sputum; massive hemorrhage is unusual
Other respiratory effects include dyspnea, prolonged expirations, wheezing, scattered rhonchi, accessory muscle use, barrel chest, tachypnea, and clubbing (a late sign).
Such disorders as thrombocytopenia and disseminated intravascular coagulation can cause hemoptysis Besides their specific related findings, these disorders may share such general signs as multisystem hemorrhaging (for example, GI bleeding or epistaxis) and purpuric lesions.
In about 50% of patients, lung abscess produces blood-streaked sputum resulting from bronchial ulceration, necrosis, and granulation tissue Common associated findings include a cough with large amounts of purulent, foul-smelling sputum; a fever with chills; diaphoresis; anorexia; weight loss; a headache; weakness; dyspnea; pleuritic or dull chest pain; and clubbing
Auscultation reveals tubular or cavernous breath sounds and crackles. Percussion reveals dullness on the affected side.
Ulceration of the bronchus commonly causes recurring hemoptysis (an early sign), which can vary from blood-streaked sputum to blood Related findings include a productive cough, dyspnea, a fever, anorexia, weight loss, wheezing, and chest pain (a late symptom).
In up to 50% of cases, Klebsiella pneumonia produces dark brown or red (currant jelly) sputum, which is so tenacious that the patient has difficulty expelling it from his mouth This type of pneumonia begins abruptly with chills, a fever, dyspnea, a productive cough, and severe pleuritic chest pain
Associated findings may include cyanosis, prostration, tachycardia, decreased breath sounds, and crackles.
Pneumococcal pneumonia causes pinkish or rusty mucoid sputum. It begins with sudden, shaking chills; a rapidly rising temperature; and, in over 80% of cases, tachycardia and tachypnea. Within a few hours, the patient typically experiences a productive cough along with severe, stabbing, pleuritic pain. The agonizing chest pain leads to rapid, shallow, grunting respirations with splinting. Examination reveals respiratory distress with dyspnea and accessory muscle use, crackles, and dullness on percussion over the affected lung. Malaise, weakness, myalgia, and prostration accompany a high fever.
Severe cardiogenic or noncardiogenic pulmonary edema commonly causes frothy, blood-tinged pink sputum, which accompanies severe dyspnea, orthopnea, gasping, anxiety, cyanosis, diffuse crackles, a ventricular gallop, and cold, clammy skin This life-threatening condition may also cause tachycardia, lethargy, cardiac arrhythmias, tachypnea, hypotension, and a thready pulse.
Hemoptysis is a common finding in pulmonary embolism with infarction, a life-threatening disorder, although massive hemoptysis is infrequent Typical initial symptoms are dyspnea and anginal or pleuritic chest pain
Other common clinical features include tachycardia, tachypnea, a low-grade fever, and diaphoresis. Less commonly, splinting of the chest, leg edema, and — with a large embolus — cyanosis, syncope, and jugular vein distention may occur. Examination reveals decreased breath sounds, a pleural friction rub, crackles, diffuse wheezing, dullness on percussion, and signs of circulatory collapse (a weak, rapid pulse; hypotension), cerebral ischemia (transient loss of consciousness, convulsions), and hypoxemia (restlessness and, particularly in elderly patients, hemiplegia and other focal neurologic deficits).
Features generally develop late Hemoptysis, exertional dyspnea, and fatigue are common
Angina-like pain usually occurs with exertion and may radiate to the neck but not to the arms. Other findings include arrhythmias, syncope, a cough, and hoarseness.
Blood-streaked or blood-tinged sputum commonly occurs in pulmonary TB; massive hemoptysis may occur in advanced cavitary TB
Accompanying respiratory findings include a chronic productive cough, fine crackles after coughing, dyspnea, dullness on percussion, increased tactile fremitus, and possible amphoric breath sounds. The patient may also develop night sweats, malaise, fatigue, a fever, anorexia, weight loss, and pleuritic chest pain.
