Hemoptysis and fiberoptic bronchoscopy

The records of 110 patients admitted with hemoptysis were reviewed, in order to improve the guidelines for bronchoscopic investigation of hemoptysis when the chest roentgenogram (CXR) is normal, has minimal nonspecific abnormalities, or has a definite lesion. Seventy patients underwent fiberoptic bronchoscopy (FB) and 28 of these had a final diagnosis of carcinoma (CA). Severity of hemoptysis, presence of weight loss, pack years of smoking, and age did not distinguish patients with CA from those with non malignant reasons for hemoptysis. However, 96% of CA's occurred in patients 50 or more years old, and no CA was found in patients under 40. The median duration of hemoptysis was longer in the patients with CA than in those without malignancy (21 days vs. 4 days). Of the seventy patients on whom FB was performed, 43 had definite roentgenographic abnormality, 12 had minimal nonspecific abnormality and 15 had completely normal CXR. The number of CA's found in these 3 groups was 26, 2 and 0 respectively. FB was diagnostic in 78% of the CA group and 62% of the non malignant cases. Fiberoptic bronchoscopy is indicated in any patient with unexplained hemoptysis when any one of the following risk factors are present: 1) age 40 or greater, 2) hemoptysis present for one week or longer and 3) presence of any abnormality on the CXR.