Causes of Lung cancer
List of causes of Lung cancer
Following is a list of causes or underlying conditions
(see also Misdiagnosis of underlying causes of Lung cancer)
that could possibly cause Lung cancer includes:
- Metastatic lung cancer - many lung cancers result from metastasis of other cancers.
- Common tumors that spread to the lungs include:
- Bladder cancer
- Neuroblastoma
- Sarcoma
- Wilm's tumor
- However, almost any cancer has the ability to spread to the lungs
- Most cancers can spread to the lungs. The most common types include:
- Unknown primary
- The most common cause of lung cancer is long-term exposure to tobacco smoke
- Passive smoking
- Air pollution
- Asbestos
- Radon
- Certain occupations where exposure to arsenic, chromium, nickel, aromatic hydrocarbons, and ethers occurs may increase the risk of lung cancer
- Genetic factors
Longer list of causes of Lung symptoms:
see full list of causes for Lung symptoms
Lung cancer Causes: Book Excerpts
Lung cancer as a complication of other conditions:
Other conditions that might have
Lung cancer as a complication may,
potentially, be an underlying cause of Lung cancer.
Our database lists the following as having
Lung cancer as a complication of that condition:
Lung cancer as a symptom:
Conditions listing Lung cancer
as a symptom may also be potential underlying causes of Lung cancer.
Our database lists the following as having
Lung cancer as a symptom of that condition:
What causes Lung cancer?
Article excerpts about the
causes of Lung cancer:
87% of lung cancer is caused by smoking, so what about the other 13%?
There is evidence that exposure to tobacco smoke in the home, usually from
a smoking spouse, may increase the risk of lung cancer in non-smoking
women. Nearly 9 out of 10 non-smoking Americans are exposed to
environmental tobacco smoke (also known as "second-hand" smoke), as
measured by levels of nicotine in their blood. The best scientific studies
show that restrictions on second hand smoke reduce the risk of death and
injury to non-smokers, including the hundreds of thousands of children
with asthma and other respiratory illness. The FDA has classified
second-hand smoke as a Group A carcinogen (known to cause cancer in
humans.) Studies have also evaluated environmental tobacco exposure
outside the home, either in a work or social setting but they provide
inconclusive results. More studies are needed to determine how much
exposure might be harmful in any of these settings. (Source: excerpt from Lung Cancer: NWHIC)
Medical news summaries relating to Lung cancer:
The following medical news items are relevant to causes of Lung cancer:
Cause statistics for Lung cancer:
The following are statistics from various sources about the causes of Lung cancer:
Related information on causes of Lung cancer:
As with all medical conditions,
there may be many causal factors.
Further relevant information on causes of Lung cancer may be found in:
Causes of Lung cancer: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the causes of Lung cancer.
Hemoptysis:
Differential Diagnosis
(In a Page: Signs and Symptoms)
-
Other sources of bleeding (e.g., hematemesis, epistaxis, and other causes of upper airway bleeding)
-
Airway disease is the most common cause of hemoptysis
–Bronchitis (acute or chronic) causes more than 25% of cases
–Cancers (metastatic and primary lung
cancers) cause up to 25% of all cases
–Bronchiectasis causes up to 10% of cases
–Foreign body
–Trauma
-
Parenchymal disease
–Infections: Tuberculosis (5%), pneumonia (5%), lung abscess, aspergilloma
–Coagulopathy: Anticoagulant use,
thrombocytopenia, DIC
–Cystic fibrosis
–Inflammatory: SLE, Wegener’s
granulomatosis, Goodpasture's syndrome
–Iatrogenic: Transbronchial or percutaneous lung biopsy, bronchoscopy, intubation
–Cocaine use
- Cardiovascular disease
–Pulmonary infarction/embolism
–Congestive heart failure
–Mitral stenosis
–AVM
–Trauma to pulmonary artery (e.g., Swan-
Ganz catheterization)
–Aortic aneurysm
–Osler-Weber-Rendu syndrome: Congenital
telangiectasias
-
Fistula formation between vasculature and airway
-
Catamenial hemoptysis (intrathoracic endometriosis): Cyclic bleeding with menses
-
Diffuse alveolar hemorrhage syndromes: ARDS, crack cocaine use, SLE, cytotoxic drug use
-
Inflammatory
–Behçet syndrome: Recurrent oral and genital ulcers, uveitis, and arthritis
–Henoch-Schönlein purpura: Most common systemic vasculitis in children; presents with palpable purpura, abdominal pain, hematuria, and arthritis
–Idiopathic pulmonary hemosiderosis - Idiopathic in 20% of cases
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Hemoptysis:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
-
Think anatomically and physiologically of why we bleed and the source of the blood
-
Upper airway
–Nose bleed
–Chronic sinus disease
–Postoperative bleeding
–Dental disease
–Trauma (including CNS)
-
Digestive tract
–Esophageal varices
–Gastric bleeding (unlikely to come from intestine; that is, distal to antrum)
–Oral ulcers/trauma
-
Lower airways
–Tracheobronchial tree bronchiectasis (e.g., with CF)
–Bronchial erosion (e.g., from tracheotomy tube)
–Wegener granulomatosis
-
Parenchyma
–Pulmonary hemorrhage
–Pulmonary tuberculosis
–Lung abscess
–Hemorrhagic fevers (rare in U.S.)
–Paragonimiasis (a trematode infection)
–Lung contusion from trauma
–Primary pulmonary hemosiderosis
–Swyer-James syndrome
-
Cardiovascular causes
–Pulmonary embolism
–Multiple pulmonary telangiectasia (e.g.,
Osler-Weber-Rendu)
–Ruptured arteriovenous fistula
–Mitral stenosis
-
Bleeding disorders (may present from any source)
–Hemophilia, leukemia, and other blood dyscrasias
–Increased consumption of coagulation factors (e.g., disseminated vascular coagulation)
-
The most common source of blood originating in the lower airways is from small bronchial lesions secondary to inflammation from infection
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Hemoptysis:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Bronchial adenoma
Bronchial adenoma is an insidious disorder that causes recurring hemoptysis in up to 30% of patients, along with a chronic cough and local wheezing.
