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

Bronchoscopy to Evaluate Hemoptysis in Older Men with Nonsuspicious Chest Roentgenograms: ResultsThere were 58 current smokers, 41 ex-smokers, and seven patients who had never smoked. Chest roentgenogram findings are shown in Table 1. About one third of the patients had a chest roentgenogram read as normal, with the remainder having the abnormalities shown. Patients with normal chest roentgenograms were significantly younger than patients with nonlocalizing abnormalities (mean age, 58.9 years vs 62.5 years, p<0.05).
Table 2 shows the final diagnoses of the cause of hemoptysis. Six patients (5.7 percent) had cancer diagnosed at bronchoscopy; five had non-small cell bronchogenic carcinomas and one had a pulmonary metastasis of a previously undiagnosed renal cell carcinoma.

In Table 3, characteristics of these six patients with cancer are compared with those of the patients without cancer. Cancer patients were significantly older, and had nonsignificant increases in smoking history, duration (but not volume) of hemoptysis, and in frequency of chronic obstructive pulmonary disease, weight loss, and hoarseness. They were less likely to have had evidence of acute bronchitis (purulent sputum by history or inflammation noted at bronchoscopy) or a normal chest roentgenogram, but again these changes were not significant. All of the cancers occurred in patients who had smoked within the last five years. other

Comparison of chest roentgenogram findings was remarkable for the occurrence of three instances of tortuous aorta among the cancer patients (50 percent) compared with only two in 100 patients without cancer (2 percent, p<0.001). This p value remains significant after adjustment for multiple comparisons (ie, the 19 different chest roentgenogram findings). Because the most plausible explanation for this observation was that the aorta obscured visualization of the central lung fields, we also examined the occurrence of central abnormalities as a group; ie, tortuous aorta, prominent pulmonary arteries, and hilar fullness. These were present in four of six cancer patients (67 percent) compared with six of 100 patients without cancer (6 percent, p<0.001).
Table 1—Che8t Roentgenogram Findings

Finding No. of patients
Normal 38
Nonlocalizing abnormalities 68
Minima] fibrosis 18
Pleural changes 14
Cardiomegaly 11
Costophrenic angle blunting 9
Calcified granuloma 9
Hyperexpanded lung fields 6
Tortuous aorta 5
Blebs or bullae 5
Postoperative changes 4
Cephalization 4
Minimal atelectasis 4
Prominent pulmonary arteries 3
Elevated hemidiaphragm 2
Hilar fullness 2
Questionable infiltrates 1
Increased interstitial markings 1
Skeletal abnormalities 1
Goiter causing tracheal deviation 1

Table 2—Diagnoses in 106 Men with Hemoptysis and a Nonsuspicious Chest Roentgenogram

Diagnoses No. of Patients
Bronchogenic carcinoma 5
Metastatic renal carcinoma 1
Bronchitis 54
No diagnosis 27
Warfarin induced 5
Nasopharyngeal source 3
Tracheitis 2
Bronchiectasis 2
Congestive heart failure 2
Postoperative 1
Pulmonary hypertension 1
Acid inhalation 1
Pulmonary embolus 1
Drug related (hydralazine) 1

Table 3—Characteristics Associated with a Bronchoscopic Diagnosis of Cancer

Characteristic Patients with Cancer (n = 6) Patients without Cancer (n = 100) p Value
Mean age (yrs) 70 61 p<0.05
Mean smoking history (pack-years) 62 49 NS
Smoking history >20 pack-years 100% 88% NS
Smoked within last five years 100% 65% NS
Hemoptysis > one week 67% 49% NS
Hemoptysis ^5 ml/day 67% 54% NS
Hemoptysis ^100 ml/day 17% 21% NS
Chronic obstructive pulmonary disease 67% 44% NS
Purulent sputum 17% 38% NS
Inflamed mucosa seen at bronchoscopy 17% 34% NS
Weight loss 33% 7% NS
Hoarseness 17% 2% NS
Chest roentgenogram findings
Normal 17% 37% NS
Tortuous aorta 50% 2% p<0.001
Centrally obscuring abnormalities
(tortuous aorta, prominent pulmonary arteries, or hilar fullness) 67% 6% p<0.001

Category: Bronchoscopy

Tags: bronchoscopy, chest roentgenogram, hemoptysis, lung cancer