Finding the cause of hemoptysis in children

In the evaluation of suspected hemoptysis, it is sometimes unclear whether the blood originates from pulmonary or nonpulmonary sources. In many children, the source of the blood is actually the nose or mouth. Blood that is bright red or frothy is consistent with hemoptysis, while blood that is dark red or brownish may be a sign of hematemesis. Respiratory infection is a common cause of hemoptysis, but it is also important to consider other causes, such as foreign-body aspiration and congenital abnormalities. A localized wheeze may indicate a foreign body, while petechiae and ecchymosis may suggest a coagulopathy. If infection is suspected, sputum for staining and culture should be obtained. Flexible bronchoscopy may be indicated; however, rigid bronchoscopy is preferred in cases of substantial airway bleeding or a suspected foreign body. Most acute episodes of hemoptysis are self-limited, but severe or massive hemoptysis requires immediate intervention.