Characteristics of Patients Admitted with Hemoptysis to an Inner City Hospital

Introduction: Hemoptysis is defined as the expectoration of blood from the lungs or tracheobronchial tree. There is a wide variation in its severity and etiology. In this study we aimed to determine the characteristics of patients admitted with hemoptysis to an inner city hospital.Methods: This was a retrospective review of all patients admitted to Bronx-Lebanon Hospital Center from January 2006 to July 2009 with the diagnosis of hemoptysis. Data regarding demographic characteristics, severity and etiology of hemoptysis and management of those patients was obtained.Results: 95 patients with hemoptysis were identified, 22 were excluded due to incomplete data and 73 were included in the final analysis. Males accounted for 48% of the cohort. Common comorbid diseases found were hypertension (60%), obstructive airway disease (47%), HIV infection (26%) and diabetes mellitus (17%). Twenty-three (32%) patients had normal chest imaging, either chest roentgenogram (CXR) or CXR and chest CT. Forty-six patients underwent CXR and chest CT, in 37% of those, either/both test revealed some findings. In 19 (51%) of patient who underwent CXR and chest CT for hemoptysis evaluation, the CXR was normal and the chest CT revealed abnormalities. Mild hemoptysis was seen in 79% of the patients with only one patient presenting with severe hemoptysis. Etiology was identified in 85% of the cases, infectious etiology being the most common (75%). Pneumocystis jiroveci was identified as a cause in 5.5% of the cases and no source in 15%. Invasive procedures were performed in 35% of patients, including flexible fiberoptic bronchoscopy in 23(31%) patients, bronchial artery embolization in 2(3%) patients and thoracotomy in one. Bronchoscopy identified source in 30% patients. Conclusion: Mild hemoptysis was the most common presentation in our inner city cohort. In patients presenting with hemoptysis and a normal CXR, chest CT should be considered as it is more sensitive to detect abnormalities leading to bleeding. In addition, infectious etiologies remain the most common etiology for hemoptysis. Clinicians should be aware that infection with Pneumocystis jiroveci can present with hemoptysis in HIV infected patients.