[Usefulness of computerized tomography and bronchoscopy in patients with hemoptysis. Analysis of 482 cases]

M Haro, J Jiménez, A Tornero, M Vizcaya, R Tirado, T Cros
Anales de Medicina Interna: Organo Oficial de la Sociedad Española de Medicina Interna 2002, 19 (2): 59-65

OBJECTIVE: We have examined the computed chest tomography (CT) and bronchoscopy utility in diagnosis and accurately identifying the sites of pulmonary bleeding in patients with hemoptysis.

METHODS: We prospectively reviewed the etiology and the site of bleeding of 482 patients with hemoptysis who had undergone bronchoscopy and CT when we suspected a carcinoma, bronchiectasis or the type of bleeding. We analyzed the age, sex, history of tobacco, bleeding, chest radiography, chest computed tomography and bronchoscopy.

RESULTS: 62 years (DS 13.6), 84.4% males, 80% smokers and a volume of bleeding of 42.5 ml/day (DS 89) for 15 days (DS 25). Lung cancer was identified in 43%, bronchiectasis in 20%, chronic obstructive lung disease in 14%, pneumonia 8% and an unknown etiology in only 3%. Bronchoscopy located the site of bleeding in 77% and CT in 83%. When we examine only the lung carcinomas, the chest radiography was normal in 11% and the bronchoscopy was diagnostic in 87%, including 6 cases with a normal CT. Simultaneously chest CT or radiography and bronchoscopy detected all the lung cancers. When the chest radiography was inespecific (32%), CT was diagnostic in 43% and bronchoscopy in 14% (p < 0.001) or localized the site of bleeding in 52% with the CT or 23% with the bronchoscopy (< 0.001).

CONCLUSIONS: We concluded that bronchoscopy and CT were useful and complementary in etiologic diagnosis and to localize the site of bleeding in patients with hemoptysis. The bronchoscopy was preferable in patients with a lung cancer and the CT when we studied all the etiologies or the patients without a lung cancer, especially when the radiography was normal. When we simultaneously used a CT or a radiography and the bronchoscopy, all the lung cancers were detected.

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