Hemoptysis diagnostic study of choice: Difference between revisions

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{{CMG}}; {{AE}} {{SSH}}
{{CMG}}; {{AE}} {{SSH}}
== Overview ==
== Overview ==
The initial diagnostic study in a patient with hemoptysis is [[Chest X-ray|chest x-ray]]. If diagnosis is not found on [[Chest X-ray|chest x-ray]], the next step is to perform [[High Resolution CT|high resolution CT scan]] or [[bronchoscopy]]. [[High Resolution CT|HRCT]] is better for diagnosis of [[bronchiectasis]] or [[Lung cancer|lung carcinoma]]. Flexible [[bronchoscopy]] is better for diagnosis of [[Mucous membrane|mucosal]] abnormalities such as [[bronchitis]], Dieulafoy disease or [[Kaposi's sarcoma|kaposi sarcoma]].


== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==


===== Template statements =====
=== Study of choice ===
* The initial diagnostic study in a patient with hemoptysis is [[Chest X-ray|chest x-ray]].<ref name="KhalilFedida2015">{{cite journal|last1=Khalil|first1=A.|last2=Fedida|first2=B.|last3=Parrot|first3=A.|last4=Haddad|first4=S.|last5=Fartoukh|first5=M.|last6=Carette|first6=M.-F.|title=Severe hemoptysis: From diagnosis to embolization|journal=Diagnostic and Interventional Imaging|volume=96|issue=7-8|year=2015|pages=775–788|issn=22115684|doi=10.1016/j.diii.2015.06.007}}</ref>
* [[Chest X-ray|Chest x-ray]] might show underlying cause. However, it might be normal as well.<ref name="Andersen2016">{{cite journal|last1=Andersen|first1=P. E.|title=Imaging and interventional radiological treatment of hemoptysis|journal=Acta Radiologica|volume=47|issue=8|year=2016|pages=780–792|issn=0284-1851|doi=10.1080/02841850600827577}}</ref>
* The next step is to perform [[High Resolution CT|high resolution CT scan]] or [[bronchoscopy]].<ref name="LeeKim2015">{{cite journal|last1=Lee|first1=Myoung Kyu|last2=Kim|first2=Sang-Ha|last3=Yong|first3=Suk Joong|last4=Shin|first4=Kye Chul|last5=Kim|first5=Hyun Sik|last6=Yu|first6=Tae-Sun|last7=Choi|first7=Eun Hee|last8=Lee|first8=Won-Yeon|title=Moderate hemoptysis: recurrent hemoptysis and mortality according to bronchial artery embolization|journal=The Clinical Respiratory Journal|volume=9|issue=1|year=2015|pages=53–64|issn=17526981|doi=10.1111/crj.12104}}</ref>
* [[High Resolution CT|HRCT]] is better in some conditions, such as:<ref name="GuptaSrivastava2013">{{cite journal|last1=Gupta|first1=Mudit|last2=Srivastava|first2=Deep Narayan|last3=Seith|first3=Ashu|last4=Sharma|first4=Sanjay|last5=Thulkar|first5=Sanjay|last6=Gupta|first6=Rashmi|title=Clinical Impact of Multidetector Row Computed Tomography Before Bronchial Artery Embolization in Patients With Hemoptysis: A Prospective Study|journal=Canadian Association of Radiologists Journal|volume=64|issue=1|year=2013|pages=61–73|issn=08465371|doi=10.1016/j.carj.2011.08.002}}</ref><ref name="NoëJaffé2011">{{cite journal|last1=Noë|first1=G.D.|last2=Jaffé|first2=S.M.|last3=Molan|first3=M.P.|title=CT and CT angiography in massive haemoptysis with emphasis on pre-embolization assessment|journal=Clinical Radiology|volume=66|issue=9|year=2011|pages=869–875|issn=00099260|doi=10.1016/j.crad.2011.03.001}}</ref>
** [[Bronchiectasis]]
** [[Carcinoma|Carcinomas]]
* Flexible [[bronchoscopy]] is better in some conditions, such as:<ref name="SakrDutau2010">{{cite journal|last1=Sakr|first1=L.|last2=Dutau|first2=H.|title=Massive Hemoptysis: An Update on the Role of Bronchoscopy in Diagnosis and Management|journal=Respiration|volume=80|issue=1|year=2010|pages=38–58|issn=1423-0356|doi=10.1159/000274492}}</ref>
