Chest
Volume 120, Issue 5, November 2001, Pages 1592-1594
Journal home page for Chest

Clinical Investigations
LUNG CANCER
Long-term Outcome and Lung Cancer Incidence in Patients With Hemoptysis of Unknown Origin

https://doi.org/10.1378/chest.120.5.1592Get rights and content

Study objective

To provide current data on the long-term outcome and incidence of lung cancer in a large cohort of patients with hemoptysis of unknown origin.

Design

A retrospective chart review followed by a telephone interview for follow-up.

Setting

A university-affiliated tertiary referral center for pulmonary diseases.

Patients

Seven hundred twenty-two patients who presented with hemoptysis from January 1990 to December 1993. One hundred thirty-five patients were identified as having hemoptysis of unknown origin.

Results

One hundred thirty-five patients (19%) had hemoptysis of unknown origin; follow-up data were obtained in 115 patients, of whom 100 were still alive. The mean time of observation was 6.6 years after initial presentation. Lung cancer developed in 7 of 115 patients (6%) and was unresectable once detected; all of these patients were smokers > 40 years old, and malignancy developed within 3 years after first presentation.

Conclusions

Hemoptysis of unknown origin is present in a minority of patients presenting with hemoptysis if evaluated at a referral center for pulmonary diseases. Lung cancer seems to be increasing in these patients compared to previous studies, and closer follow-up or additional testing may be indicated in the defined population at risk.

Section snippets

Materials and Methods

A retrospective chart review was performed on all patients who were referred to the pulmonary department for evaluation of hemoptysis between January 1990 and December 1993. Workup and results were reviewed. All patients underwent careful bronchoscopic evaluation of the tracheobronchial tree and chest radiography. A chest CT was performed at the discretion of the evaluating pulmonary physician. All bronchoscopic examinations were performed with a fiberoptic instrument in standard fashion.

Results

Within the reviewed period, 722 patients were evaluated for hemoptysis and all charts were available for review (Table 1). Four hundred eight-seven patients (67%) were men, and 235 patients (33%) were women. The mean age was 46.7 years (SD, 13.6; range 20 to 81 years). Four hundred forty patients (61%) were classified as smokers. A clinical diagnosis of COPD was present in 213 patients (30%).

In 587 patients (81%), a source and etiology for the bleeding could be identified at the time of initial

Discussion

Hemoptysis remains a distressing symptom and, at times, a challenging diagnostic problem. Clear guidelines for the initial workup and follow-up in patients without a definitive diagnosis are missing. Mostly, this appears to be due to a lack of current available data and follow-up in large groups. The etiology for hemoptysis may vary depending on geographic location, and infections such as tuberculosis play a significant role in developing countries.89 In many countries, malignancies are the

References (12)

There are more references available in the full text version of this article.

Cited by (79)

  • Managing Massive Hemoptysis

    2020, Chest
    Citation Excerpt :

    In a study of 80 patients with large or massive hemoptysis, chest radiograph was able to discern the location of hemorrhage in only 46% of cases and suggested the specific cause of bleeding in only 35%.37 In a separate study of 722 patients with minor and massive hemoptysis, a new diagnosis of malignancy was made in 144 patients; of these, 35 patients (24%) had normal chest radiograph findings.40 Multidetector CT scan is superior to chest radiograph in ability to identify both the anatomic origin and underlying cause of hemorrhage and to define the course of both bronchial and nonbronchial collateral arteries.37,38,41,42

  • Bronchoscopy in the investigation of outpatients with hemoptysis at a lung cancer clinic

    2018, Respiratory Medicine
    Citation Excerpt :

    Our study of 337 patients which includes a large modern prospective cohort presenting to a lung cancer clinic with hemoptysis has allowed us to analyze in detail the utility of investigations performed for lung cancer and investigate patient symptom and tumor types related to lung cancer in patients with hemoptysis. Given the fact that chest x-rays miss many patients with lung cancer and hemoptysis [6,7], it is routine practice that all patients undergo CT imaging. Chest CT has the ability to identify abnormalities in patients with hemoptysis secondary to lung cancer and also provide accurate staging compared to chest x-rays and standard bronchoscopy [1,8].

  • Lung Cancer Emergencies

    2018, IASLC Thoracic Oncology
View all citing articles on Scopus
View full text