[Usefulness of computed tomography of the chest in the evaluation of patients with massive hemoptysis].

BACKGROUND: The role of chest CT scan in the assessment of patients with hemoptysis is uncertain. AIM: To evaluate the usefulness of CT scan in patients with non massive hemoptysis. PATIENTS AND METHODS: Ninety six patients, 60 male, aged 23 to 76 years old, who presented with hemoptysis to an University Hospital, were studied. All patients were studied with a chest radiograph, a fiberoptic bronchoscopy and a high resolution CT scan. RESULTS: The final causes of hemoptysis were bronchiectasis in 27 cases, bronchogenic carcinoma in 24 cases and lung infections in nine. The source of bleeding was not identified in 18 patients (19%). CT scan clarified abnormalities seen in the chest radiograph in 30 patients (31%) and provided new diagnostic information in 13 (14%). CT scan correctly localized the source of bleeding found by fiberoptic bronchoscopy in 35 of 43 patients (81%), whereas chest radiograph did so in 27 (77%). All patients with bronchogenic carcinoma were identified by chest radiograph or bronchoscopy. Twenty of the 27 patients with bronchiectasis had radiological abnormalities in the chest radiograph. In only two patients, with lung metastases and non conclusive chest radiograph and bronchoscopy, CT scan provided information that significantly modified clinical management. CONCLUSIONS: CT scan was useful to stage patients with bronchogenic carcinoma and to assess the extension of bronchiectasis, but its impact in the management and clinical evolution of patients was limited. Therefore we do not recommend the routine use of CT scan in the assessment of patients with hemoptysis.