Is investigation of patients with haemoptysis and normal chest radiograph justified?

Muthu Thirumaran ¹, Ramachandran Sundar ¹, Ian M Sutcliffe ¹ and David C Currie ^1*

¹ Dewsbury and District Hospital, Mid Yorkshire Hospitals NHS Trust, United Kingdom

^* To whom correspondence should be addressed. E-mail: david.currie{at}midyorks.nhs.uk.

Accepted 23 April 2009

Abstract

Background: Haemoptysis is a common clinical symptom. A small proportion of patients present with haemoptysis and normal chest radiograph. Investigation strategy for this group of patients is unclear. The aim of this study is to see whether further investigations for this group of patients are justified.

Methods: We conducted a retrospective analysis of consecutive patients presenting with haemoptysis and normal chest radiograph over a period of 56 months irrespective of their smoking status. These patients were investigated by Computed Tomography of Thorax and Fibreoptic Bronchoscopy.

Results: 275 episodes of haemoptysis with normal chest radiograph were investigated further in 270 patients (males-60%). The median age was 60 years. Twenty six patients were diagnosed to have respiratory tract malignancies (Larynx-1, Trachea-1, Lung-22, Carcinoid-1 and Leiomyoma-1). Eight (31%) of the 26 patients with respiratory tract malignancy had radical treatment. Fibreoptic Bronchoscopy was diagnostic of cancer in 14 (54%) of the 26 patients with malignancy. Computed Tomography of Thorax was suggestive of cancer in 24 (96%) of the 25 patients with malignancy.

Conclusion: We conclude that further investigation of haemoptysis in smokers is justified regardless of amount or frequency of haemoptysis based on 9.6% rate of malignancy in our consecutive series. We recommend that these patients are investigated with Computed Tomography of Thorax followed by Fibreoptic Bronchoscopy.