Pediatric Pulmonary Hemorrhage vs. Extrapulmonary Bleeding in the Differential Diagnosis of Hemoptysis

Abstract

Introduction: Hemoptysis is an important symptom which causes a major concern, and warrants immediate diagnostic attention. The authors compared a group of patients with pediatric pulmonary hemorrhage with pediatric patients diagnosed with extrapulmonary bleeding focusing on differences in etiology, outcome and differential diagnosis of hemoptysis. Methods: We performed the retrospective analysis of medical charts of 134 pediatric patients admitted to the Emergency Department because of pulmonary and extrapulmonary hemorrhage and were diagnosed with suspected hemoptysis or developed hemoptysis (ICD10-CM code R04.2). The cases with pulmonary hemorrhage (Group 1) were compared with cases of extrapulmonary bleeding (Group 2) using the Fisher Exact test or Pearson's χ 2 test for categorical variables. The t-test was used to assess differences between continuous variables of the patients in the two groups. Results: Bloody cough was the presenting symptom in 73.9% of cases. 30 patients had pulmonary hemorrhage (Group 1), while 104 patients had extrapulmonary bleeding (Group 2). The underlying causes of bleeding in Group 2 included epistaxis, inflammatory diseases of nasopharynx and larynx, foreign bodies, gingivitis, and hypertrophy of adenoids. Mortality rate was 10% in Group 1, whereas Group 2 did not have any mortality outcomes during the observation period. Etiologycal factors were significantly different between hemoptysis and extrapulmonary bleeding in children Conclusions: Our research suggested that pulmonary and extrapulmonary bleeding are two conditions that differ significantly and cannot be unified under one diagnostic code. It is important to differentiate between focal and diffuse cases, and between pulmonary and extrapulmonary hemorrhage due to the diversity of clinical courses and outcomes.

Case Report: Hemoptysis Caused by Pulmonary Tuberculosis Complicated With Bronchial Artery-Pulmonary Artery Fistula in Children

“…Due to its hidden onset and atypical clinical symptoms, tuberculosis in children has not been sufficiently investigated. According to the Global Tuberculosis Report released in 2019 by WHO, around 10 million new cases were reported worldwide in 2018, 11% of which involved children younger than 15 years ( 1 ). China is one of the 30 countries with a high burden of tuberculosis, and the epidemic situation among children is not optimistic.…”

“…The causes of hemoptysis in children vary— respiratory issues or diseases such as bronchitis, pneumonia, pulmonary tuberculosis, presence of foreign bodies in the respiratory tract, and bronchiectasis can cause hemoptysis. Other rare potential causes include vascular malformations, congenital heart disease, idiopathic pulmonary hypertension, and pulmonary embolism ( 1 ). During clinical practice, we observed patients with multiple conditions causing hemoptysis.…”

An Adolescent Presented With Hemoptysis: Pulmonary Artery Aneurysm in Pediatric Behçet’s Disease

“…In a study examining the causes of hemoptysis in children, the frequency of vascular anomalies was only 6%. 6 Although vascular anomalies rarely cause hemoptysis, they should be considered in the differential diagnosis as they can cause life-threatening bleeding. PAA is usually located bilaterally in branches of the lower lobes.…”

Hemoptysis during pregnancy: a comprehensive review of literature and an unprecedented case report of oropharyngeal carcinoma

“…Hemoptysis occurs very rarely in pregnancy and may be initially linked to emergency medical conditions such as pulmonary embolism [1,2], which can be induced and exacerbated by pregnancy [3][4][5][6]. Alternatively, due to physiological blood dilution during pregnancy [7,8] and a lower platelet count which is common during pregnancy [9][10][11], oral cavity bleedings [12,13] linked to gingival abnormalities may mimic hemoptysis [14,15].…”