In 50% of patients with SLE, pleuritis and pneumonitis cause hemoptysis, a cough, dyspnea, pleuritic chest pain, and crackles
Related findings are a butterfly rash in the acute phase, nondeforming joint pain and stiffness, photosensitivity, Raynaud’s phenomenon, seizures or psychoses, anorexia with weight loss, and lymphadenopathy.
Torn tracheal mucosa may cause hemoptysis, hoarseness, dysphagia, neck pain, airway occlusion, and respiratory distress.
Lung or airway injury from bronchoscopy, laryngoscopy, mediastinoscopy, or lung biopsy can cause bleeding and hemoptysis.
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Rarely, an aortic aneurysm ruptures into the tracheobronchial tree, causing hemoptysis and sudden death.
Although individuals with this type of injury may not have obvious external chest injuries, they sometimes show other indications of internal damage, such as hemoptysis. Health care providers should evaluate survivors of explosive detonations for other classic signs and symptoms of a blast lung injury, such as chest pain, cyanosis, dyspnea, and wheezing. Treatment includes careful administration of fluids and oxygen to ensure tissue perfusion.
This insidious disorder causes recurring hemoptysis in up to 30% of patients along with a chronic cough and local wheezing.
Inflamed bronchial surfaces and eroded bronchial blood vessels cause hemoptysis, which can vary from blood-tinged sputum to blood (in about 20% of patients). The patient typically has a chronic cough producing copious amounts of foul-smelling, purulent sputum. He may also exhibit coarse crackles, clubbing (a late sign), fever, weight loss, fatigue, weakness, malaise, and dyspnea on exertion.
The first sign of this disorder is typically a productive cough that lasts at least 3 months. Eventually this leads to production of blood-streaked sputum; massive hemorrhage is unusual. Other respiratory effects include dyspnea, prolonged expirations, wheezing, scattered rhonchi, accessory muscle use, barrel chest, tachypnea, and clubbing (a late sign).
Such disorders as thrombocytopenia and disseminated intravascular coagulation can cause hemoptysis, multisystem hemorrhaging (for example, GI bleeding or epistaxis), and purpuric lesions.
Hemoptysis occurs in this cancer, but hoarseness is usually the initial sign. Other findings may include dysphagia, dyspnea, stridor, cervical lymphadenopathy, and neck pain.
In about 50% of patients, this disorder produces blood-streaked sputum resulting from bronchial ulceration, necrosis, and granulation tissue. Common associated findings include a cough producing large amounts of purulent, foul-smelling sputum; fever with chills; diaphoresis; anorexia; weight loss; headache; weakness; dyspnea; pleuritic or dull chest pain; and clubbing. Auscultation reveals tubular or cavernous breath sounds and crackles. Percussion reveals dullness on the affected side.
Ulceration of the bronchus commonly causes recurring hemoptysis (an early sign), which can vary from blood-streaked sputum to blood. Related findings include a productive cough, dyspnea, fever, anorexia, weight loss, wheezing, and chest pain (a late symptom).
The pneumonic form of this acute bacterial infection, caused by Yersinia pestis, can produce hemoptysis, a productive cough, chest pain, tachypnea, dyspnea, increasing respiratory distress, and cardiopulmonary insufficiency. Pneumonic plague begins abruptly with chills, fever, headache, and myalgia.
In up to 50% of patients, Klebsiella pneumonia produces dark brown or red (currant-jelly) sputum, which is so tenacious that the patient has difficulty expelling it from his mouth. This type of pneumonia begins abruptly with chills, fever, dyspnea, a productive cough, and severe pleuritic chest pain. Associated findings may include cyanosis, prostration, tachycardia, decreased breath sounds, and crackles.