Bronchiectasis
Inflamed bronchial surfaces and eroded bronchial blood vessels cause hemoptysis, which can vary from blood-tinged sputum to blood (in about 20% of cases) The patient’s sputum may also be copious, foul-smelling, and purulent
He may exhibit a chronic cough, coarse crackles, clubbing (a late sign), a fever, weight loss, fatigue, weakness, malaise, and dyspnea on exertion.
Bronchitis (chronic)
The first sign of chronic bronchitis is typically a productive cough that lasts at least 3 months Eventually this leads to the production of blood-streaked sputum; massive hemorrhage is unusual
Other respiratory effects include dyspnea, prolonged expirations, wheezing, scattered rhonchi, accessory muscle use, barrel chest, tachypnea, and clubbing (a late sign).
Coagulation disorders
Such disorders as thrombocytopenia and disseminated intravascular coagulation can cause hemoptysis Besides their specific related findings, these disorders may share such general signs as multisystem hemorrhaging (for example, GI bleeding or epistaxis) and purpuric lesions.
Lung abscess
In about 50% of patients, lung abscess produces blood-streaked sputum resulting from bronchial ulceration, necrosis, and granulation tissue Common associated findings include a cough with large amounts of purulent, foul-smelling sputum; a fever with chills; diaphoresis; anorexia; weight loss; a headache; weakness; dyspnea; pleuritic or dull chest pain; and clubbing
Auscultation reveals tubular or cavernous breath sounds and crackles. Percussion reveals dullness on the affected side.
Lung cancer
Ulceration of the bronchus commonly causes recurring hemoptysis (an early sign), which can vary from blood-streaked sputum to blood Related findings include a productive cough, dyspnea, a fever, anorexia, weight loss, wheezing, and chest pain (a late symptom).
Plague (Yersinia pestis)
The pneumonic form of this acute bacterial infection can produce hemoptysis, a productive cough, chest pain, tachypnea, dyspnea, increasing respiratory distress, and cardiopulmonary insufficiency, along with the sudden onset of chills, a fever, a headache, and myalgia.
Pneumonia
In up to 50% of cases, Klebsiella pneumonia produces dark brown or red (currant jelly) sputum, which is so tenacious that the patient has difficulty expelling it from his mouth This type of pneumonia begins abruptly with chills, a fever, dyspnea, a productive cough, and severe pleuritic chest pain
Associated findings may include cyanosis, prostration, tachycardia, decreased breath sounds, and crackles.
Pneumococcal pneumonia causes pinkish or rusty mucoid sputum. It begins with sudden, shaking chills; a rapidly rising temperature; and, in over 80% of cases, tachycardia and tachypnea. Within a few hours, the patient typically experiences a productive cough along with severe, stabbing, pleuritic pain. The agonizing chest pain leads to rapid, shallow, grunting respirations with splinting. Examination reveals respiratory distress with dyspnea and accessory muscle use, crackles, and dullness on percussion over the affected lung. Malaise, weakness, myalgia, and prostration accompany a high fever.
Pulmonary edema
Severe cardiogenic or noncardiogenic pulmonary edema commonly causes frothy, blood-tinged pink sputum, which accompanies severe dyspnea, orthopnea, gasping, anxiety, cyanosis, diffuse crackles, a ventricular gallop, and cold, clammy skin This life-threatening condition may also cause tachycardia, lethargy, cardiac arrhythmias, tachypnea, hypotension, and a thready pulse.
Pulmonary embolism with infarction
Hemoptysis is a common finding in pulmonary embolism with infarction, a life-threatening disorder, although massive hemoptysis is infrequent Typical initial symptoms are dyspnea and anginal or pleuritic chest pain
Other common clinical features include tachycardia, tachypnea, a low-grade fever, and diaphoresis. Less commonly, splinting of the chest, leg edema, and — with a large embolus — cyanosis, syncope, and jugular vein distention may occur. Examination reveals decreased breath sounds, a pleural friction rub, crackles, diffuse wheezing, dullness on percussion, and signs of circulatory collapse (a weak, rapid pulse; hypotension), cerebral ischemia (transient loss of consciousness, convulsions), and hypoxemia (restlessness and, particularly in elderly patients, hemiplegia and other focal neurologic deficits).
Pulmonary hypertension (primary)
Features generally develop late Hemoptysis, exertional dyspnea, and fatigue are common
Angina-like pain usually occurs with exertion and may radiate to the neck but not to the arms. Other findings include arrhythmias, syncope, a cough, and hoarseness.
Pulmonary TB
Blood-streaked or blood-tinged sputum commonly occurs in pulmonary TB; massive hemoptysis may occur in advanced cavitary TB
Accompanying respiratory findings include a chronic productive cough, fine crackles after coughing, dyspnea, dullness on percussion, increased tactile fremitus, and possible amphoric breath sounds. The patient may also develop night sweats, malaise, fatigue, a fever, anorexia, weight loss, and pleuritic chest pain.
Systemic lupus erythematosus (SLE)
In 50% of patients with SLE, pleuritis and pneumonitis cause hemoptysis, a cough, dyspnea, pleuritic chest pain, and crackles
Related findings are a butterfly rash in the acute phase, nondeforming joint pain and stiffness, photosensitivity, Raynaud’s phenomenon, seizures or psychoses, anorexia with weight loss, and lymphadenopathy.
Tracheal trauma
Torn tracheal mucosa may cause hemoptysis, hoarseness, dysphagia, neck pain, airway occlusion, and respiratory distress.
