Allergy Asthma Respir Dis AARD Allergy, Asthma & Respiratory Disease 2288-0402 2288-0410 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma, Allergy and Clinical Immunology 10.4168/aard.2016.4.2.114 Original Article The cause of hemoptysis according to age and the amount of hemoptysis in children Kwak Hae Won 1 Kim Hyung Young 1 Son Seung Kook 1 Kim Hye-Young 2 http://orcid.org/0000-0002-2782-3918 Park Hee Ju 1 Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea. Department of Pediatrics, Pusan National University Hospital, Busan, Korea. Correspondence to: Hee Ju Park. Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Korea. Tel: +82-55-360-3150, Fax: +82-55-360-2181, phj7294@hanmail.net 03 2016 31 03 2016 4 2 114 118 04 08 2015 30 09 2015 01 10 2015 © 2016 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma, Allergy and Clinical Immunology 2016 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/). Purpose

Studies on hemoptysis is rare because hemoptysis is an uncommon symptom in children. The aim of this study was to identify the causes of hemoptysis in children.

 Methods

Medical chart review of patients with hemoptysis was retrospectively conducted at 2 tertiary hospitals from November 2008 to December 2014. Patients were divided into 3 groups according to age. The amount of hemoptysis was categorized as mild (<20 mL/day), moderate (20–99 mL/day), and massive (≥100 mL/day).

 Results

A total of 59 patients were identified, and their mean age was 11.0±5.6 years. Among the causes of hemoptysis, respiratory tract infection was most common. Other causes included vasculitis syndrome, neoplasm in the airway, idiopathic pulmonary hemosiderosis, cardiac disease, and bronchiectasis. According to age, a significant difference was identified between the age groups in children with pneumonia (<6 years vs. 12–18 years, P=0.001). Differences were verified between the age groups in children with tuberculosis (<6 years vs. 12–18 years and 6–11 years vs. 12–18 years, P=0.023). According to amounts of hemoptysis, no significant difference was identified regardless of the causes.

 Conclusion

This study showed that the causes of hemoptysis in children were heterogeneous and the respiratory tract infection was most common. In children with hemoptysis, the age of onset and the amount of hemoptysis are needed to be considered for more precise diagnosis and more proper management of the underlying cause of hemoptysis.

 Hemoptysis Tuberculosis Child Pusan National University http://dx.doi.org/10.13039/501100002543

This work was supported by academic research fund for free assignment of Pusan National University.

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Characteristic Value
Age (yr) 11.0±5.6
 <6 14 (23.7)
 6-11 15 (25.4)
 ≥12 30 (50.8)
Sex
 Male 28 (47.5)
 Female 31 (52.5)
Accompanying symptom
 Cough 47/58 (81.0)
 Sputum 26/58 (44.8)
 Fever 20/58 (34.5)
 Chest pain 5/52 (9.6)
Amount of hemoptysis
 Small (<20 mL) 31/50 (62.0)
 Moderate (20-99 mL) 13/50 (26.0)
 Massive (≥100 mL) 6/50 (12.0)
Abnormalities of imaging modalities
 Chest X-ray 28/55 (50.9)
 Chest CT 28/43 (65.1)
PCR
 Rhino virus 2/16 (12.5)
 Respiratory syncytial virus 1/16 (6.3)
 Influenza virus 1/16 (6.3)
 Parainfluenza virus 1/16 (6.3)
 Adenovirus 1/16 (6.3)
 M. tuberculosis 3/17 (17.6)
Sputum culture
 M. tuberculosis 4/24 (16.7)
 Other bacteria 3/13 (23.1)
Interferon gamma releasing assay 3/11 (27.3)
Prognosis
 Recurrence 8 (13.6)
 Death 2 (3.4)

Values are presented as mean±standard deviation or number (%).

CT, computed tomography; PCR, polymerase chain reaction; M. tuberculosis, Mycobacterium tuberculosis.

