A prospective evaluation of hemoptysis cases in a tertiary referral hospital Og ˘ uz Uzun, Yıldız Atasoy, Serhat Findik, Atilla Güven Atici and Levent Erkan Deparment of Pulmonary Medicine, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey Abstract Background and Aims: Hemoptysis is symptomatic of a potentially serious and life-threatening thoracic disease. The purpose of this study was to evaluate the relative frequency of the different causes of hemoptysis, the change of the frequency of diseases, the value of the evaluation process and the outcome in a tertiary referral hospital. Methods: A prospective study was carried out on consecutive patients presented with hemoptysis. Results: A total of 178 patients (136 male, 42 female) were included to the study. Lung cancer (51), pulmonary embolism (23) and bronchiectasis (23) constituted most of the diagnosis. The most frequent cause of hemoptysis in males was by far lung carcinoma (50). Twelve cases of bronchiectasis and 11 cases of pulmonary embolism were observed in females. While lung cancer and pulmonary embolism were associated with mild to moderate amounts of bleeding (84% and 100%, respectively), patients with active tuberculosis and pulmonary vasculitis had severe to massive hemoptysis (50% and 44%, respectively). Transthoracic and other organ biopsies, spiral computed tomography (CT) angiography (X pres/GX model TSX- 002a, Toshiba, Tochigi Ken, Japan) and aortography yielded high diagnostic results in our group (100%, 67%, 59% and 100%, respectively). The most frequent final diagnosis in patients with normal chest radiograph was pulmonary embolism (seven cases). Conclusions: Lung cancer, pulmonary embolism and bronchiectasis were the main causes of hemoptysis in this prospective cohort; however, this is the first report showing pulmonary embolism as a leading cause of hemoptysis. CT angiography with high-resolution CT should be the primary diagnostic modality if the initial investigation is inconclusive in hemoptysis cases. Please cite this paper as: Uzun O, Atasoy Y, Findik S, Atici AG and Erkan L. A prospective evaluation of hemoptysis cases in a tertiary referral hospital. The Clini- cal Respiratory Journal 2010; 4: 131–138. Introduction Hemoptysis is symptomatic of a potentially serious and life-threatening thoracic disease and warrants urgent investigation. Because the treatment and prog- nosis of hemoptysis are related to underlying diseases, the relative frequency of underlying causes is impor- tant. The etiology of hemoptysis varies among differ- ent series according to time of publication, the geographic location, the hospital and the diagnostic tests employed. The predominant cause of hemoptysis has changed from tuberculosis (TB) and bronchiecta- sis (1, 2) to lung cancer (3–5) since the control of TB in developed countries in the last 50 years and increase in the prevalence of smoking. However, despite modern diagnostic means, the cause cannot be detected in most patients with hemoptysis (6). There has been many changes in the practice of medicine, including widespread antibiotic use and new diagnostic methods that may have changed the preva- lence of diseases causing hemoptysis or revealed some cryptogenic causes undetected in previous studies. The Key words bronchiectasis – hemoptysis – lung cancer – pulmonary embolism Correspondence Og ˘ uz Uzun, MD, 19 Mayıs Universitesi, Tıp Fak, Gög ˘ üs Hst. AD 55139, Kurupelit Samsun, Turkey. Tel: +90 362 4590767 Fax: +90 362 4576041 email: oguzuzun67@yahoo.com.tr Received: 14 May 2009 Revision requested: 9 June 2009; 4 July 2009 Accepted: 15 July 2009 DOI:10.1111/j.1752-699X.2009.00158.x Authorship Dr. Uzun and Dr. Erkan designed the study. Dr. Uzun, Atasoy, Findik and Atici collected data and performed study. Dr. Atasoy analysed data, and Dr. Uzun wrote the paper. Ethics This study has been approved by the Local Institutional Board. Conflict of interest The authors have stated explicitly that there are no conflicts of interest in connection with this article. The Clinical Respiratory Journal ORIGINAL ARTICLE 131 The Clinical Respiratory Journal (2010) • ISSN 1752-6981 © 2009 Blackwell Publishing Ltd