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ACR Appropriateness Criteria® Hemoptysis

2014; Lippincott Williams & Wilkins; Volume: 29; Issue: 3 Linguagem: Inglês

10.1097/rti.0000000000000084

1536-0237

Loren H. Ketai, Tan-Lucien Mohammed, Jacobo Kirsch, Jeffrey P. Kanne, Jonathan H. Chung, Edwin F. Donnelly, Mark E. Ginsburg, Darel E. Heitkamp, Travis S. Henry, Ella A. Kazerooni, Jonathan M. Lorenz, Barbara L. McComb, James G. Ravenel, Anthony Saleh, Rakesh Shah, Robert M. Steiner, Robert D. Suh,

Pulmonary Hypertension Research and Treatments

Hemoptysis is defined as the expectoration of blood originating from the tracheobronchial tree or pulmonary parenchyma, ranging from 100 mL to 1 L in volume over a 24-hour period. This article reviews the literature on the indications and usefulness of radiologic studies for the evaluation of hemoptysis. The following recommendations are the result of evidence-based consensus by the American College of Radiology Appropriateness Criteria Expert Panel on Thoracic Radiology: (1) Initial evaluation of patients with hemoptysis should include a chest radiograph; (2) Patients at high risk for malignancy (>40 y old, >40 pack-year smoking history) with negative chest radiograph, computed tomography (CT) scan, and bronchoscopy can be followed with observation for the following 3 years. Radiography and CT are recommended imaging modalities for follow-up. Bronchoscopy may complement imaging during the period of observation; (3) In patients who are at high risk for malignancy and have suspicious chest radiograph findings, CT is suggested for initial evaluation; CT should also be considered in patients who are active or exsmokers, despite a negative chest radiograph; and (4) Massive hemoptysis can be effectively treated with either surgery or percutaneous embolization. Contrast-enhanced multidetector CT before embolization or surgery can define the source of hemoptysis as bronchial systemic, nonbronchial systemic, and/or pulmonary arterial. Percutaneous embolization may be used initially to halt the hemorrhage before definitive surgery.