HEMOPTYSIS - PROSPECTIVE HIGH-RESOLUTION CT BRONCHOSCOPIC CORRELATION/

The precise roles of fiberoptic bronchoscopy (FOB) and computed tomogr aphy (CT) of the chest in the evaluation of patients presenting with h emoptysis have not been clearly defined, On the assumption that both p rocedures would likely provide unique and complementary information, a prospective study with blinded interpreters using a modified high-res olution CT technique (HRCT) and FOB was designed to evaluate 57 consec utive patients admitted to Bellevue Hospital with hemoptysis. Etiologi es included bronchiectasis (25 percent), tuberculosis (16 percent),lun g cancer (12 percent), aspergilloma (12 percent), and bronchitis (5 pe rcent): in an additional 5 percent of cases, hemoptysis proved to be d ue miscellaneous causes, while in 19 percent hemoptysis proved to be c ryptogenic. Patients with lung cancer all were at least 50 years old, smoked an average of 78 pack-years, and had less severe hemoptysis but of longer duration. All had conditions diagnosed both by HRCT and FOB . High-resolution CT proved of particular value in diagnosing bronchie ctasis and aspergillomas, while FOB was diagnostic of bronchitis and m ucosal lesions such as Kaposi's sarcoma. Fiberoptic bronchoscopy local ized bleeding in only 51 percent of cases. The high sensitivity of CT in identifying both the intraluminal and extraluminal extent of centra l lung cancers in conjunction with its value in diagnosing bronchiecta sis suggest that CT should be obtained prior to bronchoscopy in all pa tients presenting with hemoptysis.