Hemoptysis: Comparison of Diagnostic Accuracy of Multi Detector CT Scan and Bronchoscopy (original) (raw)
Related papers
American Journal of Roentgenology, 2002
OBJECTIVE. We assessed the capacity of chest radiography and CT to determine the cause and site of bleeding in patients with either large or massive hemoptysis compared with bronchoscopy. MATERIALS AND METHODS. We reviewed the chest radiographs, CT scans, and bronchoscopic findings in 80 patients with either large or massive hemoptysis who were admitted to our intensive care unit between January 1995 and June 1999. RESULTS. Findings on chest radiography were normal in only 13% of patients, of whom 70% had bronchiectasis. The chest radiographs revealed the site of bleeding in 46% of the patients and the cause in 35%, most of whom had tuberculosis or tumors. CT was more efficient than bronchoscopy for identifying the cause of bleeding (77% vs 8%, respectively; p < 0.001), whereas the two methods were comparable for identifying the site of bleeding (70% vs 73%, respectively; p = not significant). CONCLUSION. These data suggest that CT could replace bronchoscopy as the first-line procedure for screening patients with large and those with massive hemoptysis. However, these results must be confirmed in a prospective multicenter study.
Morphologic spectrum of undetermined causes of hemoptysis- a pathologistÂ’s role
Turkish Journal of Pathology, 2020
Objective: Hemoptysis is the expectoration of blood or blood-streaked sputum from the tracheobronchial tree. The etiology may derive from nonneoplastic conditions such as infections, chronic pulmonary diseases, and vasculitis or neoplastic causes. Sometimes a definitive cause for hemoptysis cannot be found after ample diagnostic workup. The role of biopsy in such cases is to help the clinician in arriving at the final diagnosis. Diffuse alveolar hemorrhage is the main histopathological finding in hemoptysis and it appears with diffuse chest infiltrates radiologically. Material and Method: A retrospective study of 2 years duration was conducted to identify the morphological spectrum of diseases presenting with hemoptysis. A total of 243 lung biopsies obtained by various methods were retrieved in this study period and 20 cases with hemoptysis of undetermined etiology were detected. Results: Based on imaging and histopathology findings, the etiological causes of hemoptysis were divided into hemoptysis with and without capillaritis or due to tumor/tumor-like lesions and due to miscellaneous conditions. The most common etiology was vasculitis followed by infections. Conclusion: Histopathology helps to detect the etiology, particularly in cases of hemoptysis due to non-immunologic causes. In immunologic cases, histopathological findings may support the diagnosis in correlation with the clinical/imaging features.
Clin Respir J, 2009
Background and Aims: Hemoptysis is symptomatic of a potentially serious and life-threatening thoracic disease. The purpose of this study was to evaluate the relative frequency of the different causes of hemoptysis, the change of the frequency of diseases, the value of the evaluation process and the outcome in a tertiary referral hospital. Methods: A prospective study was carried out on consecutive patients presented with hemoptysis. Results: A total of 178 patients (136 male, 42 female) were included to the study. Lung cancer (51), pulmonary embolism (23) and bronchiectasis (23) constituted most of the diagnosis. The most frequent cause of hemoptysis in males was by far lung carcinoma (50). Twelve cases of bronchiectasis and 11 cases of pulmonary embolism were observed in females. While lung cancer and pulmonary embolism were associated with mild to moderate amounts of bleeding (84% and 100%, respectively), patients with active tuberculosis and pulmonary vasculitis had severe to massive hemoptysis (50% and 44%, respectively). Transthoracic and other organ biopsies, spiral computed tomography (CT) angiography (X pres/GX model TSX-002a, Toshiba, Tochigi Ken, Japan) and aortography yielded high diagnostic results in our group (100%, 67%, 59% and 100%, respectively). The most frequent final diagnosis in patients with normal chest radiograph was pulmonary embolism (seven cases). Conclusions: Lung cancer, pulmonary embolism and bronchiectasis were the main causes of hemoptysis in this prospective cohort; however, this is the first report showing pulmonary embolism as a leading cause of hemoptysis. CT angiography with high-resolution CT should be the primary diagnostic modality if the initial investigation is inconclusive in hemoptysis cases.
A prospective evaluation of hemoptysis cases in a tertiary referral hospital
The Clinical Respiratory Journal, 2009
Background and Aims: Hemoptysis is symptomatic of a potentially serious and life-threatening thoracic disease. The purpose of this study was to evaluate the relative frequency of the different causes of hemoptysis, the change of the frequency of diseases, the value of the evaluation process and the outcome in a tertiary referral hospital. Methods: A prospective study was carried out on consecutive patients presented with hemoptysis. Results: A total of 178 patients (136 male, 42 female) were included to the study. Lung cancer (51), pulmonary embolism (23) and bronchiectasis (23) constituted most of the diagnosis. The most frequent cause of hemoptysis in males was by far lung carcinoma (50). Twelve cases of bronchiectasis and 11 cases of pulmonary embolism were observed in females. While lung cancer and pulmonary embolism were associated with mild to moderate amounts of bleeding (84% and 100%, respectively), patients with active tuberculosis and pulmonary vasculitis had severe to massive hemoptysis (50% and 44%, respectively). Transthoracic and other organ biopsies, spiral computed tomography (CT) angiography (X pres/GX model TSX-002a, Toshiba, Tochigi Ken, Japan) and aortography yielded high diagnostic results in our group (100%, 67%, 59% and 100%, respectively). The most frequent final diagnosis in patients with normal chest radiograph was pulmonary embolism (seven cases). Conclusions: Lung cancer, pulmonary embolism and bronchiectasis were the main causes of hemoptysis in this prospective cohort; however, this is the first report showing pulmonary embolism as a leading cause of hemoptysis. CT angiography with high-resolution CT should be the primary diagnostic modality if the initial investigation is inconclusive in hemoptysis cases.
Diagnosis and management of hemoptysis
REVIEW ABSTRACT Hemoptysis is the expectoration of blood that originates from the lower respiratory tract. It is usually a self-limiting event but in fewer than 5% of cases it may be massive, representing a life-threatening condition that warrants urgent investigations and treatment. This article aims to provide a comprehensive literature review on hemoptysis, analyzing its causes and pathophysiologic mechanisms, and providing details about anatomy and imaging of systemic bronchial and nonbronchial arteries responsible for hemoptysis. Strengths and limits of chest radiography, bronchoscopy, multidetector computed tomography (MDCT), MDCT angiography and digital subtraction angiography to assess the cause and lead the treatment of hemoptysis were reported, with particular emphasis on MDCT angiography. Treatment options for recurrent or massive hemoptysis were summarized, highlighting the predominant role of bronchial artery embolization. Finally, a guide was proposed for managing massive and non-massive hemoptysis, according to the most recent medical literature.
To assess the role fiberoptic bronchoscopy in the evaluation of hemoptysis
International Journal of Research in Medical Sciences, 2016
Background: To prospectively evaluate the efficiency of the fiberoptic bronchoscopy (FOB) examination in the evaluation of patients with hemoptysis. Methods: We prospectively reviewed 50 patients who underwent FOB for hemoptysis. There were 39 male and 11 female. The mean age was 46 years with a range from 21 to 83 years. The patients were divided between two groups on the basis of their chest roentograms (46% with normal and 54% with abnormal findings). Results: Hemoptysis in normal and abnormal chest roentograms was respectively attributed to bronchiectasis in 5 (21.7%) and 3 (11.1%) cases, bronchogenic carcinoma in 2 (8.6%) and 9 (33.3%) cases, bronchitis in 2 (8.6%) and 3 (11.1%) cases, tuberculosis in 2 (8.6%) and 5 (18.5%) cases, cryptogenic causes in 8 (34.7%) and 4 (14.8%) cases and pseudohemoptysis in 2 (8.6%) cases (bleeding from upper respiratory tract). Conclusions: Fob plays a pivotal role in the evaluation of hemoptysis. It was found that left upper lobe followed by right upper lobe was the site most consistent with the findings, with bronchogenic carcinoma being the most common non-infectious cause. Infectious etiology was the most common pathology behind hemoptysis and bronchiectasis was the most important risk factor.
Evaluate the patients of hemoptysis with apparently normal chest x-ray by various modalities
2016
Introduction: Hemoptysis is defined as expectoration of blood that originates from tracheo-bronchial tree or pulmonary parenchyma (lower respiratory tract) and mostly bronchial artery is responsible. A large number of patients presenting hemoptysis with normal chest radiographs may have serious underlying disorders. In such patients we required CT scanning with contrast and High resolution and fiber-optic bronchoscopy. Materials and methods: A total 50 patients had been registered OPD/IPD for study, patients had hemoptysis with apparently normal x-ray chest and patients exclude with having pseudo hemoptysis, spurious hemoptysis, hemtemesis. Sputum for AFB and gram staining, pyogenic culture sensitivity (if needed), Sputum for fungal smear (if needed), Routine Blood examination, Blood biochemistry, Mantaux Test, HRCT. FOB, ECG, if needed 2D ECHO. Results: In the present study a definite diagnosis was made in 37 patients (74%). The diagnosis was made by HRCT, broncheactisis in 26(52%)...
