Approach to Hemoptysis: Etiology, Diagnosis, and Management

Hemoptysis is defined as the expectoration of blood originating from the pulmonary or bronchial vasculature into the airway. It may range from mild blood-streaked sputum to life-threatening massive bleeding that demands urgent intervention. Although minor hemoptysis is far more common, massive hemoptysis carries a high risk of mortality primarily due to asphyxiation rather than exsanguination. Identifying the underlying etiology is often complex, as causes vary by geography and comorbid conditions. In low and middle-income countries, pulmonary tuberculosis and bronchiectasis remain predominant causes, whereas in high-income regions, bronchogenic carcinoma is more frequent. A multidisciplinary approach involving pulmonology, interventional radiology, and thoracic surgery is essential. Early bronchoscopy, high-resolution or contrast-enhanced CT imaging, and, when indicated, bronchial artery embolization (BAE) play key roles in diagnosis and management. This review summarizes the etiology, pathophysiology, diagnostic approach, and therapeutic strategies in hemoptysis, emphasizing evidence-based clinical decision-making and interventional options that reduce morbidity and mortality