The Evaluation of Hemoptysis with Fiberoptic Bronchoscopy

Abstract

Hemoptysis, a relatively common event in pulmonary disease, is the primary reason for seeking consultation in approximately 10 to 15 percent of an average chest clinic population. 1 American Thoracic Society statement on the management of hemoptysis.. Am Rev Resp Dis. 1966; 93: 471 Google Scholar , 8 Crocco JA Rooney JJ Fankushen DS Massive hemoptysis.. Arch Intern Med. 1968; 121: 495 Crossref PubMed Scopus (184) Google Scholar Many of these patients will have expectoration of blood with no other subjective complaints, and they will have normal findings on physical examination and chest x-ray film. Although indirect methods may be helpful in localizing the site and cause of the bleeding, the definitive diagnosis is frequently dependent on bronchoscopy. In most situations the standard metal bronchoscope is of limited utility because the examiner is able to see only the proximal portions of the bronchial tree, and is offered insufficient time or maneuverability to allow lavage of the bronchial segments in an attempt to localize the site of bleeding. This is particularly true in the patient with vigorous or massive hemoptysis, who may be a poor risk due to underlying pulmonary disease and/or hypoxia secondary to airway obstruction by the blood. In such situations the examiner is confronted with blood scattered throughout the bronchial tree, and the limitations of the rigid bronchoscope preclude a complete diagnostic evaluation.