Other causes
Diagnostic tests
Lung or airway injury from bronchoscopy, laryngoscopy, mediastinoscopy, or lung biopsy can cause bleeding and hemoptysis.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Introduction: Malignant Neoplasms:
What causes cancer?
(Professional Guide to Diseases (Eighth Edition))
Researchers have found that cancer develops from mutations within the genes of cells. Thus, cancer is a genetic disease. Cancer susceptibility genes are of two types. Some are oncogenes, which activate cell division and influence embryonic development, and some are tumor suppressor genes, which halt cell division.
These genes are typically found in normal human cells, but certain kinds of mutations may transform the normal cells. Inherited defects may cause a genetic mutation, whereas exposure to a carcinogen may cause an acquired mutation. Current evidence indicates that carcinogenesis results from a complex interaction of carcinogens and accumulated mutations in several genes.
In animal studies of the ability of viruses to transform cells, some human viruses exhibit carcinogenic potential. For example, the Epstein-Barr virus, the cause of infectious mononucleosis, has been linked to Burkitt's lymphoma and nasopharyngeal cancer.
High-frequency radiation, such as ultraviolet and ionizing radiation, damages the genetic material known as deoxyribonucleic acid (DNA), possibly inducing genetically transferable abnormalities. Other factors, such as a person's tissue type and hormonal status, interact to potentiate radiation's carcinogenic effect. Examples of substances that may damage DNA and induce carcinogenesis include:
❑alkylating agents — leukemia
❑aromatic hydrocarbons and benzopyrene (from polluted air) — lung cancer
❑asbestos — mesothelioma of the lung
❑tobacco — cancer of the lung, oral cavity and upper airways, esophagus, pancreas, kidneys, and bladder
❑vinyl chloride — angiosarcoma of the liver.
Diet has also been implicated, especially in the development of GI cancer as a result of a high animal fat diet. Additives composed of nitrates and certain methods of food preparation — particularly charbroiling — are also recognized factors.
The role of hormones in carcinogenesis is still controversial, but it seems that excessive use of some hormones, especially estrogen, produces cancer in animals. Also, the synthetic estrogen diethylstilbestrol causes vaginal cancer in some daughters of women who were treated with it. It's unclear, however, whether changes in human hormonal balance retard or stimulate cancer development.
Some forms of cancer and precancerous lesions result from genetic predisposition either directly (as in Wilms' tumor and retinoblastoma) or indirectly (in association with inherited conditions such as Down syndrome or immunodeficiency diseases). Expressed as autosomal recessive, X-linked, or autosomal dominant disorders, their common characteristics include:
❑early onset of malignant disease
❑increased incidence of bilateral cancer in paired organs (breasts, adrenal glands, kidneys, and eighth cranial nerve [acoustic neuroma])
❑increased incidence of multiple primary malignancies in nonpaired organs
❑abnormal chromosome complement in tumor cells.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Lung cancer:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Most experts agree that lung cancer is attributable to inhalation of carcinogenic pollutants by a susceptible host. Who's most susceptible? Any smoker older than age 40, especially if he began to smoke before age 15, has smoked a whole pack or more per day for 20 years, or works with or near asbestos.
Pollutants in tobacco smoke cause progressive lung cell degeneration. Lung cancer is 10 times more common in smokers than in nonsmokers; 80% of patients with lung cancer are smokers. Cancer risk is determined by the number of cigarettes smoked daily, the depth of inhalation, how early in life smoking began, and the nicotine content of cigarettes. Two other factors also increase susceptibility: exposure to carcinogenic industrial and air pollutants (asbestos, uranium, arsenic, nickel, iron oxides, chromium, radioactive dust, and coal dust) and familial susceptibility.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Malignant spinal neoplasms:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Primary tumors of the spinal cord may be extramedullary (occurring outside the spinal cord) or intramedullary (occurring within the cord itself). Extramedullary tumors may be intradural (meningiomas and schwannomas), which account for 60% of all primary malignant spinal cord neoplasms, or extradural (metastatic tumors from breasts, lungs, prostate, leukemia, or lymphomas), which account for 25% of these malignant neoplasms.
Intramedullary tumors, or gliomas (astrocytomas or ependymomas), are comparatively rare, accounting for only about 10%. In children, they're low-grade astrocytomas.
Spinal cord tumors are rare compared with intracranial tumors (ratio of 1:4). They occur equally in men and women, with the exception of meningiomas, which occur mostly in women. Spinal cord tumors can occur anywhere along the length of the cord or its roots.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Hemoptysis:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Aortic aneurysm (ruptured)
Rarely, an aortic aneurysm ruptures into the tracheobronchial tree, causing hemoptysis and sudden death.
Blast lung injury
Although individuals with this type of injury may not have obvious external chest injuries, they sometimes show other indications of internal damage, such as hemoptysis. Health care providers should evaluate survivors of explosive detonations for other classic signs and symptoms of a blast lung injury, such as chest pain, cyanosis, dyspnea, and wheezing. Treatment includes careful administration of fluids and oxygen to ensure tissue perfusion.
Bronchial adenoma
This insidious disorder causes recurring hemoptysis in up to 30% of patients along with a chronic cough and local wheezing.
Bronchiectasis
Inflamed bronchial surfaces and eroded bronchial blood vessels cause hemoptysis, which can vary from blood-tinged sputum to blood (in about 20% of patients). The patient typically has a chronic cough producing copious amounts of foul-smelling, purulent sputum. He may also exhibit coarse crackles, clubbing (a late sign), fever, weight loss, fatigue, weakness, malaise, and dyspnea on exertion.
Bronchitis (chronic)
The first sign of this disorder is typically a productive cough that lasts at least 3 months. Eventually this leads to production of blood-streaked sputum; massive hemorrhage is unusual. Other respiratory effects include dyspnea, prolonged expirations, wheezing, scattered rhonchi, accessory muscle use, barrel chest, tachypnea, and clubbing (a late sign).