Pneumococcal pneumonia causes pinkish or rusty mucoid sputum. It begins with sudden shaking chills; a rapidly rising temperature; and, in over 80% of patients, tachycardia and tachypnea. Within a few hours, the patient typically experiences a productive cough along with severe, stabbing, pleuritic pain that leads to rapid, shallow, grunting respirations with splinting. Examination reveals respiratory distress with dyspnea and accessory muscle use, crackles, and dullness on percussion over the affected lung. Malaise, weakness, myalgia, and prostration accompany a high fever.
Occurring in young adults, this genetic disorder causes intermittent hemoptysis along with cyanosis, clubbing, mild dyspnea, fatigue, vertigo, syncope, confusion, and speech and visual impairments. The patient may bleed from the nose, mouth, or lips. Ruby red patches appear on the face, tongue, skin, mucous membranes, or nail beds.
Blunt chest trauma commonly causes a cough with hemoptysis. Other signs and symptoms that appear over several hours include dyspnea, tachypnea, chest pain, tachycardia, hypotension, crackles, and decreased or absent breath sounds over the affected area. Severe respiratory distress—with oppressive dyspnea, nasal flaring, use of accessory muscles, extreme anxiety, cyanosis, and diaphoresis—may develop at any time.
Severe cardiogenic or noncardiogenic pulmonary edema commonly causes frothy, blood-tinged pink sputum, which accompanies severe dyspnea, orthopnea, gasping, anxiety, cyanosis, diffuse crackles, a ventricular gallop, and cold, clammy skin. This life-threatening condition may also cause tachycardia, lethargy, cardiac arrhythmias, tachypnea, hypotension, and a thready pulse.
Hemoptysis is a common finding in this life-threatening disorder, although massive hemoptysis is rare. Typical initial symptoms are dyspnea and anginal or pleuritic chest pain. Other common clinical features include tachycardia, tachypnea, low-grade fever, and diaphoresis. Less common features include splinting of the chest, leg edema, and—with a large embolus—cyanosis, syncope, and jugular vein distention. Examination reveals decreased breath sounds, pleural friction rub, crackles, diffuse wheezing, dullness on percussion, and signs of circulatory collapse (weak, rapid pulse and hypotension), cerebral ischemia (transient loss of consciousness and seizures), and hypoxemia (restlessness and, particularly in elderly patients, hemiplegia and other focal neurologic deficits).
Hemoptysis, exertional dyspnea, and fatigue generally develop late in this disorder. Angina-like pain usually occurs with exertion and may radiate to the neck but not to the arms. Other findings include arrhythmias, syncope, cough, and hoarseness.
Blood-streaked or blood-tinged sputum commonly occurs in this disorder; massive hemoptysis may occur in advanced cavitary tuberculosis. Accompanying respiratory findings include a chronic productive cough, fine crackles after coughing, dyspnea, dullness on percussion, increased tactile fremitus and, possibly, amphoric breath sounds. The patient may also develop night sweats, malaise, fatigue, fever, anorexia, weight loss, and pleuritic chest pain.
This chronic disorder causes a productive cough with mucopurulent sputum that later becomes blood streaked. Occasionally, massive hemoptysis may occur. Other findings include fine end-inspiratory crackles at lung bases, exertional dyspnea, tachypnea, weight loss, fatigue, and weakness.
In 50% of patients with this disorder, pleuritis and pneumonitis cause hemoptysis, a cough, dyspnea, pleuritic chest pain, and crackles. Related findings are a butterfly rash in the acute phase, nondeforming joint pain and stiffness, photosensitivity, Raynaud’s phenomenon, seizures or psychoses, anorexia with weight loss, and lymphadenopathy.
Torn tracheal mucosa may cause hemoptysis, hoarseness, dysphagia, neck pain, airway occlusion, and respiratory distress.
Necrotizing, granulomatous vasculitis characterizes this multisystem disorder. Findings include hemoptysis, chest pain, cough, wheezing, dyspnea, epistaxis, severe sinusitis, and hemorrhagic skin lesions.
