- think cystic fibrosis
- most common cause - lower respiratory tract infxn
- other common causes - FB aspiration, also chest trauma
- less common causes - neoplasm, vascular dz, AVM, congenital heart disease
- Do CBC, coags, CXR. Consider bronchoscopy, bleeding scan

Hemoptysis is rare in healthy children, although it can be seen with relative frequency in children who have cystic fibrosis. The single most common cause is acute lower respiratory tract infection. Another  common cause is foreign body aspiration, particularly in children younger than 4 years of age. Chest trauma that involves a contusion also can cause hemoptysis. Much less common causes include neoplasms, vascular diseases, and arteriovenous malformation. In countries in which corrective cardiac surgery is widely available, the incidence of hemoptysis due to congenital heart disease has declined significantly.

Initial laboratory tests for a child in whom hemoptysis is suspected include complete blood count and coagulation studies. Chest radiography then should be performed to localize the site of bleeding and to aid in diagnosis, although in one third of cases the results are normal. If the radiographic findings are normal but significant bleeding continues, bronchoscopy or the administration of radiolabeled red blood cells may be warranted. Sputum culture may be helpful in defining the specific bacterial cause of an infectious process, but it rarely is useful for diagnostic purposes. A sweat chloride test may be considered if there is a history of recurrent bleeding or if other information from the history or physical examination suggests cystic fibrosis.

In most children, hemoptysis is mild and self-limited; most cases do not require invasive measures. Specific therapy is directed toward the underlying cause. In life-threatening or massive bleeding, aggressive measures must be started immediately. Mechanical ventilation, blood transfusions, fluid resuscitation, and oxygen may be required. Bronchoscopy may be necessary for both diagnosis and therapy.

Pianosi P, al-Sadoon H. Hemoptysis in children. Pediatr Rev. 1996;17:344-348
Thompson JW, Nguyen CD, Lazar RH, et al. Evaluation and management of
hemoptysis in infants and children. A report of nine cases. Ann Otol
Rhinol Laryngol. 1996;105:516-520