Pulmonary Embolism and Hemoptysis

Clinical Presentation and Frequency

Hemoptysis occurs in approximately 11% of patients with confirmed pulmonary embolism, making it a recognized symptom, though less frequent than dyspnea or chest pain 1
The European Society of Cardiology suggests that hemoptysis is present in 11% of patients with confirmed pulmonary embolism, and in 7% of patients without pulmonary embolism, making it somewhat specific when present 1
Pulmonary embolism is suspected on the basis of dyspnea, chest pain, pre-syncope/syncope, and/or hemoptysis in most patients, as recommended by the European Society of Cardiology 2, 3, 4
Cough develops in nearly half of patients with documented pulmonary embolism, and cough can occasionally be the presenting complaint, according to the American College of Chest Physicians 5, 6

Small distal emboli create areas of alveolar hemorrhage resulting in hemoptysis, pleuritis, and pleural effusion, as described by the European Society of Cardiology 2, 3
This clinical presentation is known as "pulmonary infarction" and is usually due to distal emboli causing pleural irritation, as stated by the European Society of Cardiology 1, 2, 3

Pleuritic chest pain combined with dyspnea is one of the most frequent presentations of pulmonary embolism, according to the European Society of Cardiology 1
Pulmonary embolism should be considered in patients with cough, particularly when accompanied by risk factors such as history of deep vein thrombosis/pulmonary embolism, immobilization in past 4 weeks, or malignancy, as recommended by the European Respiratory Society 7
The presence of hemoptysis increases the clinical probability of pulmonary embolism when combined with other symptoms and risk factors, as suggested by the European Society of Cardiology 1, 2