Lung or airway injury from bronchoscopy, laryngoscopy, mediastinoscopy, or lung biopsy can cause bleeding and hemoptysis.
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
❑ Bronchitis
❑ Pneumonia
❑ Pulmonary edema
❑ Pulmonary infarction
❑ Tuberculosis
❑ Bronchogenic carcinoma
❑ Chest trauma
❑ Bronchiectasis
❑ Bronchial adenoma
❑ A-V malformation
❑ Aspergilloma
❑ Vasculitis
❑ Lung abscess
❑ Mitral stenosis
❑ Hereditary hemorrhagic telangiectasia
❑ Parasitic
Source: Field Guide to Bedside Diagnosis, 2007
A lung abscess is a manifestation of necrotizing pneumonia, commonly the result of aspiration of oropharyngeal contents. Poor oral hygiene with dental or gingival (gum) disease is strongly associated with a putrid lung abscess. Septic pulmonary emboli commonly produce cavitary lesions. Infected cystic lung lesions and cavitating bronchial carcinoma must be distinguished from lung abscesses.
Source: Handbook of Diseases, 2003
Rarely, an aortic aneurysm ruptures into the tracheobronchial tree, causing hemoptysis and sudden death.
Inflamed bronchial surfaces and eroded bronchial blood vessels cause hemoptysis, which can vary from blood-tinged sputum to blood (in about 20% of patients). The patient’s sputum may also be copious, foul-smelling, and purulent. He may exhibit a chronic cough, coarse crackles, clubbing (a late sign), fever, weight loss, fatigue, weakness, malaise, and dyspnea on exertion.
The first sign of bronchitis is typically a productive cough that lasts at least 3 months. Eventually this leads to production of blood-streaked sputum; massive hemorrhage is unusual. Other respiratory effects include dyspnea, prolonged expirations, wheezing, scattered rhonchi, accessory muscle use, barrel chest, tachypnea, and clubbing (a late sign).
Such disorders as thrombocytopenia and disseminated intravascular coagulation can cause hemoptysis. Besides their specific related findings, coagulation disorders may share such general signs as multisystem hemorrhaging (for example, GI bleeding or epistaxis) and purpuric lesions.
Hemoptysis occurs in laryngeal cancer, but hoarseness is the usual early sign. Other findings may include dysphagia, dyspnea, stridor, cervical lymphadenopathy, and neck pain.
In about 50% of patients, lung abscess produces blood-streaked sputum resulting from bronchial ulceration, necrosis, and granulation tissue. Common associated findings include a cough with large amounts of purulent, foul-smelling sputum; fever with chills; diaphoresis; anorexia; weight loss; headache; weakness; dyspnea; pleuritic or dull chest pain; and clubbing. Auscultation reveals tubular or cavernous breath sounds and crackles. Percussion reveals dullness on the affected side.
Ulceration of the bronchus commonly causes recurring hemoptysis (an early sign), which can vary from blood-streaked sputum to blood. Related findings include a productive cough, dyspnea, fever, anorexia, weight loss, wheezing, and chest pain (a late symptom).
Pneumococcal pneumonia causes pinkish or rusty mucoid sputum. It begins with sudden shaking chills; a rapidly rising temperature; and, in more than 80% of patients, tachycardia and tachypnea. Within a few hours, the patient typically experiences a productive cough along with severe, stabbing, pleuritic pain. The agonizing chest pain leads to rapid, shallow, grunting respirations with splinting. Examination reveals respiratory distress with dyspnea and accessory muscle use, crackles, and dullness on percussion over the affected lung. Malaise, weakness, myalgia, and prostration accompany high fever.
Occurring in young adults, pulmonary arteriovenous fistula causes intermittent hemoptysis. Associated signs and symptoms include cyanosis, clubbing, mild dyspnea, fatigue, vertigo, syncope, confusion, and speech and visual impairments. The patient may bleed from the nose, mouth, or lips. Ruby red patches appear on the face, tongue, skin, mucous membranes, or nail beds.
