Hemoptysis with diagnostic dilemma

Hemoptysis is a common symptom. Although initial diagnostic workup, including a chest radiograph, often gives a clue to the cause, it provides no diagnostic hints in 3.0-42.2% of episodes of hemoptysis. To describe those cases with no diagnostic hints at initial investigations, experts have used different terms, including unexplained hemoptysis, idiopathic hemoptysis, cryptogenic hemoptysis and hemoptysis with normal chest radiographs. As hemoptysis is a common symptom of bronchogenic carcinoma, there is a concern of having underlying malignancy. Physicians value high-resolution computed tomography and fiberoptic bronchoscopy as the next investigations to establish diagnosis. These investigations however are expensive and nonspecific results are common in those cases of hemoptysis where initial diagnostic workup gives no clues to the cause. As a result, controversies exist with regard to their use. In this article, the author has proposed diagnostic approaches to evaluate those cases of hemoptysis with no diagnostic hints at initial investigation, after extensive review of published articles related to the case scenario.