Hemoptysis

Chest radiography is the initial imaging test used in the evaluation of a patient with hemoptysis. Chest radiography may sometimes reveal the location and the underlying cause of hemoptysis, e.g. lung cancer (Figure 14.1). Other diagnostic findings may include lung abscess, mycetoma, arteriovenous malformation, broncholithiasis, etc. Patchy alveolar infiltrates seen bilaterally may indicate diffuse pulmonary alveolar hemorrhage, as seen in Goodpasture’s syndrome or pulmonary vasculitides (Figure 14.2). However, chest radiography may only reveal non-specific findings or no relevant abnormalities in 20-40% of patients with hemoptysis.1 It may also show abnormalities in areas other than the actual site of bleeding and potentially mislead the clinician. For example, blood from an upper lobe lesion may extend to the lower lung, resulting in areas of parenchymal opacification in the lower lungs. The radiograph can also be used to help target bronchoscopy. However, the diagnostic yield of fiberoptic bronchoscopy for patients with hemoptysis and a normal or non-localizing chest radiograph is only 10-20%.