Chest
Volume 112, Issue 2, August 1997, Pages 440-444
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Clinical Investigations
Hemoptysis: Etiology, Evaluation, and Outcome in a Tertiary Referral Hospital

https://doi.org/10.1378/chest.112.2.440Get rights and content

Objectives

Hemoptysis, an important and alarming symptom, often indicates serious disease. This study was designed to assess the different causes of hemoptysis, the relative importance of the different diagnostic modalities employed, and the outcome in an Israeli population cohort.

Design

A retrospective analysis of 208 patients with hemoptysis at the Hadassah University Hospital, Jerusalem, Israel between January 1980 and August 1995.

Results

Bronchiectasis (20%), lung cancer (19%), bronchitis (18%), and pneumonia (16%) accounted for most causes of hemoptysis. In contrast to older studies, active tuberculosis was a rare finding (1.4%). Bronchiectasis and bleeding diathesis were major causes of moderate to severe hemoptysis while bronchitis and lung cancer were commonly associated with milder degrees of bleeding. CT scan was the most sensitive diagnostic test when employed alone, with a positive yield of 67%. However, it failed to locate at least three cases of lung cancer. When combining a CT study together with a bronchoscopy, the positive yield increased to 93%. The mortality rate for patients with mild to moderate hemoptysis was low (2.5% and 6%, respectively), while patients with massive hemoptysis had high mortality rates (38%). Patients with lung cancer or bleeding diathesis had higher mortality rates compared with the rest of the cohort.

Conclusions

Hemoptysis is a common symptom with a good prognosis in most cases. However, patients exhibiting massive bleeding or those with lung malignancy and patients with bleeding diathesis had a poorer prognosis. Patients older than 50 years with a positive smoking history need an extensive evaluation and follow-up to exclude lung carcinoma. The combined use of bronchoscopy and chest CT has the best yield in evaluating hemoptysis.

Section snippets

Materials and Methods

We retrospectively reviewed the records of both inpatients and outpatients with hemoptysis at the Hadassah University Hospital, Jerusalem, Israel. Between January 1980 and August 1995, 249 inpatient and 50 outpatient files were identified. Ninety-one files were excluded owing to lack of adequate information or they were files of children younger than 13 years old. After exclusion, 208 files were evaluated.

Medical records with a hospital discharge diagnosis of hemoptysis were reviewed for the

Results

Of the 208 patients evaluated, 127 (61%) were male and 81 (39%) were female. The average age was 58±17 years with a range of 20 to 96 years of age. One hundred ten (53%) patients had a positive smoking history and most of them were male (90/110, 82%).

Discussion

Bronchiectasis, lung cancer, bronchitis, and pneumonia are the leading causes of hemoptysis in the cohort studied. Most of the data regarding hemoptysis are based on retrospective studies published between 1930 and 1960, although new data have been gathered lately in studies that examined the utility of CT scan and fiberoptic bronchoscopy in the evaluation of hemoptysis. In most of the studies, one can find a bias secondary to patient selection or the diagnostic investigation employed. Table 5

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