Epidemiology

Hemoptysis may be defined as mild, moderate or massive. The precise degree of hemoptysis required for each categorization is arbitrary and not standardized. Despite lack of clinical utility, mild hemoptysis is usually defined as less than 5 mL of blood in 24 h, moderate hemoptysis is defined as 5 to 600 mL in 24 h, and massive hemoptysis is greater than 600 mL in 24 h.1 Often patients are unable to accurately estimate the degree of bleeding, and the emergency department time frame requires a more appropriate time categorization. A reasonable amount of hemoptysis considered massive in volume would be greater than 50 mL in a single expectoration.

In a retrospective meta-analysis of six prior studies of hemoptysis, Marshall found an infectious nontubercular cause in approximately 25 percent of cases, tuberculosis in 5 percent, neoplasia in 28 percent, miscellaneous and multiple causes in 13 percent; and an undetermined cause in 28 percent. 2 In another study, cardiovascular causes account for 3 percent of total hemoptysis cases, most due to congestive heart failure, and trauma accounts for less than 3 percent. 3 In summary, out of every four cases of hemoptysis, one neoplasm, one nontubercular infectious case, one miscellaneous case, and one idiopathic case may be expected.

Hemoptysis is described in both sexes, with a 60:40 male predominance, and in all age groups.4 It is rare in children and increases in frequency with age. The true incidence is unknown, since many cases are unreported. Lifestyle activities, such as smoking, predispose patients to lung disease and an increased risk of hemoptysis. Male gender, age over 40, and history of smoking are risk factors for a neoplastic cause of hemoptysis. 2

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