** [[Mucous membrane|Mucosal]] abnormalities including:
*** [[Bronchitis]]
*** Dieulafoy disease
*** [[Kaposi's sarcoma|Kaposi sarcoma]]
==Diagnosis of Mild to Moderate Hemoptysis==
The algorithm is based on the American Family Physician Journal of hemoptysis: Diagnosis and Management <ref>name="pmid16225028">{{cite journal| author=Bidwell JL, Pachner RW| title=Hemoptysis: diagnosis and management. | journal=Am Fam Physician | year= 2005 | volume= 72 | issue= 7 | pages= 1253-60 | pmid=16225028 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16225028  }} </ref>
{{Family tree/start}}
{{familytree  | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | | | | A01= <u>'''Hemoptysis'''</u>}}
{{familytree  | | | | | |,|-|-|-|-|-|-|-|^|-|-|-|-|-|-|.| | | | | | | | | | | |}}
{{familytree  | | | | | B01 | | | | | | | | | | | | | B02 | | | | | | | | | | |B01= <u>'''Mild hemoptysis'''</u> <br> ❑ <30 cc in 24 hours <ref> name="pmid12243312">{{cite journal| author=Fidan A, Ozdoğan S, Oruç O, Salepçi B, Ocal Z, Cağlayan B| title=Hemoptysis: a retrospective analysis of 108 cases. | journal=Respir Med | year= 2002 | volume= 96 | issue= 9 | pages= 677-80 | pmid=12243312 | doi= | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12243312  }} </ref> | B02= <u>'''Moderate hemoptysis'''</u> <br> ❑ 30-200 cc in 24 hours <ref> name="pmid12243312">{{cite journal| author=Fidan A, Ozdoğan S, Oruç O, Salepçi B, Ocal Z, Cağlayan B| title=Hemoptysis: a retrospective analysis of 108 cases. | journal=Respir Med | year= 2002 | volume= 96 | issue= 9 | pages= 677-80 | pmid=12243312 | doi= | pmc=|url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12243312  }} </ref> }}
{{familytree  | | | | | |!| | | | | | | | | | | | | | |!| | | | | | | | | | | |}}
{{familytree  | | | | | C01 | | | | | | | | | | | | | C02 | | | | | | | | | | |C01= [[Chest X-ray]] (CXR) | C02= [[Chest X-ray]] and CT }}
{{familytree  | |,|-|-|-|^|-|-|-|.| | | | | | |,|-|-|-|^|-|-|-|.| | | | | | | |}}
{{familytree  | D01 | | | | | | D02 | | | | | D03 | | | | | | D04 | | | | | | |D01= Diagnose found | D02= Diagnose unknown | D03= Diagnose found | D04= Diagnose unknown}}
{{familytree  | |!| | | | | | | |!| | | | | | |!| | | | | | | |!| | | | | | | |}}
{{familytree  | E01 | | | | | | E02 | | | | | E03 | | | | | | E04 | | | | | | |E01= Treat underlying disease | E02= <div style="float: left; text-align: left; height: 10em; width: 12em; padding:1em;"> '''Risk of malignancy'''<ref name="pmid22158327">{{cite journal| author=Parkin DM, Boyd L, Walker LC| title=16. The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010. | journal=Br J Cancer | year= 2011 | volume= 105 Suppl 2 | issue=  | pages= S77-81 | pmid=22158327 | doi=10.1038/bjc.2011.489 | pmc=PMC3252065 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22158327  }} </ref><br>
❑ [[Smoking]] <br>


=== Study of choice: ===
❑ Occupational exposure <br>
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
* The following result of [gold standard test] is confirmatory of [disease name]:
** Result 1
** Result 2
* The [name of the investigation] should be performed when:
** The patient presented with symptoms/signs 1. 2, 3.
** A positive [test] is detected in the patient.
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
* The diagnostic study of choice for [disease name] is [name of the investigation].
* There is no single diagnostic study of choice for the diagnosis of [disease name].
* There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
* [Disease name] is mainly diagnosed based on clinical presentation.
* Investigations:
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.


