What Does It Mean if You Cough Up Blood?

Coughing up blood (hemoptysis) can be caused by a number of conditions, some of which are serious. See a doctor if you cough up blood to determine the underlying cause.  

Call 911 and get to a hospital’s emergency department if you cough up blood and:

• You had trauma or injury to the chest
• More than a one teaspoon of blood is coughed up
• Blood is also in the urine or stool
• If you are taking blood thinning medications (anticoagulants)
• It is accompanied by chest pain, fever, dizziness, lightheadedness, or shortness of breath

Causes of coughing up blood that are non-life-threatening include: 

• Airway diseases
  • Bronchitis and bronchiectasis 
  • Bronchial neoplasm (cancer)
  • Foreign bodies in the airways
  • Broncholiths (calcified lymph node)
  • Airway infections 
  • Fistulas 
  • Dieulafoy lesion 
• Pulmonary parenchymal diseases 
  • Infection, such as tuberculosis, mycetoma, lung abscess, and necrotizing pneumonia 
  • Rheumatic and immune disorders, such as anti-glomerular basement membrane (i.e., Goodpasture) syndrome, lupus pneumonitis/vasculitis, granulomatosis with polyangiitis, microscopic polyangiitis, primary antiphospholipid antibody syndrome, Behçet syndrome, pulmonary capillaritis, and idiopathic pulmonary hemosiderosis
  • Genetic disorders of connective tissue, such as Ehlers-Danlos syndrome
  • Catamenial hemoptysis
• Pulmonary vascular disorders 
  • Elevated pulmonary capillary pressure 
  • Pulmonary arteriovenous malformation (PAVM) 
  • Pulmonary or bronchial artery aneurysms, such as Hughes-Stovin syndrome, which may be a type of Behçet syndrome
  • Pulmonary artery pseudoaneurysms 
  • Pulmonary embolism (thrombotic, fat, septic) 
• Trauma and bleeding disorders
  • Bleeding disorders, such as, thrombocytopenia, disseminated intravascular anticoagulation, platelet dysfunction syndromes, and von Willebrand disease, and use of anticoagulant or antiplatelet medications 
  • Airway or parenchymal trauma
  • Iatrogenic injury
• Miscellaneous causes 
  • Drugs and toxins: habitual smokers of free-base cocaine ("crack"), levamisole-contaminated cocaine 
  • Bevacizumab treatment 
  • Nitrogen dioxide exposure in indoor ice arenas 
  • E-cigarette or vaping product use associated lung injury (EVALI) 
  • Other drugs: riociguat, hydralazine, and argemone alkaloid-contaminated cooking oil 
  • Idiopathic pulmonary hemosiderosis 
  • Fibrosing mediastinitis 
  • Pulmonary amyloid 

Common causes of coughing up blood that can be life-threatening include: 

• Bronchiectasis 
• Tuberculosis 
• Fungal infections, such as aspergilloma and invasive parenchymal fungal infections 
• Bronchogenic cancer 

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

• Other lung infections such as bacterial lung abscess and/or necrotizing pneumonia
• 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
• Chemotherapy and bone marrow transplantation
• Pulmonary vascular diseases 
  • Pulmonary arteriovenous malformations (PAVMs)
  • Mitral stenosis 
  • Pulmonary embolism 
  • Congenital heart disease or severe pulmonary hypertension 
• Acquired and iatrogenic trauma (trauma from a medical procedure)
• Posterior arterial nosebleeds
• Penetrating, rather than blunt, trauma 
• Right heart catheterization (i.e., pulmonary artery catheterization) 
• 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 
• Acute bronchitis