[Utility of the clinical history, physical examination and radiography in the localization of bleeding in patients with hemoptysis].
OBJECTIVE
We examined the medical history, physical examination and chest radiography utility to accurately identifying the site of pulmonary bleeding in patients with hemoptysis.


METHODS
We prospectively reviewed and compared the suspected site of bleeding obtained with the medical history, physical examination and chest radiography (right or left) in 466 patients with hemoptysis after the confirmation with a bronchoscopy, computed chest tomography (CT) or bronchial arteriography, and separately analysing the more common etiologies and the volume of bleeding.


RESULTS
Age 62.6 years (DS 14), 85% males, 80% smokers with a volume of bleeding of 42.5 ml/day (DS 86) and > or = 100 ml/day in 13.5%. Medical history localized the site of bleeding in 1-13% (p < 0.0001), clinical responses in 8-29% (p < 0.0001), physical examination in 13-47.5% (p < 0.0001) and chest radiography in 14.5-88% (p = 0.04), with a more frequent accurately location findings (p < 0.01) that gradually increased as the previous results with the lung carcinomas and decreased with bronchiectasis or chronic bronchitis. When the volume of bleeding was > or = 100 ml/day, clinical responses utility improved (p = 0.04) as when it was < 100 ml/day with the radiography (p = 0.0001). Specificity, sensitivity and predictive values were variable and better with the radiography than with the medical history or physical examination.


CONCLUSIONS
We concluded that chest radiography was most useful than the medical history or physical examination to localize the site of bleeding in patients with hemoptysis. Almost all of the findings that suggests the site of bleeding were accurate and they increased with the radiography or decreased with the physical examination and specially with the medical history in patients with bronchiectasis or chronic bronchitis.
Haro Estarriol
M
M
Sección de Neumología (Planta 4aB), Hospital Universitario de Girona Doctor Josep Trueta, Avenida de Francia s/n. 17007 Girona. mip.mharo@htrueta.scs.es
Vizcaya Sánchez
M
M
Rubio Goday
M
M
Jiménez López
J
J
Núñez Ares
A
A
Tornero Molina
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D001987:Bronchiectasis / Q000150:complications / Q000175:diagnosis; D001991:Bronchitis / Q000150:complications / Q000175:diagnosis; D001999:Bronchoscopy; D002276:Carcinoid Tumor / Q000150:complications / Q000175:diagnosis; D002277:Carcinoma / Q000150:complications / Q000175:diagnosis; D002908:Chronic Disease; D004938:Esophageal Neoplasms / Q000150:complications / Q000175:diagnosis; D005260:Female; D006469:Hemoptysis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008171:Lung Diseases / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008175:Lung Neoplasms / Q000150:complications / Q000175:diagnosis; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010808:Physical Examination; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012907:Smoking / Q000453:epidemiology; D014057:Tomography, X-Ray Computed