Coagulation disorders
Such disorders as thrombocytopenia and disseminated intravascular coagulation can cause hemoptysis, multisystem hemorrhaging (for example, GI bleeding or epistaxis), and purpuric lesions.
Laryngeal cancer
Hemoptysis occurs in this cancer, but hoarseness is usually the initial sign. Other findings may include dysphagia, dyspnea, stridor, cervical lymphadenopathy, and neck pain.
Lung abscess
In about 50% of patients, this disorder produces blood-streaked sputum resulting from bronchial ulceration, necrosis, and granulation tissue. Common associated findings include a cough producing large amounts of purulent, foul-smelling sputum; fever with chills; diaphoresis; anorexia; weight loss; headache; weakness; dyspnea; pleuritic or dull chest pain; and clubbing. Auscultation reveals tubular or cavernous breath sounds and crackles. Percussion reveals dullness on the affected side.
Lung cancer
Ulceration of the bronchus commonly causes recurring hemoptysis (an early sign), which can vary from blood-streaked sputum to blood. Related findings include a productive cough, dyspnea, fever, anorexia, weight loss, wheezing, and chest pain (a late symptom).
Plague
The pneumonic form of this acute bacterial infection, caused by Yersinia pestis, can produce hemoptysis, a productive cough, chest pain, tachypnea, dyspnea, increasing respiratory distress, and cardiopulmonary insufficiency. Pneumonic plague begins abruptly with chills, fever, headache, and myalgia.
Pneumonia
In up to 50% of patients, Klebsiella pneumonia produces dark brown or red (currant-jelly) sputum, which is so tenacious that the patient has difficulty expelling it from his mouth. This type of pneumonia begins abruptly with chills, fever, dyspnea, a productive cough, and severe pleuritic chest pain. Associated findings may include cyanosis, prostration, tachycardia, decreased breath sounds, and crackles.
Pneumococcal pneumonia causes pinkish or rusty mucoid sputum. It begins with sudden shaking chills; a rapidly rising temperature; and, in over 80% of patients, tachycardia and tachypnea. Within a few hours, the patient typically experiences a productive cough along with severe, stabbing, pleuritic pain that leads to rapid, shallow, grunting respirations with splinting. Examination reveals respiratory distress with dyspnea and accessory muscle use, crackles, and dullness on percussion over the affected lung. Malaise, weakness, myalgia, and prostration accompany a high fever.
Pulmonary arteriovenous fistula
Occurring in young adults, this genetic disorder causes intermittent hemoptysis along with cyanosis, clubbing, mild dyspnea, fatigue, vertigo, syncope, confusion, and speech and visual impairments. The patient may bleed from the nose, mouth, or lips. Ruby red patches appear on the face, tongue, skin, mucous membranes, or nail beds.
Pulmonary contusion
Blunt chest trauma commonly causes a cough with hemoptysis. Other signs and symptoms that appear over several hours include dyspnea, tachypnea, chest pain, tachycardia, hypotension, crackles, and decreased or absent breath sounds over the affected area. Severe respiratory distress—with oppressive dyspnea, nasal flaring, use of accessory muscles, extreme anxiety, cyanosis, and diaphoresis—may develop at any time.
Pulmonary edema
Severe cardiogenic or noncardiogenic pulmonary edema commonly causes frothy, blood-tinged pink sputum, which accompanies severe dyspnea, orthopnea, gasping, anxiety, cyanosis, diffuse crackles, a ventricular gallop, and cold, clammy skin. This life-threatening condition may also cause tachycardia, lethargy, cardiac arrhythmias, tachypnea, hypotension, and a thready pulse.
Pulmonary embolism with infarction
Hemoptysis is a common finding in this life-threatening disorder, although massive hemoptysis is rare. Typical initial symptoms are dyspnea and anginal or pleuritic chest pain. Other common clinical features include tachycardia, tachypnea, low-grade fever, and diaphoresis. Less common features include splinting of the chest, leg edema, and—with a large embolus—cyanosis, syncope, and jugular vein distention. Examination reveals decreased breath sounds, pleural friction rub, crackles, diffuse wheezing, dullness on percussion, and signs of circulatory collapse (weak, rapid pulse and hypotension), cerebral ischemia (transient loss of consciousness and seizures), and hypoxemia (restlessness and, particularly in elderly patients, hemiplegia and other focal neurologic deficits).
Pulmonary hypertension (primary)
Hemoptysis, exertional dyspnea, and fatigue generally develop late in this disorder. Angina-like pain usually occurs with exertion and may radiate to the neck but not to the arms. Other findings include arrhythmias, syncope, cough, and hoarseness.
Pulmonary tuberculosis
Blood-streaked or blood-tinged sputum commonly occurs in this disorder; massive hemoptysis may occur in advanced cavitary tuberculosis. Accompanying respiratory findings include a chronic productive cough, fine crackles after coughing, dyspnea, dullness on percussion, increased tactile fremitus and, possibly, amphoric breath sounds. The patient may also develop night sweats, malaise, fatigue, fever, anorexia, weight loss, and pleuritic chest pain.
Silicosis
This chronic disorder causes a productive cough with mucopurulent sputum that later becomes blood streaked. Occasionally, massive hemoptysis may occur. Other findings include fine end-inspiratory crackles at lung bases, exertional dyspnea, tachypnea, weight loss, fatigue, and weakness.
Systemic lupus erythematosus
In 50% of patients with this disorder, pleuritis and pneumonitis cause hemoptysis, a cough, dyspnea, pleuritic chest pain, and crackles. Related findings are a butterfly rash in the acute phase, nondeforming joint pain and stiffness, photosensitivity, Raynaud’s phenomenon, seizures or psychoses, anorexia with weight loss, and lymphadenopathy.
