title: ACR Appropriateness Criteria hemoptysis.
abstract: Hemoptysis is defined as the expectoration of blood originating from the tracheobronchial tree or pulmonary parenchyma, ranging from 100 mL to 1 L in volume over a 24-hour period. This article reviews the literature on the indications and usefulness of radiologic studies for the evaluation of hemoptysis. The following recommendations are the result of evidence-based consensus by the American College of Radiology Appropriateness Criteria Expert Panel on Thoracic Radiology: (1) Initial evaluation of patients with hemoptysis should include a chest radiograph; (2) Patients at high risk for malignancy (>40 y old, >40 pack-year smoking history) with negative chest radiograph, computed tomography (CT) scan, and bronchoscopy can be followed with observation for the following 3 years. Radiography and CT are recommended imaging modalities for follow-up. Bronchoscopy may complement imaging during the period of observation; (3) In patients who are at high risk for malignancy and have suspicious chest radiograph findings, CT is suggested for initial evaluation; CT should also be considered in patients who are active or exsmokers, despite a negative chest radiograph; and (4) Massive hemoptysis can be effectively treated with either surgery or percutaneous embolization. Contrast-enhanced multidetector CT before embolization or surgery can define the source of hemoptysis as bronchial systemic, nonbronchial systemic, and/or pulmonary arterial. Percutaneous embolization may be used initially to halt the hemorrhage before definitive surgery.
authors: Department of Radiology, University of Maryland Medical Center, Baltimore, MD, USA. jjeudymd@gmail.com
authors: Jean
authors: J
authors: Jeudy
authors: Arfa R
authors: AR
authors: Khan
authors: Tan-Lucien
authors: TL
authors: Mohammed
authors: Judith K
authors: JK
authors: Amorosa
authors: Kathleen
authors: K
authors: Brown
authors: Debra Sue
authors: DS
authors: Dyer
authors: Jud W
authors: JW
authors: Gurney
authors: Heber
authors: H
authors: MacMahon
authors: Anthony G
authors: AG
authors: Saleh
authors: Kay H
authors: KH
authors: Vydareny
mesh_terms: D006469:Hemoptysis / Q000473:pathology*; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D012955:Societies, Medical / Q000592:standards*; D015898:Tomography Scanners, X-Ray Computed; D014481:United States