Haemoptysis: aetiology, evaluation amd outcome - a prospective study in a third-world country

Haemoptysis is an alarming symptom, and the management depends upon the ast rology. Emergency management depends upon localization of the site of bleed ing by roentgenogram, computerized chest tompgraphy and bronchoscopy. We prospectively evaluated 52 patients with haemoptysis admitted to the Che st Hospital, Kuwait for 1 year (January 1998 to December 1998)and followed them up for 1 year (January 1999 to December 1999). There were 42 males (80 .8%) and 10 (19.2%) females, with a mean age of 42.2 (16-86) years. Of thes e, 26.9% were Kuwaiti nationals, 36.5% were Arab non-Kuwaiti nationals, 34. 6% were Asians and 1.9% were other nationals. The aetiologies of haemoptysis were bronchiectasis (21.2%), old pulmonary t uberculosis with bronchiectasis (17.3%), active pulmonary tuberculosis (15. 4%), bronchitis (5.8%), aspergilloma, rheumatic heart disease and carcinoid (1.9%). Aetiology could not be identified in 25% of patients. The site of bleeding in haemoptysis could not be localized by the consultants in 18 (32 %) by roentgenogram, 16 patients (37%) by CT scan and 23 patients (50%) by Fibreoptic bronchoscopy. Sequential estimation of hemoglobin showed a mean of 13.56 (SD 1.9) and 13.31 (SD I S) after 24h. The difference in mean was statistically significant (p <0.036). Conservative management was given in 80.8%. and embolotherapy or surgical i ntervention in 19.2% of patients. Only 12% of patients had recurrent haemop tysis at 1-year follow up In conclusion, bronchiectasis and pulmonary tuberculosis were the major cau ses of haemoptysis in this study. Roentgenogram, CT scan and fibreoptic bro nchoscopy are useful for localizing the site of bleeding. Sequential estima tion of haemoglobin may be helpful in assessing me severity of haemoptysis, but larger studies are required to address this observation. The outcome o f haemoptysis is generally good, with a low mortality and recurrence rate.