Tracheal trauma
Torn tracheal mucosa may cause hemoptysis, hoarseness, dysphagia, neck pain, airway occlusion, and respiratory distress.
Wegener’s granulomatosis
Necrotizing, granulomatous vasculitis characterizes this multisystem disorder. Findings include hemoptysis, chest pain, cough, wheezing, dyspnea, epistaxis, severe sinusitis, and hemorrhagic skin lesions.
Other causes
Diagnostic tests
Lung or airway injury from bronchoscopy, laryngoscopy, mediastinoscopy, or lung biopsy can cause bleeding and hemoptysis.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Hemoptysis:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Bronchitis
❑ Pneumonia
❑ Pulmonary edema
❑ Pulmonary infarction
❑ Tuberculosis
❑ Bronchogenic carcinoma
❑ Chest trauma
❑ Bronchiectasis
❑ Bronchial adenoma
❑ A-V malformation
❑ Aspergilloma
❑ Vasculitis
❑ Lung abscess
❑ Mitral stenosis
❑ Hereditary hemorrhagic telangiectasia
❑ Parasitic
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Lung cancer:
Causes
(Handbook of Diseases)
Most experts agree that lung cancer is attributable to inhalation of carcinogenic pollutants by a susceptible host. Most susceptible are those persons who smoke or who work with or near asbestos.
Pollutants in tobacco smoke cause progressive lung cell degeneration. Lung cancer is 10 times more common in smokers than in nonsmokers; indeed, 80% of lung cancer patients are or were smokers.
Cancer risk is determined by the number of cigarettes smoked daily, the depth of inhalation, how early in life smoking began, and the nicotine content of the cigarettes. Two other factors also increase susceptibility: exposure to carcinogenic industrial and air pollutants (asbestos, uranium, arsenic, nickel, iron oxides, chromium, radioactive dust, and coal dust), and familial susceptibility.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Hemoptysis:
Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Aortic aneurysm (ruptured)
Rarely, an aortic aneurysm ruptures into the tracheobronchial tree, causing hemoptysis and sudden death.
Bronchial adenoma
Bronchial adenoma
is an insidious disorder that causes recurring hemoptysis in up to 30% of patients, along with a chronic cough and local wheezing.
Bronchiectasis
Inflamed bronchial surfaces and eroded bronchial blood vessels cause hemoptysis, which can vary from blood-tinged sputum to blood (in about 20% of patients). The patient’s sputum may also be copious, foul-smelling, and purulent. He may exhibit a chronic cough, coarse crackles, clubbing (a late sign), fever, weight loss, fatigue, weakness, malaise, and dyspnea on exertion.
Bronchitis (chronic)
The first sign of bronchitis is typically a productive cough that lasts at least 3 months. Eventually this leads to production of blood-streaked sputum; massive hemorrhage is unusual. Other respiratory effects include dyspnea, prolonged expirations, wheezing, scattered rhonchi, accessory muscle use, barrel chest, tachypnea, and clubbing (a late sign).
Coagulation disorders
Such disorders as thrombocytopenia and disseminated intravascular coagulation can cause hemoptysis. Besides their specific related findings, coagulation disorders may share such general signs as multisystem hemorrhaging (for example, GI bleeding or epistaxis) and purpuric lesions.
Laryngeal cancer
Hemoptysis occurs in laryngeal cancer, but hoarseness is the usual early sign. Other findings may include dysphagia, dyspnea, stridor, cervical lymphadenopathy, and neck pain.
Lung abscess
In about 50% of patients, lung abscess produces blood-streaked sputum resulting from bronchial ulceration, necrosis, and granulation tissue. Common associated findings include a cough with large amounts of purulent, foul-smelling sputum; fever with chills; diaphoresis; anorexia; weight loss; headache; weakness; dyspnea; pleuritic or dull chest pain; and clubbing. Auscultation reveals tubular or cavernous breath sounds and crackles. Percussion reveals dullness on the affected side.
Lung cancer
Ulceration of the bronchus commonly causes recurring hemoptysis (an early sign), which can vary from blood-streaked sputum to blood. Related findings include a productive cough, dyspnea, fever, anorexia, weight loss, wheezing, and chest pain (a late symptom).
Plague (Yersinia pestis)
The pneumonic form of plague can produce hemoptysis, productive cough, chest pain, tachypnea, dyspnea, increasing respiratory distress, and cardiopulmonary insufficiency, along with the sudden onset of chills, fever, headache, and myalgias.
Pneumonia
In up to 50% of patients,
Klebsiella pneumonia produces dark brown or red (currant-jelly) sputum, which is so tenacious that the patient has difficulty expelling it from his mouth. This type of pneumonia begins abruptly with chills, fever, dyspnea, a productive cough, and severe pleuritic chest pain. Associated findings may include cyanosis, prostration, tachycardia, decreased breath sounds, and crackles.
Pneumococcal pneumonia causes pinkish or rusty mucoid sputum. It begins with sudden shaking chills; a rapidly rising temperature; and, in more than 80% of patients, tachycardia and tachypnea. Within a few hours, the patient typically experiences a productive cough along with severe, stabbing, pleuritic pain. The agonizing chest pain leads to rapid, shallow, grunting respirations with splinting. Examination reveals respiratory distress with dyspnea and accessory muscle use, crackles, and dullness on percussion over the affected lung. Malaise, weakness, myalgia, and prostration accompany high fever.
Pulmonary arteriovenous fistula
Occurring in young adults, pulmonary arteriovenous fistula causes intermittent hemoptysis. Associated signs and symptoms include cyanosis, clubbing, mild dyspnea, fatigue, vertigo, syncope, confusion, and speech and visual impairments. The patient may bleed from the nose, mouth, or lips. Ruby red patches appear on the face, tongue, skin, mucous membranes, or nail beds.