Blunt chest trauma commonly causes a cough with hemoptysis. Other signs and symptoms appear gradually within several hours after the injury and include dyspnea, tachypnea, chest pain, tachycardia, hypotension, crackles, and decreased or absent breath sounds over the affected area. Severe respiratory distress — with oppressive dyspnea, nasal flaring, use of accessory muscles, extreme anxiety, cyanosis, and diaphoresis — may develop at any time.
Severe cardiogenic or noncardiogenic pulmonary edema commonly causes frothy, blood-tinged pink sputum, which accompanies severe dyspnea, orthopnea, gasping, anxiety, cyanosis, diffuse crackles, a ventricular gallop, and cold, clammy skin. This life-threatening condition may also cause tachycardia, lethargy, cardiac arrhythmias, tachypnea, hypotension, and a thready pulse.
Hemoptysis is a common finding in pulmonary embolism with infarction — a life-threatening disorder — although massive hemoptysis is infrequent. Typical initial symptoms are dyspnea and anginal or pleuritic chest pain. Other common clinical features include tachycardia, tachypnea, low-grade fever, and diaphoresis. Less commonly, splinting of the chest, leg edema, and — with a large embolus — cyanosis, syncope, and distended jugular veins may occur. Examination reveals decreased breath sounds, pleural friction rub, crackles, diffuse wheezing, dullness on percussion, and signs of circulatory collapse (weak, rapid pulse; hypotension), cerebral ischemia (transient loss of consciousness, convulsions), and hypoxemia (restlessness and, particularly in elderly patients, hemiplegia and other focal neurologic deficits).
Features generally develop late. Hemoptysis, exertional dyspnea, and fatigue are common. Angina-like pain usually occurs with exertion and may radiate to the neck but not to the arms. Other findings include arrhythmias, syncope, cough, and hoarseness.
Blood-streaked or blood-tinged sputum commonly occurs in pulmonary tuberculosis; massive hemoptysis may occur in advanced cavitary tuberculosis. Accompanying respiratory findings include a chronic productive cough, fine crackles after coughing, dyspnea, dullness to percussion, increased tactile fremitus, and possible amphoric breath sounds. The patient may also develop night sweats, malaise, fatigue, fever, anorexia, weight loss, and pleuritic chest pain.
Initially, silicosis — a chronic disorder — causes a productive cough with mucopurulent sputum. Subsequently, the sputum becomes blood-streaked and, occasionally, massive hemoptysis may occur. Other findings include fine, end-inspiratory crackles at lung bases, exertional dyspnea, tachypnea, weight loss, fatigue, and weakness.
Torn tracheal mucosa may cause hemoptysis, hoarseness, dysphagia, neck pain, airway occlusion, and respiratory distress.
Necrotizing, granulomatous vasculitis characterizes Wegener’s granulomatosis — a multisystem disorder. Findings include hemoptysis, chest pain, cough, wheezing, dyspnea, epistaxis, severe sinusitis, and hemorrhagic skin lesions.
Lung or airway injury from bronchoscopy, laryngoscopy, mediastinoscopy, or lung biopsy can cause bleeding and hemoptysis.
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Bronchial adenoma is an insidious disorder that causes recurring hemoptysis along with a chronic cough and local wheezing. The patient with bronchial adenoma may also have recurrent infection, dyspnea, and wheezing.
With bronchiectasis, inflamed bronchial surfaces and eroded bronchial blood vessels cause hemoptysis, which can vary from blood-tinged sputum to blood (in about 20% of patients). The patient’s sputum may also be copious, foul-smelling, and purulent. He may exhibit a chronic cough, coarse crackles, clubbing (a late sign), fever, weight loss, fatigue, weakness, malaise, and dyspnea on exertion.
