A prospective evaluation of hemoptysis cases in a tertiary referral hospital

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.

A prospective study was carried out on consecutive patients presented with hemoptysis.

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).

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.