Pulmonary contusion
Blunt chest trauma commonly causes a cough with hemoptysis. Other signs and symptoms appear gradually within several hours after the injury and include dyspnea, tachypnea, chest pain, tachycardia, hypotension, crackles, and decreased or absent breath sounds over the affected area. Severe respiratory distress — with oppressive dyspnea, nasal flaring, use of accessory muscles, extreme anxiety, cyanosis, and diaphoresis — may develop at any time.
Pulmonary edema
Severe cardiogenic or noncardiogenic pulmonary edema commonly causes frothy, blood-tinged pink sputum, which accompanies severe dyspnea, orthopnea, gasping, anxiety, cyanosis, diffuse crackles, a ventricular gallop, and cold, clammy skin. This life-threatening condition may also cause tachycardia, lethargy, cardiac arrhythmias, tachypnea, hypotension, and a thready pulse.
Pulmonary embolism with infarction
Hemoptysis is a common finding in pulmonary embolism with infarction — a life-threatening disorder — although massive hemoptysis is infrequent. Typical initial symptoms are dyspnea and anginal or pleuritic chest pain. Other common clinical features include tachycardia, tachypnea, low-grade fever, and diaphoresis. Less commonly, splinting of the chest, leg edema, and — with a large embolus — cyanosis, syncope, and distended jugular veins may occur. Examination reveals decreased breath sounds, pleural friction rub, crackles, diffuse wheezing, dullness on percussion, and signs of circulatory collapse (weak, rapid pulse; hypotension), cerebral ischemia (transient loss of consciousness, convulsions), and hypoxemia (restlessness and, particularly in elderly patients, hemiplegia and other focal neurologic deficits).
Pulmonary hypertension (primary)
Features generally develop late. Hemoptysis, exertional dyspnea, and fatigue are common. Angina-like pain usually occurs with exertion and may radiate to the neck but not to the arms. Other findings include arrhythmias, syncope, cough, and hoarseness.
Pulmonary tuberculosis
Blood-streaked or blood-tinged sputum commonly occurs in pulmonary tuberculosis; massive hemoptysis may occur in advanced cavitary tuberculosis. Accompanying respiratory findings include a chronic productive cough, fine crackles after coughing, dyspnea, dullness to percussion, increased tactile fremitus, and possible amphoric breath sounds. The patient may also develop night sweats, malaise, fatigue, fever, anorexia, weight loss, and pleuritic chest pain.
Silicosis
Initially, silicosis — a chronic disorder — causes a productive cough with mucopurulent sputum. Subsequently, the sputum becomes blood-streaked and, occasionally, massive hemoptysis may occur. Other findings include fine, end-inspiratory crackles at lung bases, exertional dyspnea, tachypnea, weight loss, fatigue, and weakness.
Systemic lupus erythematosus (SLE)
In 50% of patients with SLE, pleuritis and pneumonitis cause hemoptysis, cough, dyspnea, pleuritic chest pain, and crackles. Related findings are a butterfly rash in the acutephase, nondeforming joint pain and stiffness, photosensitivity, Raynaud’s phenomenon, convulsions or psychoses, anorexia with weight loss, and lymphadenopathy.
Tracheal trauma
Torn tracheal mucosa may cause hemoptysis, hoarseness, dysphagia, neck pain, airway occlusion, and respiratory distress.
Wegener’s granulomatosis
Necrotizing, granulomatous vasculitis characterizes Wegener’s granulomatosis — a multisystem disorder. Findings include hemoptysis, chest pain, cough, wheezing, dyspnea, epistaxis, severe sinusitis, and hemorrhagic skin lesions.
Other causes
Diagnostic tests
Lung or airway injury from bronchoscopy, laryngoscopy, mediastinoscopy, or lung biopsy can cause bleeding and hemoptysis.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Hemoptysis:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Bronchial adenoma
Bronchial adenoma is an insidious disorder that causes recurring hemoptysis along with a chronic cough and local wheezing. The patient with bronchial adenoma may also have recurrent infection, dyspnea, and wheezing.
Bronchiectasis
With bronchiectasis, inflamed bronchial surfaces and eroded bronchial blood vessels cause hemoptysis, which can vary from blood-tinged sputum to blood (in about 20% of patients). The patient’s sputum may also be copious, foul-smelling, and purulent. He may exhibit a chronic cough, coarse crackles, clubbing (a late sign), fever, weight loss, fatigue, weakness, malaise, and dyspnea on exertion.
Bronchitis (chronic)
The first sign of chronic bronchitis is typically a productive cough that lasts at least 3 months. Eventually this leads to production of blood-streaked sputum; massive hemorrhage is unusual. Other respiratory effects include dyspnea, prolonged expirations, wheezing, scattered rhonchi, accessory muscle use, barrel chest, tachypnea, and clubbing (a late sign).
Coagulation disorders
Such coagulation disorders as thrombocytopenia and disseminated intravascular coagulation can cause hemoptysis. In addition to their specific related findings, coagulation disorders may share such general signs as multisystem hemorrhaging (for example, GI bleeding or epistaxis) and purpuric lesions.
Laryngeal cancer
Hemoptysis occurs in laryngeal cancer, but hoarseness is the usual early sign. Other findings may include dysphagia, dyspnea, stridor, cervical lymphadenopathy, and neck pain.
Lung abscess
In about 50% of patients, a lung abscess produces blood-streaked sputum resulting from bronchial ulceration, necrosis, and granulation tissue. Common associated findings include a cough with large amounts of purulent, foul-smelling sputum; fever with chills; diaphoresis; anorexia; weight loss; headache; weakness; dyspnea; pleuritic or dull chest pain; and clubbing. Auscultation reveals tubular or cavernous breath sounds and crackles. Percussion reveals dullness on the affected side.