==== The comparison table for diagnostic studies of choice for [disease name] ====
❑ Family history <br>
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #FFFFFF; color: #FFFFFF; text-align: center;" |
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
|}
<small> ✔= The best test based on the feature </small>
 
===== Diagnostic results =====
The following result of [investigation name] is confirmatory of [disease name]:
* Result 1
* Result 2
 
===== Sequence of Diagnostic Studies =====
The [name of investigation] should be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.
 
=== Diagnostic Criteria ===
* Here you should describe the details of the diagnostic criteria.
*Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for the diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
*Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
*Be very clear as to the number of criteria (or threshold) that needs to be met out of the total number of criteria.
*Distinguish criteria based on their nature (e.g. clinical criteria / pathological criteria/ imaging criteria) before discussing them in details.
*To view an example (endocarditis diagnostic criteria), click [[Endocarditis diagnosis|here]]
*If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
*You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
* [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
* There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
 
* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
* The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
 
* [Disease name] may be diagnosed at any time if one or more of the following criteria are met:
** Criteria 1
** Criteria 2
** Criteria 3
 
IF there are clear, established diagnostic criteria:
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
*The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
*The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
IF there are no established diagnostic criteria: 
*There are no established criteria for the diagnosis of [disease name].


❑ Previous cancer treatment </div> | E03= Treat underlying disease | E04= Bronchoscopy to find diagnosis}}
{{familytree  | | | | | |,|-|-|-|^|-|-|-|.| | | | | | |,|-|-|-|^|-|-|-|.| | | |}}
{{familytree  | | | | | F01 | | | | | | F02 | | | | | F03 | | | | | | F04 | | | F01= Yes | F02= No | F03= Diagnose found | F04= Diagnose unknown}}
{{familytree  | | | | | |!| | | | | | | |!| | | | | | |!| | | | | | | |!| | | |}}
{{familytree  | | | | | G01 | | | | | | G02 | | | | | G03 | | | | | | G04 | | | G01= [[CT]] or [[bronchoscopy]] to find diagnosis| G02= Close monitoring | G03= Treat underlying disease | G04= Close monitoring}}
{{familytree  | |,|-|-|-|^|-|-|-|.| | | |!| | | | | | | | | | | | | | | | | | |}}
{{familytree  | H01 | | | | | | H02 | | H03 | | | | | | | | | | | | | | | | | | H01= Diagnose found | H02= Diagnose unknown | H03= If hemoptysis persist consult with pneumonologist}}
{{familytree  | |!| | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | |}}
{{familytree  | I01 | | | | | | I02 | | | | | | | | | | | | | | | | | | | | | |I01= Treat underlying Disease | I02= Close monitoring}}
{{familytree  | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |}}
{{Family tree/end}}


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Medicine]]
[[Category:Gastroenterology]]
[[Category:Up-To-Date]]
[[Category:Radiology]]
[[Category:Emergency medicine]]

Latest revision as of 22:02, 29 July 2020

Hemoptysis Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]

Overview

The initial diagnostic study in a patient with hemoptysis is chest x-ray. If diagnosis is not found on chest x-ray, the next step is to perform high resolution CT scan or bronchoscopy. HRCT is better for diagnosis of bronchiectasis or lung carcinoma. Flexible bronchoscopy is better for diagnosis of mucosal abnormalities such as bronchitis, Dieulafoy disease or kaposi sarcoma.

