What is the Difference Between Epistaxis and Hemoptysis

Epistaxis and hemoptysis are two different conditions that are characterized by bleeding. Generally, bleeding can be external or internal. External bleeding occurs when people get a cut or wound. Internal bleeding occurs when people have an injury to an internal organ.

The key difference between epistaxis and hemoptysis is their symptoms. Epistaxis is a condition that results in nose bleeding, while hemoptysis is a condition that results in the discharge of blood or blood-stained mucus from the bronchi, larynx, trachea, and lungs.

CONTENTS

1. Overview and Key Difference
2. What is Epistaxis 
3. What is Hemoptysis
4. Similarities – Epistaxis and Hemoptysis
5. Epistaxis vs Hemoptysis in Tabular Form
6. Summary – Epistaxis vs Hemoptysis
7. FAQ – Epistaxis and Hemoptysis

What is Epistaxis?

Epistaxis is also called a nosebleed. It occurs due to the loss of blood from the tissue that lines the inside of the nose and can occur in one or both nostrils. Epistaxis can be caused by dry air, allergies, recreational drugs, blood thinning medications, high altitudes, and deviated septum.

Figure 01: Epistaxis

Epistaxis can be diagnosed through medical history, physical examination, endoscopy, X-rays, and CT scans. Furthermore, nosebleed treatments depend on the cause. Treatments may include nasal packing, cauterization, adjustment of medications that trigger bleeding, surgery, and ligation.

What is Hemoptysis?

Hemoptysis occurs when people cough up blood from the lungs. The common causes of hemoptysis include bronchitis, lung cancer, damaged airways from cystic fibrosis, pneumonia, tuberculosis, and chronic obstructive pulmonary disease (COPD). Moreover, symptoms of this condition are sputum that is frothy and has bright red blood, fever, cough, night sweats, weight loss, fatigue, shortness of breath, and chest pain.

Figure 02: Hemoptysis

Hemoptysis can be diagnosed through medical history, physical examination, chest X-ray, CT scan, and bronchoscopy. Furthermore, treatments for hemoptysis depend on how much blood people are coughing up. Some treatment methods include intubation, oxygenation, giving medications such as iced saline, epinephrine, antibiotics, coagulants, using tiny balloons or cuffs to put pressure on the area, laser therapy, cryotherapy, argon plasma coagulation (APC) and embolization.

Similarities Between Epistaxis and Hemoptysis

1. Epistaxis and hemoptysis are both characterized by bleeding.
2. Both can be caused by underlying conditions.
3. They can be dangerous and may lead to hypovolemic shock.

Difference Between Epistaxis and Hemoptysis

Definition

1. Epistaxis is the loss of blood from the tissue that lines the inside of the nose.
2. Hemoptysis is when people cough up blood or blood-stained mucus from the bronchi, larynx, trachea, and lungs.

Cause

1. Epistaxis can be caused by dry air, allergies, recreational drugs, blood thinning medications, high altitudes,  deviated septum, alcohol use, bleeding disorders like hemophilia or von Willebrand disease, high blood pressure, facial and nasal surgery, nasal tumors, nasal polyps, immune thrombocytopenia, leukemia, hereditary hemorrhagic telangiectasia, and pregnancy.
2. Hemoptysis can be caused by bronchitis, lung cancer, damaged airways from cystic fibrosis, pneumonia, tuberculosis, COPD, congestive heart failure, cocaine use, inflammatory or autoimmune conditions, lung abscess, non-cancerous lung tumors, parasitic infections, using blood thinners, endometriosis, Hughes-Stovin syndrome, and sarcoidosis.

Symptoms

1. The typical symptoms of epistaxis are blood coming from the nose, some blood that may drain down the back of the throat into the stomach, a bad taste in the back of the throat, and feeling nauseated.
2. The typical symptoms of hemoptysis are blood in the mucus, chest pain, weight loss, soaking night sweats, fever higher than 101 degrees, and shortness of breath.

