Can Coughing Up Blood Be Nothing?

Causes of coughing up blood include infection (bronchitis, bronchiectasis, pneumonia, lower respiratory tract infection, chronic obstructive pulmonary disease (COPD), smoking, foreign object that has been inhaled (aspirated), cystic fibrosis, lung cancer, esophageal cancer, tuberculosis, and others.

Coughing up blood (hemoptysis) can have many possible causes, some of which are serious, and some which may be of little concern. It is important to see a doctor for a proper diagnosis to rule out serious conditions that can cause coughing up blood. 

Causes of coughing up blood include:

• Infection: the most common cause
  • Bronchitis
  • Bronchiectasis
  • Pneumonia
  • Lower respiratory tract infection
• Chronic obstructive pulmonary disease (COPD)
• Smoking
• Foreign object that has been inhaled (aspirated) (usually seen in children)
• Cystic fibrosis
• Lung cancer
• Esophageal cancer
• Fungal infection with Aspergillus (aspergillosis)
• Tuberculosis
• Pulmonary edema
• Wegener's granulomatosis
• Inflammation of blood vessels (vasculitis) in the lung
  • Goodpasture syndrome 
  • Granulomatosis with polyangiitis
• Use of certain drugs
  • Cocaine 
  • Bevacizumab treatment 
  • Nitrogen dioxide exposure in indoor ice arenas 
  • E-cigarette or vaping product use associated lung injury (EVALI)  
• Certain or procedures
  • Bronchoscopy
  • Laryngoscopy
  • Spirometry
  • Tonsillectomy
  • Upper airway biopsy

Uncommon causes of coughing up blood that can be serious or life-threatening include:

• Other lung infections such as bacterial lung abscess and/or necrotizing pneumonia
• Acute bronchitis 
• Immunologic lung diseases, such as anti-glomerular basement membrane (anti-GBM; Goodpasture) disease, granulomatosis with polyangiitis, systemic lupus erythematosus (SLE), idiopathic pulmonary hemosiderosis, primary antiphospholipid antibody syndrome, Behçet syndrome, and microscopic polyangiitis
• Penetrating, rather than blunt, trauma 
• Chemotherapy and bone marrow transplantation
  • Pulmonary vascular diseases 
  • Pulmonary arteriovenous malformations (PAVMs)
  • Mitral stenosis 
  • Blood clot in the lung (pulmonary embolism)
  • Congenital heart disease or severe pulmonary hypertension 
• Acquired and iatrogenic trauma
• Posterior arterial nosebleeds
• Right heart catheterization (i.e., pulmonary artery catheterization) 
• Heart failure and heart valve disorders 
• Medical interventions, including percutaneous or transbronchial lung biopsy, cryobiopsy, central vein venipuncture during pacemaker insertion, and ablative procedures for endobronchial masses
• Fistulas, such as fistulas between the aorta and the airway