Lung cancer
In patients with lung cancer, ulceration of the bronchus commonly causes recurring hemoptysis (an early sign), which can vary from blood-streaked sputum to blood. Related findings include a productive cough, dyspnea, fever, anorexia, weight loss, wheezing, and chest pain (a late symptom).
Pneumonia
In up to 50% of patients, Klebsiella pneumonia produces dark brown or red (currant-jelly) sputum, which is so tenacious that the patient has difficulty expelling it from his mouth. This type of pneumonia begins abruptly with chills, fever, dyspnea, a productive cough, and severe pleuritic chest pain. Associated findings may include cyanosis, prostration, tachycardia, decreased breath sounds, and crackles.
Pneumococcal pneumonia causes pinkish or rusty mucoid sputum. It begins with sudden shaking chills; a rapidly rising temperature; and, in over 80% of patients, tachycardia and tachypnea. Within a few hours, the patient typically experiences a productive cough along with severe, stabbing, pleuritic pain. The agonizing chest pain leads to rapid, shallow, grunting respirations with splinting. Examination reveals respiratory distress with dyspnea and accessory muscle use, crackles, and dullness on percussion over the affected lung. Malaise, weakness, myalgia, and prostration accompany high fever.
Pulmonary contusion
Pulmonary contusion, resulting from blunt chest trauma, commonly causes a cough with hemoptysis. Other signs and symptoms appear gradually within several hours after the injury and include dyspnea, tachypnea, chest pain, tachycardia, hypotension, crackles, and decreased or absent breath sounds over the affected area. Severe respiratory distress — with oppressive dyspnea, nasal flaring, use of accessory muscles, extreme anxiety, cyanosis, and diaphoresis — may develop at any time.
Pulmonary edema
Severe pulmonary edema commonly causes frothy, blood-tinged pink sputum, which accompanies severe dyspnea, orthopnea, gasping, anxiety, cyanosis, diffuse crackles, a ventricular gallop, and cold, clammy skin. This life-threatening condition may also cause tachycardia, lethargy, cardiac arrhythmias, tachypnea, hypotension, and a thready pulse.
Pulmonary embolism with infarction
Hemoptysis is a common finding in this life-threatening disorder, although massive hemoptysis is infrequent. Typical initial symptoms are dyspnea and anginal or pleuritic chest pain. Other common clinical features include tachycardia, tachypnea, low-grade fever, and diaphoresis. Less commonly, splinting of the chest, leg edema, and — with a large embolus — cyanosis, syncope, and distended jugular veins may occur. Examination reveals decreased breath sounds, pleural friction rub, crackles, diffuse wheezing, dullness on percussion, and signs of circulatory collapse (weak, rapid pulse; hypotension), cerebral ischemia (transient loss of consciousness, convulsions), and hypoxemia (restlessness and, particularly in elderly patients, hemiplegia and other focal neurologic deficits).
Pulmonary hypertension (primary)
Features of primary pulmonary hypertension generally develop late. Hemoptysis, exertional dyspnea, and fatigue are common. Angina-like pain usually occurs with exertion and may radiate to the neck but not to the arms. Other findings include arrhythmias, syncope, cough, and hoarseness.
Pulmonary tuberculosis
Blood-streaked or blood-tinged sputum commonly occurs in pulmonary tuberculosis; massive hemoptysis may occur in advanced cavitary tuberculosis. Accompanying respiratory findings include a chronic productive cough, fine crackles after coughing, dyspnea, dullness to percussion, increased tactile fremitus, and possible amphoric breath sounds. The patient may also develop night sweats, malaise, fatigue, fever, anorexia, weight loss, and pleuritic chest pain.
Silicosis
Initially, silicosis causes a productive cough with mucopurulent sputum. Subsequently, the sputum becomes blood-streaked and, occasionally, massive hemoptysis may occur. Other findings include fine, end-inspiratory crackles at lung bases, exertional dyspnea, tachypnea, weight loss, fatigue, and weakness.
Systemic lupus erythematosus
In 50% of patients with systemic lupus erythematosus (SLE), pleuritis and pneumonitis cause hemoptysis, cough, dyspnea, pleuritic chest pain, and crackles. Related findings are a butterfly rash in the acutephase, nondeforming joint pain and stiffness, photosensitivity, Raynaud’s phenomenon, convulsions or psychoses, anorexia with weight loss, and lymphadenopathy.
Other causes
Diagnostic tests
Lung or airway injury from bronchoscopy, laryngoscopy, mediastinoscopy, or lung biopsy can cause bleeding and hemoptysis.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Hemoptysis:
Principal Causes of Hemoptysis
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
- Neonates
- Airwaytrauma
- Pulmonary hemorrhage
- Bleeding disorders
- Infants, children, and adolescents
- Trauma
- Pulmonary disorders
- Bronchitis
- Pneumonia
- Lung abscess
- Bronchiectasis including cystic fibrosis
- Foreign body
- Idiopathic pulmonary hemosiderosis
- Pulmonary hemosiderosis with cow milkhypersensitivity
- Vascular anomalies
- Pulmonaryarteriovenous malformation
- Hereditary hemorrhagic telangiectasia(Osler-Rondu-Weber disease)
- Neoplasm
- Cardiac disorders
- Goodpasture syndrome
- Vasculitis
- Bleeding disorders
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Hemoptysis:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Blast lung injury.Although individuals with blast lung injury may not have obvious external chest injuries, they sometimes show other indications of internal damage, such as hemoptysis. Health care providers should evaluate survivors of explosive detonations for other classic signs and symptoms of a blast lung injury, such as chest pain, cyanosis, dyspnea, and wheezing. Treatment includes careful administration of fluids and oxygen to ensure tissue perfusion.
