Bronchoscopy to Evaluate Hemoptysis in Older Men with Nonsuspicious Chest Roentgenograms: Cardiomegaly

Cardiomegaly might be expected to have a similar effect, particularly if the hilar regions were obscured. However, the cardiomegaly which occurred in our patients tended to be mild and was not associated with an increased likelihood of cancer (present in one patient with cancer who also had tortuous aorta, and in ten patients without cancer).
Four of the five bronchogenic carcinomas appeared to be surgically resectable. Three of these were apparently very early diagnoses; two were described as polyps and one as a patch of elevated mucosa. In two of the four cases, resection was not undertaken because of the patients poor medical condition. Follow-up information was available for one of the two surgically treated patients. This patient was cancer-free at three years.

Mean follow-up information available for the entire series was 32 months. Six additional bronchogenic carcinomas were diagnosed during this period. Two non-small cell cancers were discovered 12 and 22 months, respectively, after the index bronchoscopy. The tumor diagnosed at 22 months showed no change on chest roentgenograms taken three months apart, suggesting a relatively slow growth pattern. We believe it likely that these two tumors were present but not detected at the time of bronchoscopy. The status at the time of the index bronchoscopy of the other four lung cancers diagnosed at follow-up is unclear. One was a rapidly growing small cell cancer diagnosed at 21 months, and three were non-small cell cancers diagnosed at 59, 62, and 73 months, respectively. Here

All six patients with later diagnoses of bronchogenic carcinoma had a smoking history of at least 20 pack-years. In other characteristics listed in Table 3, they closely resembled the patients without cancer. Five had nonlocalizing abnormalities on chest roentgenogram but none was central. The two patients whose cancers appear to have been missed at bronchoscopy had peripheral tumors which were again missed at repeat bronchoscopy at the time of their diagnosis. One patient had an apical mass found by computerized tomography which was done to evaluate recurrent hemoptysis after a chest roentgenogram and bronchoscopy were normal. The other patient had an incidental finding of a peripheral nodule on chest roentgenogram which led to thoracotomy after a negative bronchoscopy.

Category: Bronchoscopy

Tags: bronchoscopy, chest roentgenogram, hemoptysis, lung cancer