The cause of hemoptysis according to age and the amount of hemoptysis in children

Hae Won Kwak; Hyung Young Kim; Seung Kook Son; Hye-Young Kim; Hee Ju Park

doi:10.4168/aard.2016.4.2.114

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This article has been corrected. See "Erratum: Acknowledgments Correction. The cause of hemoptysis according to age and the amount of hemoptysis in children" in Volume 4 on page 462.

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Kwak, Kim, Son, Kim, and Park: The cause of hemoptysis according to age and the amount of hemoptysis in children

Original Article

Allergy, Asthma & Respiratory Disease 2016; 4(2): 114-118.

Published online: 31 March 2016

DOI: https://doi.org/10.4168/aard.2016.4.2.114

The cause of hemoptysis according to age and the amount of hemoptysis in children

Hae Won Kwak¹, Hyung Young Kim¹, Seung Kook Son¹, Hye-Young Kim², Hee Ju Park¹

¹Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea.

²Department 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

Received 4 August 2015 Revised 30 September 2015 Accepted 1 October 2015

(open-access):

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/).

Abstract

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.

Keywords: Hemoptysis, Tuberculosis, Child

Figures and Tables

Table 1

Characteristics of children with hemoptysis (n=59)

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.

Table 2

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)

Table 3

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).

Table 4

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.

Notes

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

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ORCID iDs: Hee Ju Park
https://orcid.org/http://orcid.org/0000-0002-2782-3918
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