The causes of haemoptysis in malaysian patients aged over 60 and the diagnostic yield of different investigations

Can combined non-invasive methods improve diagnosis of lung cancer?

Background

Lung cancer is the most common malignancy in both gender. Early diagnosis is needed to reduce morbidity and mortality. There is a debate about the most accurate investigating modality for the diagnosis of lung cancer.

Methods

It is a retrospective cohort analysis to determine whether an approach of combined contrast-enhanced computed tomography (CECT) thorax with bronchoscopy method has higher sensitivity and specificity than combined CECT thorax with sputum cytology method. Records of patients with lung cancer who had visited the hospital within the last 6 months were retrospectively analyzed for their diagnostic modality. SPSS version 19 software was used for statistical analysis of the data. CECT scan thorax, bronchoscopy, and sputum cytology for lung cancer patients were analyzed. The CECT thorax plus bronchoscopy method was compared with the CECT thorax plus sputum cytology method. Their sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in diagnosing lung cancer were analyzed.

Results

Sixty-two patients were considered, including 62.9% males with a mean age of 55.5 years. In patients diagnosed with lung cancer, CECT thorax combined with bronchoscopy method was found to have a sensitivity of 96.67% than CECT thorax combined with sputum cytology method with a sensitivity of 90% and the difference in sensitivity between all individual approaches as well as the combined method was statistically significant with a P = 0.00001 and Chi-square value of 86.5909 owing to the low sensitivity of sputum cytology. CECT thorax combined with sputum cytology approach had a better specificity than CECT thorax combined with bronchoscopy.

Conclusion

Combined CECT thorax with sputum cytology method has a better specificity in diagnosing lung cancer than combined CECT thorax with bronchoscopy method.

Hemoptysis with no malignancy suspected on computed tomography rarely requires bronchoscopy

Background: Hemoptysis is an alarming and common symptom leading to thorough diagnostic evaluation with computed tomography and fiberoptic bronchoscopy. Increasing evidence suggests that bronchoscopy is not necessary in diagnosing lung cancer in hemoptysis patients because of high sensitivity of computed tomography. However, less attention has been paid to non-malignant etiologies of hemoptysis.

Objective: We aimed to identify the etiologies established in hemoptysis patients with no malignancy suspected on computed tomography in order to assess the necessity of bronchoscopy in these patients.

Design: We retrospectively reviewed clinical records of consecutive patients referred to evaluation for hemoptysis with no malignancy suspected on computed tomography at Aalborg University Hospital, Denmark, in an eleven-year period from 2006 to 2016.

Results: One thousand one hundred and eighty-five patients (mean age 57.5 ± 15.44 years, 61.3% male) were included in the study. Bronchoscopy was performed in 91.9% of cases. Most patients (83.5%) had cryptogenic hemoptysis, while the most frequently identified etiologies were respiratory tract infection (12.6%) and bronchiectasis (2.2%). No patients had malignant disease as their etiology.

Conclusions: The vast majority of hemoptysis cases with no malignancy suspected on computed tomography were cryptogenic and all were benign. Bronchoscopy may be reserved for patients with specific conditions suspected and those with persistent symptomatology.

Is atmospheric pressure change an Independent risk factor for hemoptysis?

Objective: Hemoptysis is one of the most important and challenging symptoms in pulmonary medicine. Because of the increased number of patients with hemoptysis in certain periods of the year, we aimed to investigate whether atmospheric changes have an effect on the development of hemoptysis with or without a secondary cause.

Methods: The data of patients presenting with hemoptysis between January 2006 and December 2011 were analyzed. Data on the daily atmospheric pressure (hectopascal, hPa), relative humidity (%), and temperature (^o C) during that time were obtained.

Results: A total of 232 patients with hemoptysis, 145 male (62.5%) and 87 female (37.5%) with an average age of 48.1(±17.6), were admitted to our hospital between 2006 and 2011. The highest admission rates were in the spring season, the highest in May (n=37, 15.9%), and the lowest admission rates were in December (n=10, 4.3%). A statistically significant negative correlation was found between the number of hemoptysis cases and mean atmospheric pressure but no relative humidity or outdoor temperature.

Conclusion: Hemoptysis is very much influenced by weather factors; in particular, low atmospheric pressures significantly affect the development of hemoptysis. Fluctuations in atmospheric pressure may also play a role in hemoptysis.

Hemoptysis--etiology, evaluation and treatment in a university hospital

OBJECTIVE

Evaluate patients admitted for hemoptysis, its etiology, use of diagnostic tests, treatment and outcome.

METHODS

A retrospective analysis was done, checking clinical files of patients admitted for hemoptysis, between 1st January 2004 and 31st December 2008.

RESULTS

Two hundred and thirty seven patients were included in this study, with a mean age of 57.9 years. In patients under 18 years, the most frequent diagnoses were Bronchiectasis and Congenital Cardiopathy. In adults, Pulmonary Tuberculosis Sequelae and Bronchiectasis were the dominant diagnoses (22.2 % and 15.8 %, respectively), followed by Lung Cancer. Active infection was responsible for bleeding in 51 patients, especially Pulmonary Tuberculosis, Pneumonia and Tracheobronchitis. The etiology of hemoptysis was not established in 6.3 %. All patients performed chest X-Ray. Chest CT was performed in 81.4 % of patients and Fiberoptic bronchoscopy in 52.7 %, the latter locating the source of bleeding in 38.4 % and establishing a final diagnosis in 17.6 %. In most patients, effective control of bleeding was achieved by medical treatment (90.7 %). During these 5 years, arterial embolization was performed in 11.8 % of patients. The main reason for embolization was recurrence prevention. There were 14 deaths (5.9 %), being identified as poor prognostic factors, hemodynamic instability and malignancy.

CONCLUSION

Hemoptysis is still a frequent symptom, being chronic infection sequelae and lung cancer their main causes. In this study, factors associated with a worse prognosis were hemodynamic instability and malignancy.

Risk Factors for a Second Episode of Hemoptysis

Objectives

Hemoptysis is an alarming symptom of underlying lung disease. Clinicians are often unsure how to deal with and follow up patients who have had a single episode of hemoptysis, especially if the cause remains unknown despite thorough examination, because a second, more severe episode of hemoptysis might occur despite an apparently stable condition. Investigations were done, using multivariate analyses, to see whether several clinical factors present during an initial episode of hemoptysis could be used to predict a second episode.

Subjects and Methods

Eighty patients with an initial episode of hemoptysis who underwent both computed tomographic and bronchoscopic examinations from 2003 through 2005 were reviewed.

Results

The isolation of bacteria from bronchial lavage fluid (odds ratio 13.5, P = 0.001) and the failure to determine the cause of the initial episode of hemoptysis (odds ratio 7.0, P = 0.014) were significant independent predictors of a second episode of hemoptysis. Subset analysis showed that isolation of either Pseudomonas aeruginosa or Haemophilus influenzae increased the likelihood of a second episode of hemoptysis (P = 0.077), even if colonization, representing host-bacterial equilibrium, had occurred. Furthermore, the failure to determine the etiology of an initial episode of hemoptysis was associated with an increased risk of a massive second episode (P = 0.042), regardless of the volume of the initial episode.

Conclusions

In patients with bacterial colonization of the respiratory tract or an initial episode of hemoptysis of unknown etiology, there is an increased possibility of a second episode of hemoptysis.

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.

OBJECTIVES

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.