Does bronchography have a role in the assessment of patients with haemoptysis?

Abstract

The results of bronchography in 96 consecutive patients investigated for haemoptysis at Papworth Hospital from 1975 to 1983 were reviewed. None of the patients included in this study gave a history suggestive of bronchiectasis and neither chest radiography nor fibreoptic bronchoscopy had shown a cause for the bleeding. Bronchography was performed through the fibreoptic bronchoscope and all included in the study showed both lungs adequately. The chest radiographic appearances were compared with the bronchographic findings. Seven of 12 patients with appearances suggesting old fibrosis showed bronchiectasis, as did eight of 10 with radiographic appearances suggestive of bronchiectasis. Eleven out of 74 patients with normal chest radiographs, however, also showed bronchiectasis. This group of 11 was compared with the other 63 but no clinical feature was found to be significantly associated with the presence of bronchiectasis. Although bronchography is now rarely used in the investigation of haemoptysis, this high yield (15%) of bronchiectasis indicates that its use should be reappraised. Follow up of the patients indicated that bronchography was not reliable at diagnosing peripheral bronchial carcinomas, which became evident later in two cases, and that asthma was present in 15 (24%) of the 63 patients with both normal chest radiographs and normal bronchograms.The patient who presents with haemoptysis as the major symptom poses a difficult problem for the investigating physician. After a full history, clinical examination, chest radiography and fibreoptic bronchoscopy, no cause is found in over half of the patients.' There has been a decline in the use of bronchography in recent years, due largely to a reduction in the prevalence of bronchiectasis. It has been held to be of limited use in the investigation of patients presenting with haemoptysis.2 Over the past nine years we have used bronchography as an adjunct to fibreoptic bronchoscopy in the investigation of patients presenting with haemoptysis. To evaluate the usefulness of this procedure we have carried out a retrospective analysis of our results.

Should patients with haemoptysis and a normal chest X-ray be bronchoscoped?

“…Adelman et al8 found one carcinoma during follow-up of 67 patients with an initially normal bronchoscopy, and Jones et al 9 reported two peripheral carcinomas becoming evident during follow-up of 96 patients.…”

H�moptysen

“…Ist die Bronchoskopie nicht diagnostisch, das native Röntgenbild negativ und die Gerinnung unauffällig sollten ein Angio-CT und eine Echokardiographie angeschlossen werden.Bezüglich der Diagnostik von Lungenembolien (Infarkten) hat dieses Vorgehen inzwischen einen höhe-ren Stellenwert als die Perfusionsszintigraphie [11].Die früher häufig angeschlossene Bronchographie [12] gilt heute als nicht mehr zeitgemäß, sie ist durch die Computertomographie abgelöst worden. Bei Bronchiektasen liefert diese auch genügend Informationen, um einen operativen Eingriff planen zu können.…”