Diagnostic Study of Choice

Study of choice

Diagnosis of Mild to Moderate Hemoptysis

The algorithm is based on the American Family Physician Journal of hemoptysis: Diagnosis and Management [7]

 
 
 
 
 
 
 
 
 
 
 
 
Hemoptysis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Mild hemoptysis
❑ <30 cc in 24 hours [8]
 
 
 
 
 
 
 
 
 
 
 
 
Moderate hemoptysis
❑ 30-200 cc in 24 hours [9]
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Chest X-ray (CXR)
 
 
 
 
 
 
 
 
 
 
 
 
Chest X-ray and CT
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Diagnose found
 
 
 
 
 
Diagnose unknown
 
 
 
 
Diagnose found
 
 
 
 
 
Diagnose unknown
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Treat underlying disease
 
 
 
 
 
Risk of malignancy[10]

❑ Smoking

❑ Occupational exposure

❑ Family history

❑ Previous cancer treatment
 
 
 
 
Treat underlying disease
 
 
 
 
 
Bronchoscopy to find diagnosis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
 
No
 
 
 
 
Diagnose found
 
 
 
 
 
Diagnose unknown
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CT or bronchoscopy to find diagnosis
 
 
 
 
 
Close monitoring
 
 
 
 
Treat underlying disease
 
 
 
 
 
Close monitoring
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Diagnose found
 
 
 
 
 
Diagnose unknown
 
If hemoptysis persist consult with pneumonologist
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Treat underlying Disease
 
 
 
 
 
Close monitoring
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

References

  1. ↑ Khalil, A.; Fedida, B.; Parrot, A.; Haddad, S.; Fartoukh, M.; Carette, M.-F. (2015). "Severe hemoptysis: From diagnosis to embolization". Diagnostic and Interventional Imaging. 96 (7–8): 775–788. doi:10.1016/j.diii.2015.06.007. ISSN 2211-5684.
  2. ↑ Andersen, P. E. (2016). "Imaging and interventional radiological treatment of hemoptysis". Acta Radiologica. 47 (8): 780–792. doi:10.1080/02841850600827577. ISSN 0284-1851.
  3. ↑ Lee, Myoung Kyu; Kim, Sang-Ha; Yong, Suk Joong; Shin, Kye Chul; Kim, Hyun Sik; Yu, Tae-Sun; Choi, Eun Hee; Lee, Won-Yeon (2015). "Moderate hemoptysis: recurrent hemoptysis and mortality according to bronchial artery embolization". The Clinical Respiratory Journal. 9 (1): 53–64. doi:10.1111/crj.12104. ISSN 1752-6981.
  4. ↑ Gupta, Mudit; Srivastava, Deep Narayan; Seith, Ashu; Sharma, Sanjay; Thulkar, Sanjay; Gupta, Rashmi (2013). "Clinical Impact of Multidetector Row Computed Tomography Before Bronchial Artery Embolization in Patients With Hemoptysis: A Prospective Study". Canadian Association of Radiologists Journal. 64 (1): 61–73. doi:10.1016/j.carj.2011.08.002. ISSN 0846-5371.
  5. ↑ Noë, G.D.; Jaffé, S.M.; Molan, M.P. (2011). "CT and CT angiography in massive haemoptysis with emphasis on pre-embolization assessment". Clinical Radiology. 66 (9): 869–875. doi:10.1016/j.crad.2011.03.001. ISSN 0009-9260.
  6. ↑ Sakr, L.; Dutau, H. (2010). "Massive Hemoptysis: An Update on the Role of Bronchoscopy in Diagnosis and Management". Respiration. 80 (1): 38–58. doi:10.1159/000274492. ISSN 1423-0356.
  7. ↑ name="pmid16225028">Bidwell JL, Pachner RW (2005). "Hemoptysis: diagnosis and management". Am Fam Physician. 72 (7): 1253–60. PMID 16225028.
  8. ↑ name="pmid12243312">Fidan A, Ozdoğan S, Oruç O, Salepçi B, Ocal Z, Cağlayan B (2002). "Hemoptysis: a retrospective analysis of 108 cases". Respir Med. 96 (9): 677–80. PMID 12243312.
  9. ↑ name="pmid12243312">Fidan A, Ozdoğan S, Oruç O, Salepçi B, Ocal Z, Cağlayan B (2002). "Hemoptysis: a retrospective analysis of 108 cases". Respir Med. 96 (9): 677–80. PMID 12243312.
  10. ↑ Parkin DM, Boyd L, Walker LC (2011). "16. The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010". Br J Cancer. 105 Suppl 2: S77–81. doi:10.1038/bjc.2011.489. PMC 3252065. PMID 22158327.
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