Multidetector CT Angiography Role in Evaluation of Vascular Causes of Hemoptysis
The Medical Journal of Cairo University, 2019
Background: Hemoptysis has many vascular and parenchymal causes. Determining the site and the cause of the bleeding is of great value in planning the proper management. Aim of Study: Is to evaluate the role of Multidetector Computerized Tomography (MDCT) in detection and localizing the site and causes of hemoptysis of vascular origin. Material and Methods: Prospective study included 50 patients suffering from hemoptysis, referred to the Department of Radiology, Amiri Hospital, Kuwait during the period from April 2016 until April 2018. MDCT pulmonary and bronchial angiography was done for all patient as well as bronchoscopy, conventional angiography and biopsy were done for some cases. Results: MDCT angiography was successful in determining the cause of hemoptysis in 88% of cases. Vsacular causes of hemoptysis included bronchial, systemic non bronchial and pulmonary arteries. Conclusion: MDCT pulmonary and bronchial angiography is a very valuable technique in determining and the source and causes of hemoptysis and planning of management.
Diagnosis and Treatment of Hemoptysis
Archivos De Bronconeumologia, 2016
Hemoptysis is the expectoration of blood from the tracheobronchial tree. It is commonly caused by bronchiectasis, chronic bronchitis, and lung cancer. The expectorated blood usually originates from the bronchial arteries. When hemoptysis is suspected, it must be confirmed and classified according to severity, and the origin and cause of the bleeding determined. Lateral and AP chest X-ray is the first study, although a normal chest X-ray does not rule out the possibility of malignancy or other underlying pathology. Multidetector computed tomography (MDCT) must be performed in all patients with frank hemoptysis, hemoptoic sputum, suspicion of bronchiectasis or risk factors for lung cancer, and in those with signs of pathology on chest X-ray. MDCT angiography has replaced arteriography in identifying the arteries that are the source of bleeding. MDCT angiography is a non-invasive imaging technique that can pinpoint the presence, origin, number and course of the systemic thoracic (bronchial and non-bronchial) and pulmonary arterial sources of bleeding. Endovascular embolization is the safest and most effective method of managing bleeding in massive or recurrent hemoptysis. Embolization is indicated in all patients with life-threatening or recurrent hemoptysis in whom MDCT angiography shows artery disease. Flexible bronchoscopy plays a pivotal role in the diagnosis of hemoptysis in patients with hemoptoic sputum or frank hemoptysis. The procedure can be performed rapidly at the bedside (intensive care unit); it can be used for immediate control of bleeding, and is also effective in locating the source of the hemorrhage. Flexible bronchoscopy is the first-line procedure of choice in hemodynamically unstable patients with life-threatening hemoptysis, in whom control of bleeding is of vital importance. In these cases, surgery is associated with an extremely high mortality rate, and is currently only indicated when bleeding is secondary to surgery and its source can be accurately and reliably located.
IP Innovative Publication Pvt. Ltd., 2017
Introduction: To study the role of CT scan chest and fiber optic bronchoscopy in evaluating patients with hemoptysis and normal chest radiograph. Materials and Method: 50 patients over the age of 15 years having hemoptysis with normal chest X ray in a government teaching hospital in Andhra Pradesh were taken as study subjects. They were evaluated using FOB and CT thorax. Other investigations were done when necessary. Results: The mean age of the study population was 44.5 ± 13.5 years with age ranging from 20yrs to 80yrs. Of them 28(56%) were males and 22 (44%) females. Out of 50 such patients, a definitive diagnosis could be established in 33 patients (66%) with commonest being tuberculosis (12/50, 24%), followed by acute bronchitis (11/50, 22%), bronchiectasis (7/50, 14%), aspergilloma (2/50, 4%), malignancy (1/50,2%). CT scan is more efficacious in establishing a diagnosis of bronchiectasis than bronchoscopy (P < 0.05) while bronchoscopy is more sensitive in making a diagnosis of bronchitis than CT scan (P < 0.05). There was no statistically significant difference between CT scan and bronchoscopy (P > 0.05) in diagnosing PTB in patients with hemoptysis and normal CXR. CT scan solely diagnosed 30% cases with bronchoscopic findings being normal. While FOB solely diagnosed 28% cases with CT features being normal. In 8% cases both modalities established the diagnosis. Conclusions: Overall, there was no statistically significant difference (P > 0.05) between CT scan and bronchoscopy in diagnosing the underlying cause of hemoptysis. Therefore, CT scan and bronchoscopy are equally important and complementary to each other in establishing diagnosis in a patient with hemoptysis and normal chest radiograph.