Hemoptysis: Comparison of Diagnostic Accuracy of Multi Detector CT Scan and Bronchoscopy

Abstract

Background:Hemoptysis is the expectorating of blood from the tracheobronchial tree or pulmonary parenchyma. There is conflicting information about usefulness of radiography, MDCT, and bronchoscopy for investigating site and cause of the bleeding in patients with hemoptysis. The present study attempted to evaluated efficacy of these methods for identifying hemoptysis’ cause and etiology on 40 patients with the disease.Methods:A total of 40 patients with Hemoptysis who were referred to Golestan and Emam Khomeini hospitals were evaluated. Complete history of symptoms, volume and duration of Hemoptysis and demographic information were documented. Radiography, MDCT, and bronchoscopy were performed on all patients in order to investigate the site and cause of the bleeding.Results:Results showed MDCT had higher efficacy in identifying bleeding site than radiography, while efficacy of radiography and bronchoscopy or efficacy of MDCT and bronchoscopy weren’t significantly different. In addition, sensitivity of MDCT (60%) for detecting cause of the bleeding was higher than that of radiography (25%) and bronchoscopy (32.5%).Conclusion:The present study suggests MDCT as a suitable method in screening patients with hemoptysis, because it managed to detect site and causes of bleeding more efficiently than other methods. Additionally, we concluded that MDCT is an appropriate technique for diagnosing malignancies that cause hemoptysis in patients.

Is Bronchoscopy Always Justified in Diagnosis of Haemoptysis?

“…In patients presenting haemoptysis, besides FOB, chest radiography and CT for primary screening are used. Many studies were performed to compare value of these examinations [8][9][10][11][12][13]. Davoodi et al [9] compared diagnostic accuracy of multi-detector CT (MDCT) and FOB in haemoptysis, and reported that MDCT scan detected the site of bleeding more efficiently and had higher sensitivity in identifying the cause of haemoptysis.…”

“…Many studies were performed to compare value of these examinations [8][9][10][11][12][13]. Davoodi et al [9] compared diagnostic accuracy of multi-detector CT (MDCT) and FOB in haemoptysis, and reported that MDCT scan detected the site of bleeding more efficiently and had higher sensitivity in identifying the cause of haemoptysis. Likewise, Thirumaran et al [8] concluded that even though CT and FOB are complementary, CT is preferable in detecting abnormalities that explain the cause of haemoptysis.…”

“…According to previous studies, in many causes of haemoptysis, e.g. bronchiectasis, idiopathic pulmonary fibrosis (IPF) and neoplasm, FOB is inferior in identification of pathological lesions in comparison to CT [8,9,14]. In the context of bronchogenic carcinoma, Sharma et al [13] concluded that in patients with normal chest radiogram and haemoptysis, FOB plays a minor role in the condition, especially when risk factors are absent.…”

An Unusual Cause of Hemoptysis

“…Common causes of hemoptysis include bronchiectasis, chronic bronchitis, pneumonia, lung cancer, tuberculosis, and fungal infections. 1 Noninvasive imaging modalities and bronchoscopy can help determine the cause of hemoptysis.…”

“…Complicated parapneumonic effusions can similarly develop multiple loculations. 1 Initial management of multiloculated pleural space infection involves chest tube insertion to evacuate the largest collection. Further tube thoracostomy insertions may be needed for separate locules if infection persists.…”