Diagnosis

1. Diagnosis of epistaxis is carried out through medical history, physical examination, a complete blood count (CBC), prothrombin time (PT), partial thromboplastin time (PTT), endoscopy, X-rays, and CT scans.
2. Diagnosis of hemoptysis is carried out through medical history, physical examination, sputum culture, bronchoscopy, complete blood count (CBC), blood clotting test, pulmonary arteriography, urinalysis, and kidney function test.

Treatment

1. Treatment options for epistaxis include medications (nasal decongestants), cauterization, nasal packing, internal artery ligation, endovascular therapy, radiosurgery, open microsurgery, or a combination of these techniques.
2. Treatment options for hemoptysis include bronchial artery angiography and embolization to stop blood flow in blood vessels,  giving medications that stop bleeding such as tranexamic acid, other medications, antibiotics,  steroids, surgery, and cancer therapy.

The following infographic summarizes the difference between epistaxis and hemoptysis.

Summary – Epistaxis vs Hemoptysis

Epistaxis and hemoptysis are related conations because they both involve bleeding. Both epistaxis and hemoptysis can be dangerous and may lead to hypovolemic shock. Moreover, sometimes, nose bleeds can lead to coughing up blood. However, epistaxis is a condition where there is bleeding from the nose, while hemoptysis is a condition where blood is coughed up from the bronchi, larynx, trachea, or lungs. This is the summary of the difference between epistaxis and hemoptysis.

FAQ: Epistaxis and Hemoptysis

1. What is the cause of epistaxis?

• Epistaxis can be caused by local trauma, prolonged inhalation of dry air, allergies, foreign body, coagulopathy, chemical irritants, sinusitis, anticoagulants, deviated septum, hereditary hemorrhagic telangiectasia, leukemia, nasal polyps, cocaine use, infection, hypertension, inflammation, alcohol abuse, nasal surgery, and thrombocytopenia.

2. What foods are good for Epistaxis?

• Iron deficiency can lead to epistaxis and also increases the risk of anemia and many other serious effects. Food that helps to prevent nosebleeds due to iron deficiency include iron-rich foods such as seafood: shrimp, crab, clam, red meat, beef, goat meat, duck meat, nuts, and whole grains.

3. What is the best treatment for epistaxis?

• The best treatments for epistaxis include sitting down at a table, leaning forward and firmly pinching the soft part of the nose for at least 10 to 15 minutes, topical vasoconstriction, chemical cautery, electrocautery, nasal packing, using of a balloon system, arterial ligation or embolization, radiosurgery, and open microsurgery.

4. What is the most common cause of hemoptysis?

• Some common causes of hemoptysis include bronchitis, bronchiectasis, aspergilloma, tumor, tuberculosis, lung abscess, coagulopathy, autoimmune disorders, AV malformation, alveolar hemorrhage, mitral stenosis, and pneumonia.

5. What is the best treatment for hemoptysis?

• The best treatments for hemoptysis include intubation, oxygenation, a body position in which the lung with possible bleeding is lower than the other lung, iced saline epinephrine, antibiotics, coagulants, laser therapy, cryotherapy, argon plasma coagulation (APC) and embolization.

Reference:

1. Thaweboon, Sorranut. “Epistaxis, Nosebleeds – Causes, Types, First Aid.” MedPark Hospital.
2.  “Coughing up Blood: Causes and When to Seek Care.” Cleveland Clinic.

Image Courtesy:

1. “Epistaxis (Nose Bleed)” By Ragesoss – File:Young_child_with_nosebleed,_smiling_cropped.jpg (CC BY-SA 4.0) via Commons Wikimedia
2. “Hemoptysis” By Hemoptysis.png: Original uploader was Garbass at en.wikipediaderivative work: Faigl.ladislav (talk) – Hemoptysis.png (Public Domain) via Commons Wikimedia

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