Pulmonary Hemorrhage

A pulmonary hemorrhage is bleeding in your airways or lungs. It happens when a blockage, injury or inflammation causes damage to the blood vessels around your respiratory tract.

Pulmonary hemorrhage can happen in one area or in many areas around your lungs. When the bleeding is spread out around the small air sacs in your lungs (alveoli), it’s called diffuse alveolar hemorrhage. Autoimmune conditions are a common cause of diffuse alveolar hemorrhage.

Pulmonary hemorrhage can be fatal. Go to an emergency room or call 911 (or your local emergency service number) if you’re coughing up blood, having trouble breathing or have any other symptoms of bleeding in your lungs. Quick treatment could save your life.

Symptoms of pulmonary hemorrhage

Symptoms of a pulmonary hemorrhage include:

• Coughing up blood or blood mixed with mucus
• Shortness of breath
• Fatigue
• Pale skin (pallor)
• Fever (less common)

Pulmonary hemorrhage causes

Many conditions and diseases can cause pulmonary hemorrhage, including:

• Autoimmune conditions like Goodpasture syndrome, lupus and granulomatosis with polyangiitis (and other types of vasculitis)
• Infections like tuberculosis and aspergillosis
• Blood-clotting disorders like hemophilia
• Tumors
• Bronchiectasis
• Idiopathic pulmonary hemosiderosis (a rare lung disease that causes episodes of diffuse alveolar hemorrhage)
• Bronchitis
• Medications
• Toxins
• Surgery complications

Risk factors

Smoking increases your risk for pulmonary hemorrhage, especially if you have a medical condition that can cause it. Quitting can reduce your risk.

Complications of pulmonary hemorrhage

Bleeding in your lungs can lead to complications like blood clots that block your airways (pulmonary embolism) and acute respiratory distress syndrome (ARDS). These conditions can prevent oxygen from getting to your body, which can be fatal.

How doctors diagnose a pulmonary hemorrhage

Healthcare providers diagnose a pulmonary hemorrhage based on your symptoms, imaging and tests. You might need:

• Blood tests
• Chest X-rays or CT scans
• Bronchoscopy (a thin tube with a camera that providers use to look inside your lungs)

Sometimes, you might need a lung biopsy (a tissue sample to look for signs of disease).

How is a pulmonary hemorrhage treated?

Healthcare providers will first need to make sure you’re getting enough oxygen and stabilize you. They’ll also need to treat the cause to manage the bleeding. Some treatments could include:

• Supplemental oxygen or mechanical ventilation to stabilize your airways and make sure you’re getting enough oxygen
• Corticosteroids to reduce inflammation
• Bronchial artery embolization, sometimes used to stop bleeding
• Blood transfusion to replace blood in your body
• Plasmapheresis to remove harmful substances from your blood
• Antifungals or antibiotics to treat infections
• Immunosuppressant medications to treat autoimmune diseases

Surgery to treat a pulmonary hemorrhage is uncommon because it’s very risky.

When should I see my healthcare provider?

Pulmonary hemorrhage is a medical emergency. Go to the ER or get emergency medical attention if you have symptoms like coughing up blood or difficulty breathing.

If you have a condition that puts you at a higher risk for pulmonary hemorrhage, like vasculitis or other autoimmune conditions, talk to your provider about what you should look out for and how to reduce your risk.

Can pulmonary hemorrhage be fatal?

Yes. If you aren’t treated quickly, you can die from a pulmonary hemorrhage. The outlook (prognosis) depends on how large the hemorrhage is and its cause.

Is pulmonary hemorrhage the same as pulmonary edema?

No. Pulmonary edema is when excess fluid collects in your lungs. Pulmonary hemorrhage is bleeding in your lungs.