DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20150636

Role of fibreoptic bronchoscopy in haemoptysis: an analysis of 157 patients

Naveed Nazir Shah, Manzoor Ahmad Wani, Syed Quibtiya Khursheed, Rakesh Bargava, Zuber Ahmad, Khurshid Ahmad Dar, Arshad Altaf Bachh

Abstract


Background: Objectives of this study were to define the role of fibreoptic bronchoscopy (FOB) in determining the etiology of haemoptysis, to determine whether bronchoscopy is useful in haemoptysis with normal chest x-ray, to determine whether early bronchoscopy is better than delayed bronchoscopy.

Methods: This prospective study was conducted on 157 patients who presented with hemoptysis to the Department of Tuberculosis and Chest diseases. All these patients underwent FOB after taking proper history and examination and ruling out any contraindication to the procedure.

Results: In patients with haemoptysis with normal CXR, a diagnosis was established in 54.5% by FOB while 38.6% had a normal bronchoscopy. An endoscopic diagnosis of bronchitis was made in 22.7% patients. In only 9.1% patients an endobronchial mass was seen on bronchoscopy, and all of them were more than 40 years of age. Active bleeding/bleeding site was localized in 18.1% patients. In patients with abnormal chest roentgenogram who underwent FOB, a definitive diagnosis was established in 75.4% cases with active bleeding/ bleeding site localized in 59.6%. Thirty five percent were having an endobronchial mass. Of all the patients who underwent FOB for recurrent haemoptysis, active bleeding/bleeding site was localized in 48.4% patients. Bleeding site was localized in 62.9% patients who underwent early FOB, while the yield was lower (29.4%) in patients who underwent delayed FOB.

Conclusions: Fibreoptic bronchoscopy (FOB) is an important and useful investigation in patients of haemoptysis in determining the bleeding site and etiology of haemoptysis. Early FOB has higher yield in localizing the bleeding site than delayed FOB.

 


Keywords


Fibreoptic bronchoscopy, Haemoptysis, Endobronchial mass

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References


Marini JJ. Haemoptysis. In: Respiratory Medicine for the House Officer. 2nd ed. Baltimore: Williams and Wilkins: 1987: 223-225.

Stoller JK. Diagnosis and management of massive haemoptysis: a review. Respir Care. 1992;32:564-81.

Chaves AD. Haemoptysis in Chest Clinic patients. Am Rev Tuberc. 1951;63:144-201.

Pursel SE, Lindskog GE. Haemoptysis: a clinical evaluation of 105 patients examined consecutively on a thoracic surgical service. Am Rev Respir Dis. 1961;84:329-36.

Abbot OA. The clinical significance of pulmonary haemorrhage: a study of 1316 patients with chest disease. Dis Chest. 1948;14:824-42.

Johnston RN, Lockhart W, Ritchie RT, Smith DM. Haemoptysis. Br Med J. 1960:1:592-5.

Thoms NW, Wilson RF, Puro HE, Arbula A. Life-threatening haemoptysis in primary lung abscess. Ann Thorac Surg. 1972;14:347-57.

Shamji FM, Vallieres E. Todd ER. Sach HJ. Massive or life-threatening haemoptysis. Chest. 1991;10:78S.

Smiddy JR, Elliot RC. The evaluation of haemoptysis with fiberoptic bronchoscopy. Chest. 1973;64:158-62.

Soll B, Selecky PA, Chang R, et al. The use of the fiberoptic bronchoscope in the evaluation of haemoptysis. Am Rev Respir Dis. 1977;115:165-8.

Ferguson FC, Kobilak RE. Dcitnck JE. Varices of bronchial veins as a source of haemoptysis in mitral stenosis. Am Heart J. 1944:28:445-9.

Snider GL. When not to use the bronchoscope for haemoptysis. Chest. 1979;76:1-2.

Adelman M. Haponik EF, Bleecker ER, Britt EJ. Cryptogenic haemoptysis. Ann Intern Med. 1985;102:829-34.

Gong H Jr, Salvatierra C. Clinical efficacy of early and delayed fiberoptic bronchoscopy in patients with haemoptysis. Am Rev Respir Dis. 1981;124:221-5.

Jackson CV. Savage PJ, Quinn I)L. Role of fiberoptic bronchoscopy in patients with haemoptysis and a normal chest roentgenogram. Chest. 1985;87:142-4.

Poe RH, Israel RH, Marin MG, et al. Utility of fiberoptic bronchoscopy in patients with haemoptysis and a non-localizing chest roentgenogram. Chest. 1988;92:70-5.

Mitchell DM, Emerson CJ, Collyer J, Collins JV. Fiberoptic bronchoscopy: ten years on. Br Med J. 1980;281:360-3

Heimer D, Bar-Ziv J, Scharf SM. Fiberoptic bronchoscopy in patients with haemoptysis and non-localizing chest roentgen graphs. Arch Intern Med. 1985;145:1427-1428.

Strickland B. Investigating haemoptysis. Br J Dis Chest 1986; 245-251.

Zavala DC. Diagnostic fiberoptic bronchoscopy. Chest. 1975; 68:12-19.

Varkey B. Rose HD. Pulmonary aspergilloma —a rational approach to treatment. Am J Med. 1976:61:626-631.

Prakash UBS. Bronchoscopy. In: Bone RC, Dantzker DR. George RB, Matthay RA, Reynolds HY, eds. Pulmonary and Critical Care Medicine. Vol 1. St. Louis: Mosby-Year Book: 1993;F(5):1-lS.

Prakash UBS. Offord KP, Stubbs SE. Bronchoscopy in North America: the ACCP survey. Chest. 1991;100:1668-75.

O’Neil KM, Lazarus AA. Indications for bronchoscopy. Arch Intern Med 1991; 151:171-174.

Weaver LJ, Solliday N, Cugell DW. Selection of patients for fiberoptic bronchoscopy. Chest. 1979;76:7-10.

Joynson DHM. Pulmonary aspergilloma. Br J Clin Pract. 1977;31:207-21.

Lederle FA, Nichol KL, Parenti CM. Bronchoscopy to evaluate haemoptysis in older men with nonsuspicious chest roentgenograms. Chest. 1989;10:43-47.

Jackson CL, Diamond S. Haemorrhage from the trachea, bronchi, and lungs of non-tuberculosis origin. Am Rev Tuberc. 1942;46:126-138.

Jindal SK, Gilhotra R, Behere D. Fiberoptic bronchoendoscopic examination in patients with haemoptysis and normal chest roentgenogram. JAPI. 1990;38:548-549.

Sharma SK, Dey AB, Pande JN, Verma K. Fiberoptic bronchoscopy in patients with haemoptysis and normal chest roentgenograms. Ind J Chest Dis & Allied Sci. 1991;33:15-8.

Heaton RW. Should patient with haemoptysis and normal chest x-ray be bronchoscope? Postgrad Med J. 1987;63:947-9.

Ingbar D. A systematic workup for haemoptysis. Contemporary Int Med. 1989;(July/Aug):60-70.

Bobrowitz ID. Ramkrishna S, Shim YS. Comparison of medical vs. surgical treatment of major haemoptysis. Arch Intern Med. 1983;143:1343-6.

Corey R, Hla RM. Major and massive haemoptysis: reassessment of conservative management. Am J Med Sci. 1987;294:301-9.

Suri JC, Goel A, Singla R. Cryptogenic haemoptysis: Role of fiberoptic bronchoscopy. Ind J Chest Dis & Allied Sci. 1990;32:149-52.