Clinical and Radiological Profile of Patients with Haemoptysis

Abstract

BACKGROUND: Haemoptysis is one of the commonest manifestations of various pulmonary diseases. Haemoptysis is an alarming and worrisome symptom for the patient as well as the physician. It has several etiologies which sometimes can be difficult to diagnose, especially in cases of massive haemoptysis.

OBJECTIVES:

• To study the various clinical features and etiological profile of the patients admitted with haemoptysis in Medicine Wards.

• To know the role of imaging and other modalities in diagnosing the cause of haemoptysis.

PARTICIPANTS: All the patients admitted with haemoptysis in SKIMS Soura from OCT 2018  to SEPT 2020.

METHODS: It was a prospective, observational study. A detailed history, examination, relevant laboratory investigations of the patients were done. Chest X ray, CT-scan and bronchoscopy was done to narrow down the etiology. All the findings were entered in a proforma and then statistically analysed.

RESULTS: The majority (61.9%) of the patients admitted had mild haemoptysis. Males (63.4%) were affected more than females. The mean age of the patients was 47.6±19.1 years. The majority of the patients belonged to the rural areas with a rural to urban ratio of 3.78. The risk factors of haemoptysis was COPD, CKD, anticoagulation, a known malignancy, tobacco smoking and past history of ATT intake. Cough is the most common presenting symptom with 91% patients having the symptom. Other symptoms include fever, dyspnoea, and chest pain. Other symptoms include fever, dyspnoea, and chest pain. X-RAY lateralised the source of bleed in 95 patients out of the total of 134 patients i.e. 70.8%. It could identify the cause of the bleed in only 24 patients i.e. a total of only 17.9%. Out of the total 111 patients who underwent CT scan, the bleed could be lateralized in 92 patients i.e. 82.8% patients. CT scan identified the cause of the bleed in 89 patients i.e. 80.1%. Bronchoscopy was only done in 20 patients out of the total of 134 patients i.e. in 14.9%. It was able to lateralise the source of bleed in 9 patients i.e. in 6.7% patients and was able to identify the cause of the bleed in only 4 patients i.e. 2.9% patients. In our study the most common cause of haemoptysis was tuberculosis (active/sequelae) with a total of 20.8% patients. 11.2% had active tuberculosis and 9.7% had post tubercular fibrotic lung disease. The second most common cause of haemoptysis was community acquired pneumonia (14.9%). Most of the patients with community acquired pneumonia had mild haemoptysis. The third common cause of haemoptysis was lung carcinoma (11.9%) and bronchiectasis (11.9%). No aetiology could be found in 8.2% patients.

CONCLUSION: CT scan is a better radiological test to diagnose the aetiology and know the site of bleed and hence majority of the patients with moderate to severe haemoptysis undergo a CT scan.

Tuberculosis continues to be the major cause of haemoptysis in Kashmir. Malignancy is the second most common cause of haemoptysis in the valley and is on a growing trend, but hasn’t yet surpassed tuberculosis.

IMPLICATIONS: While dealing with a patient with haemoptysis in Kashmir, a physician must exclude tuberculosis and malignancy in every patient. A CT scan of all the patients should be done. Patients with massive haemoptysis should undergo an urgent bronchoscopy.