Haemoptysis with a normal chest X ray

Published Date: 19th July 2016

Publication Authors: Malhotra P

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Introduction

Haemoptysis is a red-flag symptom for lung cancer, but there is no consensus on how to investigate patients with haemoptysis and a normal chest X-ray. We sought to determine the yield of CT and bronchoscopy in this patient population in patients attending two hospitals in Northern England.

Methods

Patients referred with haemoptysis and a normal CXR were retrospectively identified from clinic records. Information was collected regarding demographics, smoking status, CT and bronchoscopy findings and eventual diagnosis.

Results

A total of 492 patients were identified (371 from Leeds 01/2008-12/2013 and 121 from Whiston 01/2012-12/2013). Median age was 60 years, and 75% were current or ex-smokers. CT, bronchoscopy findings and eventual diagnosis are shown in Table 1. 26 patients were diagnosed with lung cancer and one patient each with metastatic melanoma, metastatic breast cancer and pharyngeal carcinoma. 27 of these malignant cases (25 lung cancer) were reported on CT scan. Of 436 patients with normal or probable benign findings on CT scan, two cases of cancer were subsequently diagnosed. In one patient, irregularity of the RUL bronchus was reported as retained secretions, but was found to represent squamous cell carcinoma at bronchoscopy. One patient had a normal CT scan, but was found to have a pharyngeal tumour at bronchoscopy. No cancers were diagnosed in those patients not undergoing bronchoscopy during a median follow-up of 17 months (range 6-77 months).

Conclusion

Overall, 5.9% of patients presenting with haemoptysis and a normal CXR were subsequently diagnosed with cancer (5.3% lung cancer). No cases of lung cancer were detected or subsequently diagnosed in 268 patients with completely normal CT. We recommend bronchoscopy for any airway abnormality seen on CT (even if not thought suspicious for cancer), but the yield of bronchoscopy with completely normal CT is likely to be very low.

Raju, RS; Kazmi, N; Stephens, J; Delisle, K; Malhotra, P; Callister, M. (2015).  Haemoptysis with a normal chest X-ray what are the yields of CT and bronchoscopy?  Lung Cancer. 87 (Suppl 1), S17-S18.

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