Hemoptysis with no malignancy suspected on computed tomography rarely requires bronchoscopy

Background: Hemoptysis is an alarming and common symptom leading to thorough diagnostic evaluation with computed tomography and fiberoptic bronchoscopy. Increasing evidence suggests that bronchoscopy is not necessary in diagnosing lung cancer in hemoptysis patients because of high sensitivity of computed tomography. However, less attention has been paid to non-malignant etiologies of hemoptysis. Objective: We aimed to identify the etiologies established in hemoptysis patients with no malignancy suspected on computed tomography in order to assess the necessity of bronchoscopy in these patients. Design: We retrospectively reviewed clinical records of consecutive patients referred to evaluation for hemoptysis with no malignancy suspected on computed tomography at Aalborg University Hospital, Denmark, in an eleven-year period from 2006 to 2016. Results: One thousand one hundred and eighty-five patients (mean age 57.5 ± 15.44 years, 61.3% male) were included in the study. Bronchoscopy was performed in 91.9% of cases. Most patients (83.5%) had cryptogenic hemoptysis, while the most frequently identified etiologies were respiratory tract infection (12.6%) and bronchiectasis (2.2%). No patients had malignant disease as their etiology. Conclusions: The vast majority of hemoptysis cases with no malignancy suspected on computed tomography were cryptogenic and all were benign. Bronchoscopy may be reserved for patients with specific conditions suspected and those with persistent symptomatology.