Hemoptysis in children: A single institutional experience

OBJECTIVES: The purpose of this study was to describe a single institutional experience with pediatric diffuse pulmonary hemorrhage, with an emphasis on etiology, clinical course, and outcome. METHODS: The medical records of pediatric patients admitted to Assaf Harofeh Medical Center between the years 2002 and 2011 because of hemoptysis and pulmonary infiltrates on chest radiographs were retrospectively reviewed. RESULTS: Sixteen patients were identified. All the participants had respiratory complaints, and bloody cough was the presenting symptom in 11 patients. Twelve patients were admitted to the pediatric intensive care unit: 10 required mechanical ventilation, 9 had diffuse pulmonary infiltrates, and 8 required transfusions of blood products. Eight patients had an infectious disease (1 had tuberculosis). Two patients had severe coagulopathy. Three patients had diffuse bronchiectasis (1 had immunodeficiency). Cardiac failure was identified in 1 patient. Cocaine-induced pulmonary hemorrhage was identified in an adolescent. In 4 infants, the cause of pulmonary hemorrhage was not identified. Bronchoscopy and computed tomography were each performed in 9 patients. Five patients died during the acute phase of the illness because of severe hypoxia and multiorgan failure. CONCLUSIONS: At our institution, hemoptysis is a rare but potentially life-threatening symptom. The etiology is heterogeneous. Clinical signs and chest radiographs are important for classifying the severity of the disease. Minor hemoptysis with focal findings on chest radiograph has a favorable short-term prognosis, with infectious diseases being involved in most cases.