The first sign of chronic bronchitis is typically a productive cough that lasts at least 3 months. Eventually this leads to production of blood-streaked sputum; massive hemorrhage is unusual. Other respiratory effects include dyspnea, prolonged expirations, wheezing, scattered rhonchi, accessory muscle use, barrel chest, tachypnea, and clubbing (a late sign).
Such coagulation disorders as thrombocytopenia and disseminated intravascular coagulation can cause hemoptysis. In addition to their specific related findings, coagulation disorders may share such general signs as multisystem hemorrhaging (for example, GI bleeding or epistaxis) and purpuric lesions.
Hemoptysis occurs in laryngeal cancer, but hoarseness is the usual early sign. Other findings may include dysphagia, dyspnea, stridor, cervical lymphadenopathy, and neck pain.
In about 50% of patients, a lung abscess produces blood-streaked sputum resulting from bronchial ulceration, necrosis, and granulation tissue. Common associated findings include a cough with large amounts of purulent, foul-smelling sputum; fever with chills; diaphoresis; anorexia; weight loss; headache; weakness; dyspnea; pleuritic or dull chest pain; and clubbing. Auscultation reveals tubular or cavernous breath sounds and crackles. Percussion reveals dullness on the affected side.
In patients with lung cancer, ulceration of the bronchus commonly causes recurring hemoptysis (an early sign), which can vary from blood-streaked sputum to blood. Related findings include a productive cough, dyspnea, fever, anorexia, weight loss, wheezing, and chest pain (a late symptom).
In up to 50% of patients, Klebsiella pneumonia produces dark brown or red (currant-jelly) sputum, which is so tenacious that the patient has difficulty expelling it from his mouth. This type of pneumonia begins abruptly with chills, fever, dyspnea, a productive cough, and severe pleuritic chest pain. Associated findings may include cyanosis, prostration, tachycardia, decreased breath sounds, and crackles.
Pneumococcal pneumonia causes pinkish or rusty mucoid sputum. It begins with sudden shaking chills; a rapidly rising temperature; and, in over 80% of patients, tachycardia and tachypnea. Within a few hours, the patient typically experiences a productive cough along with severe, stabbing, pleuritic pain. The agonizing chest pain leads to rapid, shallow, grunting respirations with splinting. Examination reveals respiratory distress with dyspnea and accessory muscle use, crackles, and dullness on percussion over the affected lung. Malaise, weakness, myalgia, and prostration accompany high fever.
Pulmonary contusion, resulting from blunt chest trauma, commonly causes a cough with hemoptysis. Other signs and symptoms appear gradually within several hours after the injury and include dyspnea, tachypnea, chest pain, tachycardia, hypotension, crackles, and decreased or absent breath sounds over the affected area. Severe respiratory distress — with oppressive dyspnea, nasal flaring, use of accessory muscles, extreme anxiety, cyanosis, and diaphoresis — may develop at any time.
Severe pulmonary edema commonly causes frothy, blood-tinged pink sputum, which accompanies severe dyspnea, orthopnea, gasping, anxiety, cyanosis, diffuse crackles, a ventricular gallop, and cold, clammy skin. This life-threatening condition may also cause tachycardia, lethargy, cardiac arrhythmias, tachypnea, hypotension, and a thready pulse.
Hemoptysis is a common finding in this life-threatening disorder, although massive hemoptysis is infrequent. Typical initial symptoms are dyspnea and anginal or pleuritic chest pain. Other common clinical features include tachycardia, tachypnea, low-grade fever, and diaphoresis. Less commonly, splinting of the chest, leg edema, and — with a large embolus — cyanosis, syncope, and distended jugular veins may occur. Examination reveals decreased breath sounds, pleural friction rub, crackles, diffuse wheezing, dullness on percussion, and signs of circulatory collapse (weak, rapid pulse; hypotension), cerebral ischemia (transient loss of consciousness, convulsions), and hypoxemia (restlessness and, particularly in elderly patients, hemiplegia and other focal neurologic deficits).
