A prospective analysis of 184 hemoptysis cases: diagnostic impact of chest X-ray, computed tomography, bronchoscopy.
BACKGROUND
The clinical presentation of hemoptysis often raises a number of diagnostic possibilities.


OBJECTIVE
This study was designed to evaluate the relative frequency of different causes of hemoptysis and the value of chest radiography, computed tomography (CT) scanning and fiber-optic bronchoscopy in the evaluation of a Greek cohort population.


METHODS
We prospectively followed a total of 184 consecutive patients (137 males/47 females, 145 smokers/39 nonsmokers) admitted with hemoptysis between January 2001 and December 2003 to the University Hospital of Heraklion. Follow-up data were collected on August 2005.


RESULTS
The main causes of hemoptysis were bronchiectasis (26%), chronic bronchitis (23%), acute bronchitis (15%) and lung cancer (13%). Bronchiectasis was significantly more frequent in nonsmokers (p < 0.02). Among nonsmokers, patients with moderate/severe bleeding or a history of tuberculosis were more likely to have bronchiectasis (OR 8.25; 95% CI 1.9-35.9, p = 0.007 and OR 16.5; 95% CI 1.7-159.1, p = 0.007, respectively). Nonsmokers with normal or abnormal X-rays were equally likely to have bronchiectasis (OR 2.5; 95% CI 0.66-9.39, p = 0.2). Lung cancer was only found in smokers. Smokers with normal X-rays were less likely to have lung cancer compared to smokers with abnormal X-ray (OR 5.4; 95% CI 1.54-19.34, p = 0.004). There were no smokers with normal CT and lung cancer. Follow-up data were collected in 91% of patients. Lung cancer did not develop in any patient assumed to have hemoptysis of another origin than lung cancer on initial evaluation.


CONCLUSIONS
Bronchiectasis is the main diagnosis in patients admitted with hemoptysis to a Greek University Hospital and it is more frequent among nonsmokers with moderate/severe bleeding and/or previous tuberculosis infection. Nonsmokers with moderate/severe hemoptysis and/or a history of tuberculosis should be evaluated with high-resolution CT. Smokers with hemoptysis are at increased risk for lung cancer and need to be extensively evaluated with chest CT and bronchoscopy.
Tsoumakidou
Maria
M
Department of Thoracic Medicine, University of Crete, Medical School, Heraklion, Crete, Greece.
Chrysofakis
Georgios
G
Tsiligianni
Ioanna
I
Maltezakis
Georgios
G
Siafakas
Nikolaos M
NM
Tzanakis
Nikolaos
N
D000368:Aged; D001987:Bronchiectasis / Q000150:complications / Q000175:diagnosis; D001991:Bronchitis / Q000150:complications / Q000175:diagnosis; D001999:Bronchoscopy; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006115:Greece / Q000453:epidemiology; D006469:Hemoptysis / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000150:complications / Q000175:diagnosis; D008297:Male; D011446:Prospective Studies; D013902:Radiography, Thoracic; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed