Evaluation of haemoptysis

What it is

Hemoptysis is coughing up blood. It may come as multiple episodes over a couple of days, and a patient may describe the amount as a quarter size.

Massive hemoptysis is generally defined as the expectoration of 200-300 mL or more of blood in 24 hours.

The order of the workup

1. A plain chest radiograph should come first in the workup for hemoptysis.
2. Patients with normal radiographs who have a higher risk of malignancy, meaning age 40 or above and a smoking history of 30 years or more, should undergo CT, usually with contrast.
3. If the CT is negative, pulmonary consultation and possible bronchoscopy should be pursued.

So a negative chest radiograph does not end the workup in a patient at risk of malignancy; it moves it to CT. And bronchoscopy is not the next best step after a normal film - it sits one stage further on, after a negative CT, and it comes with a pulmonary consultation rather than instead of one.