Features of primary pulmonary hypertension generally develop late. Hemoptysis, exertional dyspnea, and fatigue are common. Angina-like pain usually occurs with exertion and may radiate to the neck but not to the arms. Other findings include arrhythmias, syncope, cough, and hoarseness.
Blood-streaked or blood-tinged sputum commonly occurs in pulmonary tuberculosis; massive hemoptysis may occur in advanced cavitary tuberculosis. Accompanying respiratory findings include a chronic productive cough, fine crackles after coughing, dyspnea, dullness to percussion, increased tactile fremitus, and possible amphoric breath sounds. The patient may also develop night sweats, malaise, fatigue, fever, anorexia, weight loss, and pleuritic chest pain.
Initially, silicosis causes a productive cough with mucopurulent sputum. Subsequently, the sputum becomes blood-streaked and, occasionally, massive hemoptysis may occur. Other findings include fine, end-inspiratory crackles at lung bases, exertional dyspnea, tachypnea, weight loss, fatigue, and weakness.
In 50% of patients with systemic lupus erythematosus (SLE), pleuritis and pneumonitis cause hemoptysis, cough, dyspnea, pleuritic chest pain, and crackles. Related findings are a butterfly rash in the acutephase, nondeforming joint pain and stiffness, photosensitivity, Raynaud’s phenomenon, convulsions or psychoses, anorexia with weight loss, and lymphadenopathy.
Lung or airway injury from bronchoscopy, laryngoscopy, mediastinoscopy, or lung biopsy can cause bleeding and hemoptysis.
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Blast lung injury.Although individuals with blast lung injury may not have obvious external chest injuries, they sometimes show other indications of internal damage, such as hemoptysis. Health care providers should evaluate survivors of explosive detonations for other classic signs and symptoms of a blast lung injury, such as chest pain, cyanosis, dyspnea, and wheezing. Treatment includes careful administration of fluids and oxygen to ensure tissue perfusion.
Bronchial adenoma.Bronchial adenoma is an insidious disorder that causes recurring hemoptysis in up to 30% of patients, along with a chronic cough and local wheezing.
Bronchiectasis.Inflamed bronchial surfaces and eroded bronchial blood vessels cause hemoptysis, which can vary from blood-tinged sputum to blood (in about 20% of cases). The patient's sputum may also be copious, foul-smelling, and purulent. He may exhibit a chronic cough, coarse crackles, clubbing (a late sign), a fever, weight loss, fatigue, weakness, malaise, and dyspnea on exertion.
Bronchitis (chronic).The first sign of chronic bronchitis is typically a productive cough that lasts at least 3 months. Eventually this leads to the production of blood-streaked sputum; massive hemorrhage is unusual. Other respiratory effects include dyspnea, prolonged expirations, wheezing, scattered rhonchi, accessory muscle use, barrel chest, tachypnea, and clubbing (a late sign).
Coagulation disorders.Such disorders as thrombocytopenia and disseminated intravascular coagulation can cause hemoptysis. Besides their specific related findings, these disorders may share such general signs as multisystem hemorrhaging (for example, GI bleeding or epistaxis) and purpuric lesions.
Lung abscess.In about 50% of patients, lung abscess produces blood-streaked sputum resulting from bronchial ulceration, necrosis, and granulation tissue. Common associated findings include a cough with large amounts of purulent, foul-smelling sputum; a fever with chills; diaphoresis; anorexia; weight loss; a headache; weakness; dyspnea; pleuritic or dull chest pain; and clubbing. Auscultation reveals tubular or cavernous breath sounds and crackles. Percussion reveals dullness on the affected side.
Lung cancer.Ulceration of the bronchus commonly causes recurring hemoptysis (an early sign), which can vary from blood-streaked sputum to blood. Related findings include a productive cough, dyspnea, a fever, anorexia, weight loss, wheezing, and chest pain (a late symptom).
