| Cause | Clinical features/comments |
| Respiratory infection |
| Tuberculosis | - Radiograph showing hilar adenopathy.
|
| Aspergillosis | - Multiple nodules on CT; refer to UpToDate content on invasive aspergillosis. Cavitary disease causing hemoptysis is very uncommon in children.
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| Endemic mycoses (histoplasmosis, blastomycosis, coccidiomycosis, Cryptococcus gattii) | - Travel to an endemic area and compatible radiographic findings.
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| Other infections, (eg, Staphylococcus, Streptococcus, Klebsiella, Pseudomonas) | - Radiograph showing necrotizing pneumonia or lung abscess.
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| Influenza (eg, H1N1 influenza A) | - Fever; acute onset of respiratory symptoms during influenza season or outbreak.
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| COVID-19 | - Characteristic symptoms with disease in community.
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| Foreign body aspiration |
| | - Hemoptysis may develop days or weeks after event; inquire about any history of choking. Suspect this cause especially if the child is <3 years of age.
|
| Cystic fibrosis-related |
| Bronchiectasis | - Signs of bronchiectasis on imaging*.
- Bleeding from gastric or esophageal varices may mimic hemoptysis.
|
| Vitamin K-deficient coagulopathy | - Related to fat malabsorption.
|
| Bronchiectasis unrelated to cystic fibrosis |
| | - Signs of bronchiectasis on imaging*.
- Bronchiectasis may be postinfectious (eg, protracted bacterial bronchitis), congenital, or related to other chronic systemic diseases with lung involvement.
|
| Cardiac disease |
| Congenital heart disease | - Risk factors for hemoptysis include pulmonary venous obstructive disease, pulmonary hypertension, mitral stenosis, and left ventricular diastolic dysfunction. The mechanism for hemorrhage is elevated pulmonary venous or arterial pressure or aortopulmonary collaterals.
|
| Pulmonary edema | - Causes include congestive heart failure or high altitude.
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| Pulmonary vascular disorders |
| Arteriovenous malformations | - Often associated with HHT, which presents with epistaxis, dyspnea, and lung lesions on imaging.
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| Pulmonary hypertension | - Hemoptysis is a sign of advanced disease.
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| Pulmonary embolism | - Dyspnea, pleuritic pain, cough, and/or hemoptysis. Most patients have risk factors.
|
| Trauma |
| Endotracheal tube or tracheostomy | - Often related to suctioning. Most cases have scant bleeding and are not clinically important.
- More significant bleeding may be caused by mucosal abrasions or granulation tissue.
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| Transbronchial biopsy | - Bleeding occurs in <5% of cases and seldom is massive.
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| Chest trauma | - Due to direct airway trauma or lung contusion.
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| Latrogenic vascular trauma | - Indwelling Swan-Ganz catheter (very rarely used) can perforate the pulmonary artery.
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| Causes of diffuse alveolar hemorrhage |
| Coagulopathy (eg, von Willebrand disease) | - Coagulation profile.
- von Willebrand factor antigen, von Willebrand factor activity, and factor VIII activity.
|
| Pulmonary capillaritis | - Evaluation for systemic vasculitis (eg, polyangiitis, anti-GBM disease, SLE); medication history (refer to below).
- Urine analysis; if hematuria is detected, further evaluation for causes of glomerulonephritis (eg, anti-GBM disease).
- Lung biopsy.
|
| Pulmonary-renal syndrome | - This syndrome is the combination of diffuse alveolar hemorrhage with glomerulonephritis, which may occur with a variety of vasculitic diseases including anti-GBM disease, granulomatosis with polyangiitis, microscopic polyangiitis, and SLE.
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| Idiopathic pulmonary hemosiderosis | - BAL shows hemosiderin-laden macrophages; lung biopsy shows no evidence of capillaritis.
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| Acute idiopathic pulmonary hemorrhage of infancy | |
| Hematopoietic stem cell transplant | - In the context of pulmonary disease.
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| Pulmonary veno-occlusive disease | - Often subtle; positive hemosiderin-laden macrophages in BAL.
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| Catamenial hemoptysis | - Recurrent hemoptysis that coincides with menses, due to intrathoracic endometriosis.
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| Celiac disease | - Pulmonary hemorrhage associated with celiac disease has been termed "Lane-Hamilton syndrome" and appears to be rare.
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| Medications | - Medication history (eg, amiodarone, propylthiouracil, or penicillamine and others).
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| Toxic inhalation | - Exposure history (eg, nitrogen dioxide, pesticides, marijuana, vaping products, or cocaine).
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| Pulmonary tumors |
| Tracheobronchial tumors | - Papillomatosis, adenoma, carcinoid tumor, mucoepidermoid tumor.
|
| Parenchymal | - Metastatic tumors, primary pulmonary tumors.
- Very rare in children.
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