Bronchial adenoma.Bronchial adenoma is an insidious disorder that causes recurring hemoptysis in up to 30% of patients, along with a chronic cough and local wheezing.
Bronchiectasis.Inflamed bronchial surfaces and eroded bronchial blood vessels cause hemoptysis, which can vary from blood-tinged sputum to blood (in about 20% of cases). The patient's sputum may also be copious, foul-smelling, and purulent. He may exhibit a chronic cough, coarse crackles, clubbing (a late sign), a fever, weight loss, fatigue, weakness, malaise, and dyspnea on exertion.
Bronchitis (chronic).The first sign of chronic bronchitis is typically a productive cough that lasts at least 3 months. Eventually this leads to the production of blood-streaked sputum; massive hemorrhage is unusual. Other respiratory effects include dyspnea, prolonged expirations, wheezing, scattered rhonchi, accessory muscle use, barrel chest, tachypnea, and clubbing (a late sign).
Coagulation disorders.Such disorders as thrombocytopenia and disseminated intravascular coagulation can cause hemoptysis. Besides their specific related findings, these disorders may share such general signs as multisystem hemorrhaging (for example, GI bleeding or epistaxis) and purpuric lesions.
Lung abscess.In about 50% of patients, lung abscess produces blood-streaked sputum resulting from bronchial ulceration, necrosis, and granulation tissue. Common associated findings include a cough with large amounts of purulent, foul-smelling sputum; a fever with chills; diaphoresis; anorexia; weight loss; a headache; weakness; dyspnea; pleuritic or dull chest pain; and clubbing. Auscultation reveals tubular or cavernous breath sounds and crackles. Percussion reveals dullness on the affected side.
Lung cancer.Ulceration of the bronchus commonly causes recurring hemoptysis (an early sign), which can vary from blood-streaked sputum to blood. Related findings include a productive cough, dyspnea, a fever, anorexia, weight loss, wheezing, and chest pain (a late symptom).
Plague(Yersinia pestis).The pneumonic form of this acute bacterial infection can produce hemoptysis, a productive cough, chest pain, tachypnea, dyspnea, increasing respiratory distress, and cardiopulmonary insufficiency, along with the sudden onset of chills, a fever, a headache, and myalgia.
Pneumonia.In up to 50% of cases, Klebsiella pneumonia produces dark brown or red (currant jelly) sputum, which is so tenacious that the patient has difficulty expelling it from his mouth. This type of pneumonia begins abruptly with chills, a fever, dyspnea, a productive cough, and severe pleuritic chest pain. Associated findings may include cyanosis, prostration, tachycardia, decreased breath sounds, and crackles.
Pneumococcal pneumonia causes pinkish or rusty mucoid sputum. It begins with sudden, shaking chills; a rapidly rising temperature; and, in over 80% of cases, tachycardia and tachypnea. Within a few hours, the patient typically experiences a productive cough along with severe, stabbing, pleuritic pain. The agonizing chest pain leads to rapid, shallow, grunting respirations with splinting. Examination reveals respiratory distress with dyspnea and accessory muscle use, crackles, and dullness on percussion over the affected lung. Malaise, weakness, myalgia, and prostration accompany a high fever.
Pulmonary edema.Severe cardiogenic or noncardiogenic pulmonary edema commonly causes frothy, blood-tinged pink sputum, which accompanies severe dyspnea, orthopnea, gasping, anxiety, cyanosis, diffuse crackles, a ventricular gallop, and cold, clammy skin. This life-threatening condition may also cause tachycardia, lethargy, cardiac arrhythmias, tachypnea, hypotension, and a thready pulse.
Pulmonary embolism with infarction.Hemoptysis is a common finding in pulmonary embolism with infarction, a life-threatening disorder, although massive hemoptysis is infrequent. Typical initial symptoms are dyspnea and anginal or pleuritic chest pain. Other common clinical features include tachycardia, tachypnea, a low-grade fever, and diaphoresis. Less commonly, splinting of the chest, leg edema, and—with a large embolus—cyanosis, syncope, and jugular vein distention may occur. Examination reveals decreased breath sounds, a pleural friction rub, crackles, diffuse wheezing, dullness on percussion, and signs of circulatory collapse (a weak, rapid pulse; hypotension), cerebral ischemia (transient loss of consciousness, seizures), and hypoxemia (restlessness and, particularly in elderly patients, hemiplegia and other focal neurologic deficits).
Pulmonary hypertension (primary).With pulmonary hyperension, features generally develop late. Hemoptysis, exertional dyspnea, and fatigue are common. Angina-like pain usually occurs with exertion and may radiate to the neck but not to the arms. Other findings include arrhythmias, syncope, a cough, and hoarseness.
Pulmonary TB.Blood-streaked or blood-tinged sputum commonly occurs in pulmonary TB; massive hemoptysis may occur in advanced cavitary TB. Accompanying respiratory findings include a chronic productive cough, fine crackles after coughing, dyspnea, dullness on percussion, increased tactile fremitus, and possible amphoric breath sounds. The patient may also develop night sweats, malaise, fatigue, a fever, anorexia, weight loss, and pleuritic chest pain.
Systemic lupus erythematosus (SLE).In 50% of patients with SLE, pleuritis and pneumonitis cause hemoptysis, a cough, dyspnea, pleuritic chest pain, and crackles. Related findings are a butterfly rash in the acutephase, nondeforming joint pain and stiffness, photosensitivity, Raynaud's phenomenon, seizures or psychoses, anorexia with weight loss, and lymphadenopathy.
Tracheal trauma.Torn tracheal mucosa may cause hemoptysis, hoarseness, dysphagia, neck pain, airway occlusion, and respiratory distress.
Other causes
Diagnostic tests.Lung or airway injury from bronchoscopy, laryngoscopy, mediastinoscopy, or lung biopsy can cause bleeding and hemoptysis.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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