Is investigation of patients with haemoptysis and normal chest radiograph justified?

Abstract

Background:Haemoptysis is a common clinical symptom. A small proportion of patients present with haemoptysis and normal chest radiograph. The investigation strategy for this group of patients is unclear. The aim of this study is to see whether further investigations for this group of patients are justified.Methods:A retrospective analysis was conducted of consecutive patients presenting with haemoptysis and normal chest radiograph over a period of 56 months irrespective of their smoking status. These patients were investigated by CT of the thorax and fibreoptic bronchoscopy.Results:275 episodes of haemoptysis with normal chest radiograph were investigated further in 270 patients (60% males). The median age was 60 years. Twenty-six patients were diagnosed to have respiratory tract malignancies (larynx, 1; trachea, 1; lung, 22; carcinoid, 1; and leiomyoma, 1). Eight (31%) of the 26 patients with respiratory tract malignancy had radical treatment. Fibreoptic bronchoscopy was diagnostic of cancer in 14 (54%) of the 26 patients with malignancy. CT of the thorax was suggestive of cancer in 24 (96%) of the 25 patients with malignancy.Conclusion:It is concluded that further investigation of haemoptysis in smokers is justified regardless of the amount or frequency of haemoptysis based on a 9.6% rate of malignancy in this consecutive series. It is recommended that these patients are investigated with CT of the thorax followed by fibreoptic bronchoscopy.

Haemoptysis with a normal chest radiograph: how concerned should we be?

“…In this series, there were 22 cases of lung cancer in 270 patients, reflecting a prevalence of lung cancer of 8.2% for this clinical scenario 1. Others have reported that the prevalence of lung cancer for this clinical scenario might be 5–6% 5.…”

“…In this issue of Thorax ( see page ), Thirumaran and colleagues describe their experience with a consecutive group of patients evaluated for haemoptysis who had a normal chest radiograph 1. Over a 4-year period these investigators identified 270 patients who were evaluated for this problem.…”

“…In a hypothetical analysis of a cohort of patients presenting with haemoptysis and a normal chest radiograph the NTND was calculated for various diagnostic approaches 5. Strategies employing either FOB or CT first, followed by the other test if non-diagnostic results were obtained, resulted in a substantial NTND, just as Thirumaran and colleagues reported 1. However, a novel approach incorporating the use of sputum cytology as an initial diagnostic test resulted in a substantially lower NTND than either the FOB or CT first approach, while still maintaining a high degree of diagnostic accuracy.…”

Symptoms and Reason for a Medical Visit in Lung Cancer Patients

“…4,[11][12][13] Other studies suggested that a greater awareness by the general population and family doctors of the signs and symptoms of LC could improve the prognosis of the disease, although the design of these studies does not allow definitive conclusions to be drawn on this.…”

Is investigation of patients with haemoptysis and normal chest radiograph justified?

“…We read with interest the article by Thirumaran et al 1. They described their experience of 270 consecutive patients referred with haemoptysis and a normal chest radiograph.…”