Utilidad de la historia clínica, la exploración física y la radiografía en la localización del sangrado de los pacientes con hemoptisis

Abstract

We examined the medical history, physical examination and chest radiography utility to accurately identifying the site of pulmonary bleeding in patients with hemoptysis. We prospectively reviewed and compared the suspected site of bleeding obtained with the medical history, physical examination and chest radiography (right or left) in 466 patients with hemoptysis after the confirmation with a bronchoscopy, computed chest tomography (CT) or bronchial arteriography, and separately analysing the more common etiologies and the volume of bleeding. Age 62.6 years (DS 14), 85% males, 80% smokers with a volume of bleeding of 42.5 ml/day (DS 86) and > or = 100 ml/day in 13.5%. Medical history localized the site of bleeding in 1-13% (p < 0.0001), clinical responses in 8-29% (p < 0.0001), physical examination in 13-47.5% (p < 0.0001) and chest radiography in 14.5-88% (p = 0.04), with a more frequent accurately location findings (p < 0.01) that gradually increased as the previous results with the lung carcinomas and decreased with bronchiectasis or chronic bronchitis. When the volume of bleeding was > or = 100 ml/day, clinical responses utility improved (p = 0.04) as when it was < 100 ml/day with the radiography (p = 0.0001). Specificity, sensitivity and predictive values were variable and better with the radiography than with the medical history or physical examination. We concluded that chest radiography was most useful than the medical history or physical examination to localize the site of bleeding in patients with hemoptysis. Almost all of the findings that suggests the site of bleeding were accurate and they increased with the radiography or decreased with the physical examination and specially with the medical history in patients with bronchiectasis or chronic bronchitis.