Haemoptysis Causes (Mnemonic: CAVITTES)

By -VHTC

16 July

What Is Haemoptysis?

Haemoptysis is the expectoration (coughing up) of blood originating from the lower respiratory tract. It can be alarming and potentially life-threatening, particularly if massive or recurring.

Key Distinction:

Haemoptysis: Blood from the lungs or bronchi
Hematemesis: Blood from the GI tract (vomiting blood)

Normal vs Abnormal Sputum

Type of Sputum	Appearance	Suggests
Serous	Clear	Viral infections, pulmonary edema
Mucopurulent	Yellow-green	Bacterial infection
Blood-streaked	Tinged with red	Minor airway irritation
Frank blood	Bright red, large volume	Haemoptysis – urgent workup needed

Mnemonic: CAVITTES for Haemoptysis Causes

The mnemonic CAVITTES helps recall the major categories of haemoptysis causes:

C – Congestive Heart Failure (CHF)
A – Airway diseases (e.g., Bronchiectasis)
V – Vasculitis
V – Vascular malformations
I – Infections (e.g., Tuberculosis)
T – Trauma
T – Tumors
E – Embolism (Pulmonary embolism)
S – Stomach-related causes (often confused with true haemoptysis)

Detailed Explanation of CAVITTES Causes

C – Congestive Heart Failure (CHF)

Especially in mitral stenosis and pulmonary edema
Blood backs up into pulmonary vessels causing rupture
Pink frothy sputum is typical

A – Airway Diseases (Bronchiectasis, Chronic Bronchitis)

Damaged, dilated bronchi prone to inflammation and bleeding
Common in COPD and CF (Cystic Fibrosis)

V – Vasculitis

Autoimmune diseases affecting blood vessels (e.g., Wegener’s granulomatosis, Goodpasture syndrome)
Causes necrosis and hemorrhage
Look for systemic signs like joint pain, renal issues

V – Vascular Malformations

Pulmonary arteriovenous malformations (AVMs)
Blood bypasses normal filtration and leaks into airways

I – Infections (TB, Pneumonia, Lung Abscess)

TB is a leading cause in India
Lung abscess can erode vessels
Foul-smelling, bloody sputum may suggest necrotizing infections

T – Trauma

Includes blunt chest trauma, foreign body aspiration, or iatrogenic (bronchoscopy, biopsy)
Often sudden onset with known history

T – Tumors

Both benign and malignant
Lung cancer is a key cause, especially in smokers
Persistent blood-streaked sputum is a red flag

E – Embolism (Pulmonary Embolism)

Causes pulmonary infarction due to vessel blockage
Associated with pleuritic chest pain, dyspnea

S – Stomach Related

Often confused with haemoptysis
e.g., Mallory-Weiss tear, esophageal varices
Vomited blood is usually darker, mixed with food particles

Types of Haemoptysis

Type	Volume	Description
Mild	<30 mL/day	Streaking of blood
Moderate	30–100 mL/day	Small cupfuls
Massive	>100–600 mL/day	Life-threatening; urgent intervention

Massive haemoptysis has a mortality rate >50% if untreated.

Haemoptysis vs Hematemesis

Feature	Haemoptysis	Hematemesis
Color	Bright red, frothy	Dark red, "coffee-ground"
Source	Respiratory tract	Gastrointestinal tract
Associated symptoms	Cough, dyspnea	Nausea, vomiting
pH	Alkaline	Acidic
History	TB, bronchitis	Peptic ulcer, varices

Diagnostic Workup

History

Smoking, TB contact, recent procedures
Onset: sudden vs chronic
Volume of blood

Physical Examination

Clubbing, cyanosis, fever
Respiratory distress signs

Investigations

Chest X-ray: To detect masses, cavities, infiltrates
CT scan (HRCT): Bronchiectasis, tumors
Bronchoscopy: Localizes bleeding site
CBC: Anemia, infection
Coagulation profile: Coagulopathy
Sputum AFB: TB confirmation
D-dimer: Rule out embolism

Red Flag Signs Requiring Urgent Attention

Massive haemoptysis (>100 mL/day)
Sudden onset with chest pain or dyspnea
Recurrent haemoptysis in smokers >40 years
Unexplained weight loss, fever
Clubbing, night sweats

Management and Treatment

Stabilization

Positioning: Bleeding side down
Airway: May need intubation
Oxygen therapy

Medical Treatment

Antibiotics: If infection suspected
Antitubercular therapy: If TB
Steroids: For vasculitis
Antifibrinolytics: e.g., tranexamic acid

Interventional

Bronchial Artery Embolization (BAE): First-line for massive haemoptysis
Surgical resection: Last resort for localized irreversible causes

Clinical Case Studies

Case 1: A Young Male with TB

A 26-year-old male, known case of pulmonary TB, presents with frank blood in sputum for 3 days. Chest X-ray shows upper lobe cavity. Diagnosis: Haemoptysis due to active TB.

Management: Anti-TB therapy, tranexamic acid, monitored for volume.

Case 2: Massive Haemoptysis in a Smoker

A 58-year-old chronic smoker presents with massive haemoptysis. CT shows a centrally located mass in the bronchus. Diagnosis: Bronchogenic carcinoma.

Management: Stabilized, bronchoscopy performed. BAE followed by oncologic referral.

FAQs on Haemoptysis

Q1. What is the most common cause of haemoptysis worldwide?

Tuberculosis, especially in endemic areas.

Q2. When is haemoptysis considered life-threatening?

When it is massive (>100–600 mL/day), obstructs airways, or leads to asphyxiation.

Q3. Is blood in sputum always dangerous?

Not always. Small streaks may be from minor infections or trauma, but recurrent or large amounts always need evaluation.

Q4. Can acid reflux cause haemoptysis?

It can mimic haemoptysis, but actual respiratory tract bleeding should be ruled out.

Q5. Can aspirin cause haemoptysis?

Yes, especially in patients with bronchial irritation or coagulopathy.

Conclusion

Haemoptysis is a clinical alarm bell that warrants prompt and accurate evaluation. With the CAVITTES mnemonic, you can remember the major causes—from CHF and TB to tumors and embolism.

Early recognition, appropriate imaging, and targeted treatment are crucial to reduce morbidity and mortality.