Value of bronchoscopy after computed tomography in the diagnostic work-up of haemoptysis

Haemoptysis, a common symptom with a variety of aetiologies, requires a comprehensive diagnostic approach. Computed tomography of the thorax (CT) and bronchoscopy are crucial in this process. This study assesses the value of bronchoscopy in patients with haemoptysis and CT with no findings suspicious of malignancy.

This study retrospectively assessed patients with haemoptysis referred between January 2019 and December 2022 to the Department of Respiratory Medicine, Odense University Hospital. All patients who underwent CT and subsequently bronchoscopy due to haemoptysis were included in the study. Patients were excluded if CT or bronchoscopy was not performed, as well as patients suspected of malignancy on CT. Data, including patient characteristics, medical history, haemoptysis progression, CT, bronchoscopy results, and clinical assessments, were collected with a six-month follow-up.

A total of 469 patients were assessed for eligibility, of whom 306 were excluded, resulting in 163 eligible patients. There were 95 males (58.28%), and the mean age was 57.8 years (SD 14.48). Mild haemoptysis (92.02%) and longer than one week (63.80%) was the most common presentation. CT revealed abnormal findings in 77 (47.24%) patients and for 117 (71.78%) patients followed a bronchoscopy with no abnormal observations. No malignant findings were detected by bronchoscopy.

The findings of this study revealed that bronchoscopy did not identify malignant aetiology beyond the scope of CT. These findings combined with current evidence suggest minimal benefit of bronchoscopy subsequent to CT in the diagnostic evaluation of thoracic malignancy in these patients. Take Home Message The diagnostic approach for patients with haemoptysis typically includes computed tomography (CT) and bronchoscopy to exclude pulmonary malignancy. This study supports current evidence of minimal value of bronchoscopy subsequent to CT in the diagnostic evaluation of thoracic malignancy in these patients.