Hemoptysis and lung cancer: can we be reassured when Chest CT is negative?

Introduction: Hemoptysis is a common and challenging symptom and may be associated with life-threatening medical conditions such as lung cancer. Aims: Evaluate the sensitivity of CT and bronchoscopy in diagnosing malignant causes of hemoptysis. Methods: Retrospective study of patients presenting with hemoptysis who underwent CT and bronchoscopy at our Center, from January 2013 to December 2018. Results: A total of 111 patients were included in the study (mean age 64.3 [SD 14.1] years). Most of them (59.5%) were male and half (50.4%) had a positive smoking history. The most common etiologies for hemoptysis were pulmonary malignancy (33.3%), pneumonia (20%) and bronchiectasis (20%). Bronchoscopy provided microbiologic, cytologic and histopathologic samples, demonstrating not only the presence of infection and cancer, but also early mucosal abnormalities, squamous metaplasia and a benign papilloma. In what concerns the 37 cases of lung cancer diagnosed, there were no false negative CT-scans. Bronchoscopy confirmed 29 tumours, six were beyond bronchoscopic range. The majority of the patients with cancer were males (75.7%) and most of them had a positive smoking history (72.9%). In our series, no patient aged Conclusions: In our series, pulmonary malignancy was the main diagnosis in patients with hemoptysis evaluated with chest CT and bronchoscopy. CT, when compared to endoscopy, not only had a higher diagnostic sensitivity (100% vs 78,4%, respectively), but was also able to identify all lung cancer cases. More studies are necessary to better characterize the subgroup of patients with hemoptysis who need a more comprehensive approach in excluding malignancy.