 Etiology of hemoptysis in children
Etiology No. (%)
Respiratory tract infection 32 (54.2)
 Tracheobronchitis 15 (25.4)
 Pneumonia 9 (15.3)
 Lung abscess 1 (1.7)
 Tuberculosis 7 (11.9)
Cardiac disease 2 (3.4)
 Pulmonary artery agenesis 1 (1.7)
 Pulmonary vein hypoplasia 1 (1.7)
Bronchiectasis 1 (1.7)
Neoplasm (mucoepidermoid carcinoma) 1 (1.7)
Upper airway bleeding 6 (10.2)
 Nasopharyngeal bleeding 5 (8.5)
 Trachostomy-related 1 (1.7)
Vasculitis syndrome (microscopic polyangiitis) 2 (3.4)
Others 5 (8.5)
 Idiopathic pulmonary hemosiderosis 2 (3.4)
 Kabuki syndrome 1 (1.7)
 Pulmonary arteriovenous fistula 1 (1.7)
 Pulmonary endometriosis 1 (1.7)
Unknown 10 (16.9)
Association between age and etiology of hemoptysis
Variable < 6 yr (n = 14) 6-11 yr (n = 15) 12-18 yr (n = 30) P-value* P-value†
Infection 10 (71.4) 8 (53.3) 14 (46.7) 0.313 0.153
 Tracheobronchitis 5 (35.7) 4 (26.7) 6 (20.0) 0.538 0.274
 Pneumonia 5 (35.7) 4 (26.7) 0 (0.0) 0.001‡ < 0.001
 Lung abscess 0 (0) 0 (0) 1 (3.3) 0.617 0.353
 Tuberculosis 0 (0) 0 (0) 7 (23.3) 0.023§ 0.009
Cardiac disease 0 (0) 1 (6.7) 1 (3.3) 0.617 0.766
Bronchiectasis 0 (0) 0 (0) 1 (3.3) 0.617 0.353
Neoplasm 0 (0) 0 (0) 1 (3.3) 0.210 0.593
Vasculitis syndrome 0 (0) 0 (0) 2 (6.7) 0.374 0.185
Upper airway bleeding 0 (0) 3 (20.0) 3 (10.0) 0.617 0.353
Others 2 (14.3) 0 (0) 3 (10.0) 0.358 0.964
Unknown 2 (14.3) 3 (20.0) 5 (16.7) 0.919 0.938

*Kruskal-Wallis test. †Jonckheere-Terpstra test. ‡The difference by post hoc test was seen between the following age groups (0–5 years vs. 12–18 years). §The difference by post hoc test was seen between the following age groups (0–5 years vs. 12–18 years and 6–11 years vs. 12–18 years).

 Association between amount and etiology of hemoptysis
Variable < 20 mL (n = 31) 20–99 mL (n = 13) ≥ 100 mL (n = 6) P-value* P-value†
Infection 16 (51.6) 8 (61.5) 3 (50.0) 0.819 0.752
 Tracheobronchitis 11 (35.5) 2 (15.4) 0 (0) 0.120 0.041
 Pneumonia 4 (12.9) 3 (23.1) 1 (16.7) 0.860 0.725
 Lung abscess 0 (0) 1 (7.7) 0 (0.0) 0.241 0.315
 Tuberculosis 1 (3.2) 2 (15.4) 2 (33.3) 0.063 0.026
Cardiac disease 1 (3.2) 0 (0) 1 (16.7) 0.219 0.473
Bronchiectasis - - - 1.000 1.000
Neoplasm 1 (3.2) 0 (0) 0 (0) 0.813 0.522
Vasculitis syndrome 1 (3.2) 1 (7.7) 0 (0) 0.689 0.863
Upper airway bleeding 3 (9.7) 2 (15.4) 1 (16.7) 0.736 0.445
Others 4 (12.9) 1 (7.7) 0 (0) 0.603 0.339
Unknown 5 (3.2) 1 (7.7) 1 (16.7) 0.752 0.673

*Kruskal-Wallis test. †Jonckheere-Terpstra test.