PURPOSE:The usefulness of bronchoscopy in patients with history of solid malignancies presenting with “minor hemoptysis” is unknown. The objectives of this study are to describe the clinical presentation and bronchoscopic findings in this population.
METHODS:We conducted a retrospective analysis of patients with history of solid malignancies who presented to MD Anderson Cancer Center (MDACC) with hemoptysis during an 18 month period. We defined “minor hemoptysis” as blood-tinged sputum, blood-streaked sputum, or small clots within the sputum.
RESULTS:Out of 157 patients with hemoptysis, 79 presented with “minor hemoptysis” and 62 of those had a history of a solid tumor. Fifty-three (85.5%) of them underwent bronchoscopy, detecting active bleeding (AB) in 24 (45%) and endobronchial tumor in 17 (32%). No differences were observed in demographic data, pre-existing malignancies, comorbid conditions, antiplatelet/anticoagulant therapy, liver and renal function tests, platelet count and coagulation profile in patients with and without AB at bronchoscopy. Lung cancer was the predominant malignancy in the AB group (37.5%). The etiologies of hemoptysis in the AB group were: endobronchial tumor (n=17); bleeding arising from peripheral airway (n=4); surgical stump (n=1); post-radiotherapy mucosal changes (n=1); and telangiectatic lesion (n=1). Chest computed tomography (CT) on presentation was available in 22 of 24 patients in the AB group. CT results matched the bleeding site found in bronchoscopy in only 13 patients (59%).
CONCLUSION:About half of the patients with a history of cancer who presented to MDACC with hemoptysis had “minor hemoptysis”. In patients with history of a solid malignancy and “minor hemoptysis”, bronchoscopy found endobronchial tumor in a third of the cases and localized the active bleeding site in almost half of them. CT of the chest was unable to localize the bleeding site in nearly half of the patients with evidence of AB during bronchoscopy.
CLINICAL IMPLICATIONS:Patients with history of solid malignancies presenting with hemoptysis should be considered for bronchoscopy even if the bleeding is only “minor”. Bronchoscopy complements computed tomography in localizing the bleeding site.
DISCLOSURE:Roberto Casal, None.