Pulmonary Hemorrhage

Pulmonary hemorrhage presents a critical challenge in respiratory medicine, often manifesting as hemoptysis across a spectrum of respiratory diseases such as bronchiectasis, tumors, tuberculosis, aspergilloma, and cystic fibrosis. Hemoptysis refers to the expectoration of blood, either alone or mixed with mucus, originating from the lower respiratory tract (below the vocal cords). The severity of hemoptysis varies widely, ranging from mild to life-threatening, potentially leading to hemodynamic instability and fatal outcomes due to suffocation or shock. Pulmonary hemorrhage primarily involves bleeding from the pulmonary or bronchial vasculature, typically from the higher-pressure bronchial system. Previous classifications of pulmonary hemorrhage focused on quantifying blood loss, which can be difficult. Clinically, categorizing pulmonary hemorrhage by "magnitude and effect" may offer more practical utility. Given its high mortality rate (up to 70% before the use of bronchial artery embolization), approaching pulmonary hemorrhage requires rapid evaluation, stabilization, and definitive care—including determining the source of bleeding and appropriate management strategies such as airway protection, oxygenation, ventilation, and imaging for definitive intervention.