Hemoptisis Batuk berdarah istilah lainnya adalah hemaptoe.

Jumlah dan material yang dikeluarkan bervariasi bergantung pada darah berasal dan bercampur dahak atau tidak. Darah dapat berasal dari seluruh bagian traktus respiratorius, mulai dari bronkus, paru, hidung atau tenggorokan. Terkadang darah yang berasal dari hidung dan tenggorokan terhisap dan akhirnya keluar melalui ekspektoran. Darah yang berasal dari arteri bronkialis lebih sering menyebabkan hemaptoe massif.

Blood arising from the bronchial arteries is more often the source of massive hemoptysis, owing to its higher perfusion pressure than blood from the pulmonary circulation. The bronchial circulation may be the source of lifethreatening bleeding, for example, in patientswith bronchiectasis in whom the vessels frequently become distorted and easily ruptured. The differential diagnosis of hemoptysis includes disorders arising within the airways and the pulmonary parenchyma. Inflammatory processes (e.g., bronchitis and bronchiectasis) and neoplasms are the most common causes of blood arising within the airways. Within the pulmonary parenchyma common causes are infections, such as tuberculosis, pneumonia, Aspergillus, or lung abscess. Inflammatory processes that involve the lung, such as Wegners granulomatosis or Goodpastures syndromeare also important causes of hemoptysis (Fig. 27-16). Bleeding may be iatrogenic, as for example, after a lung biopsy or when chemotherapy for bone marrow transplantation evokes diffuse alveolar hemorrhage. Vascular disorders, including pulmonary embolism, arteriovenous malfunctions, and mitral stenosis are also to be considered in the differential diagnosis. The list of causes of hemoptysis is long and diverse (Table 27-10). The clinical setting is usually helpful in identifying the cause. Hemoptysis before middle age usually brings to mind infections; after 40 to 45 years of age or if there is a history of smoking, bronchogenic carcinoma heads the list. In patients left with a pulmonary cavity after pulmonary disease

that has healed (e.g., tuberculosis), and in regions of the country where pulmonary fungal diseases are prevalent, a bout of hemoptysis is occasionally the first sign of the disease. In patients who have a predisposing cause, such as oral contraceptives or chronic heart failure, pulmonary embolism must be considered. The evaluation of hemoptysis involves a careful history, physical examination, and a chest radiograph. Initial studies also include a complete blood count. The degree of anemia may influence the rapidity of further testing, and thrombocytopenia may be a contributing factor to hemoptysis. Rapid correction of anemia, thrombocytopenia, or coagulopathy with the transfusion of appropriate blood products may be required promptly depending upon the clinical status and degree of abnormality. Similarly, measurement of coagulation times are important. Studies of renal function and a urinalysis may be indicated when a systemic process which causes a pulmonary-renal syndrome is a possibility. Sputum should be zealously collected and, depending on the circumstance, microbiologic cultures and stains or cytologic examination should be performed. Depending on whether a cause is identified, and the risk factors for a serious cause of bleeding, the evaluation next involves additional studies to search for a source. Because hunting for the cause and the source of bleeding is generally uncomfortable for the patient and often expensive, the intensity of the search depends on the circumstances. For example, rarely is a search for the bleeding site needed in a patient with acute bronchitis, pneumonia, or