Etiology and management of pediatric hemoptysis

Abstract

Objective: To review the diagnostic and treatment strategies of hemoptysis in children.

Design: Retrospective analysis of patients evaluated between January 1, 1995, and August 31, 1999.

Setting: Tertiary pediatric referral center.

Patients: Nineteen consecutive children presenting with hemoptysis to the otolaryngology service.

Results: Chest radiography and bronchoscopy established the correct etiology in 15 patients. Infection and tracheostomy-related complications were the most common underlying problems. Other causes included congenital heart disease, pulmonary hemosiderosis, inflammatory bronchial mass, cystic fibrosis, factitious hemoptysis, and esophagitis. Appropriate management, ranging from antibiotics to emergency embolization, resulted in control of hemoptysis in all patients.

Conclusions: Hemoptysis is a rare but potentially life-threatening symptom of underlying respiratory tract abnormality in children. An efficient systematic evaluation is imperative to identifying the underlying etiology; aggressive management is important because of the potential severity of the problem. The otolaryngologist plays a pivotal role in the diagnosis and management, by flexible endoscopy of the nose, nasopharynx, and larynx, and through the use of rigid bronchoscopy, especially in cases of massive hemoptysis.