A Prospective Analysis of 184 Hemoptysis Cases – Diagnostic Impact of Chest X-Ray, Computed Tomography, Bronchoscopy

Abstract

Background:The clinical presentation of hemoptysis often raises a number of diagnostic possibilities. Objectives:This study was designed to evaluate the relative frequency of different causes of hemoptysis and the value of chest radiography, computed tomography (CT) scanning and fiber-optic bronchoscopy in the evaluation of a Greek cohort population. Methods:We prospectively followed a total of 184 consecutive patients (137 males/47 females, 145 smokers/39 nonsmokers) admitted with hemoptysis between January 2001 and December 2003 to the University Hospital of Heraklion. Follow-up data were collected on August 2005. Results:The main causes of hemoptysis were bronchiectasis (26%), chronic bronchitis (23%), acute bronchitis (15%) and lung cancer (13%). Bronchiectasis was significantly more frequent in nonsmokers (p < 0.02). Among nonsmokers, patients with moderate/severe bleeding or a history of tuberculosis were more likely to have bronchiectasis (OR 8.25; 95% CI 1.9–35.9, p = 0.007 and OR 16.5; 95% CI 1.7–159.1, p = 0.007, respectively). Nonsmokers with normal or abnormal X-rays were equally likely to have bronchiectasis (OR 2.5; 95% CI 0.66–9.39, p = 0.2). Lung cancer was only found in smokers. Smokers with normal X-rays were less likely to have lung cancer compared to smokers with abnormal X-ray (OR 5.4; 95% CI 1.54–19.34, p = 0.004). There were no smokers with normal CT and lung cancer. Follow-up data were collected in 91% of patients. Lung cancer did not develop in any patient assumed to have hemoptysis of another origin than lung cancer on initial evaluation. Conclusions:Bronchiectasis is the main diagnosis in patients admitted with hemoptysis to a Greek University Hospital and it is more frequent among nonsmokers with moderate/severe bleeding and/or previous tuberculosis infection. Nonsmokers with moderate/severe hemoptysis and/or a history of tuberculosis should be evaluated with high-resolution CT. Smokers with hemoptysis are at increased risk for lung cancer and need to be extensively evaluated with chest CT and bronchoscopy.

Thoracic Endometriosis Syndrome

“…Hemoptysis is a common clinical problem with many potential etiologies which can be caused by a variety of pulmonary diseases, including infections, chronic bronchitis and malignancies [26]. A history of hemoptysis concurrent with menstrual periods helps to differentiate catamenial hemoptysis from hemoptysis of other causes [27,28,29]. Catamenial pneumothorax is another common presentation of thoracic endometriosis.…”

Use of Multidetector Row CT to Evaluate the Need for Bronchial Arterial Embolization in Hemoptysis Patients

“…To determine whether BAE is indicated, chest computed tomography (CT) is a useful noninvasive imaging modality for initial assessment of hemoptysis, determination of its etiology and origin, and affirmation of ground glass opacity suggesting hemorrhage and aspiration of blood. Although fiberoptic bronchoscopy (FOB) is essential for pathological examination, the efficacy of CT for etiology determination and patient evaluation is well established [6,7,8], and the combined use of high-resolution CT and FOB as complementary modalities increases the positive yield [9,10]. …”

Cryptogenic Hemoptysis in Chronic Obstructive Pulmonary Disease: Characteristics and Outcome

“…It can range from a benign self-limited bleeding event to a life-threatening condition, leading to airway compromise and death. Causes of hemoptysis are various but most commonly include bronchiectasis, bronchopulmonary neoplasm and tuberculosis [1]. Hence, it represents a challenge for the caring physician who has to assess the severity and identify the etiology in order to properly manage the patient presenting with hemoptysis.…”