Plague(Yersinia pestis).The pneumonic form of this acute bacterial infection can produce hemoptysis, a productive cough, chest pain, tachypnea, dyspnea, increasing respiratory distress, and cardiopulmonary insufficiency, along with the sudden onset of chills, a fever, a headache, and myalgia.
Pneumonia.In up to 50% of cases, Klebsiella pneumonia produces dark brown or red (currant jelly) sputum, which is so tenacious that the patient has difficulty expelling it from his mouth. This type of pneumonia begins abruptly with chills, a fever, dyspnea, a productive cough, and severe pleuritic chest pain. Associated findings may include cyanosis, prostration, tachycardia, decreased breath sounds, and crackles.
Pneumococcal pneumonia causes pinkish or rusty mucoid sputum. It begins with sudden, shaking chills; a rapidly rising temperature; and, in over 80% of cases, tachycardia and tachypnea. Within a few hours, the patient typically experiences a productive cough along with severe, stabbing, pleuritic pain. The agonizing chest pain leads to rapid, shallow, grunting respirations with splinting. Examination reveals respiratory distress with dyspnea and accessory muscle use, crackles, and dullness on percussion over the affected lung. Malaise, weakness, myalgia, and prostration accompany a high fever.
Pulmonary edema.Severe cardiogenic or noncardiogenic pulmonary edema commonly causes frothy, blood-tinged pink sputum, which accompanies severe dyspnea, orthopnea, gasping, anxiety, cyanosis, diffuse crackles, a ventricular gallop, and cold, clammy skin. This life-threatening condition may also cause tachycardia, lethargy, cardiac arrhythmias, tachypnea, hypotension, and a thready pulse.
Pulmonary embolism with infarction.Hemoptysis is a common finding in pulmonary embolism with infarction, a life-threatening disorder, although massive hemoptysis is infrequent. Typical initial symptoms are dyspnea and anginal or pleuritic chest pain. Other common clinical features include tachycardia, tachypnea, a low-grade fever, and diaphoresis. Less commonly, splinting of the chest, leg edema, and—with a large embolus—cyanosis, syncope, and jugular vein distention may occur. Examination reveals decreased breath sounds, a pleural friction rub, crackles, diffuse wheezing, dullness on percussion, and signs of circulatory collapse (a weak, rapid pulse; hypotension), cerebral ischemia (transient loss of consciousness, seizures), and hypoxemia (restlessness and, particularly in elderly patients, hemiplegia and other focal neurologic deficits).
Pulmonary hypertension (primary).With pulmonary hyperension, features generally develop late. Hemoptysis, exertional dyspnea, and fatigue are common. Angina-like pain usually occurs with exertion and may radiate to the neck but not to the arms. Other findings include arrhythmias, syncope, a cough, and hoarseness.
Pulmonary TB.Blood-streaked or blood-tinged sputum commonly occurs in pulmonary TB; massive hemoptysis may occur in advanced cavitary TB. Accompanying respiratory findings include a chronic productive cough, fine crackles after coughing, dyspnea, dullness on percussion, increased tactile fremitus, and possible amphoric breath sounds. The patient may also develop night sweats, malaise, fatigue, a fever, anorexia, weight loss, and pleuritic chest pain.
Systemic lupus erythematosus (SLE).In 50% of patients with SLE, pleuritis and pneumonitis cause hemoptysis, a cough, dyspnea, pleuritic chest pain, and crackles. Related findings are a butterfly rash in the acutephase, nondeforming joint pain and stiffness, photosensitivity, Raynaud's phenomenon, seizures or psychoses, anorexia with weight loss, and lymphadenopathy.
Tracheal trauma.Torn tracheal mucosa may cause hemoptysis, hoarseness, dysphagia, neck pain, airway occlusion, and respiratory distress.
Diagnostic tests.Lung or airway injury from bronchoscopy, laryngoscopy, mediastinoscopy, or lung biopsy can cause bleeding and hemoptysis.
Source: Nursing: Interpreting Signs and Symptoms, 2007
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