The Indian Journal of Tuberculosis - LRS Institute of Tuberculosis ...
The Indian Journal of Tuberculosis - LRS Institute of Tuberculosis ... The Indian Journal of Tuberculosis - LRS Institute of Tuberculosis ...
Original Article Ind. J. Tub., 1992, 39, 33 FIBREOPTIC BRONCHOSCOPY IN PATIENTS HAVING IDIOPATHIC HAEMOPTYSIS B.K Khanna and S.K. Sharma (Received on 18.9.90; Accepted on 30.8.91) Then, fibreoptic bronchoscopy was done in each case under local anaesthesia. Bronchial biopsy was done in those patients having visible growth. In all the cases, bronchial aspirate was collected under aseptic conditions and sent for microbiological and pathological examination. Introduction Haemoptysis is a common symptom in diseases of respiratory system. It is all the more common in this country where tuberculosis is still rampant. The aetiological diagnosis can be established in not more 66% of the cases with non-invasive techniques 1 The problem, indeed, becomes challenging when this symptom occurs in an asymptomatic case presenting with a 'normal' chest X-ray (“idiopathic” haemoptysis). In our department, we have performed fibreoptic bronchoscopy (bronchial aspirate and bronchial biopsy, where indicated) in 28 such cases. The analysis of the findings in these cases is presented. Material and Methods In all 28 cases with a 'normal' chest X-ray and history of having had haemoptysis (moderate degree : more than 10 ml. but less than 100 ml) were admitted to Kasturba TB Hospital for investigation during the calender years 1987-1989. Of these, 20 cases were male and 8 female; their mean age was 26.2 years and history of previous respiratory and or cardiac illness was absent. None were smokers or ex-smokers. Repeat chest X-ray (P.A. and the relevant lateral view) was taken in each case and labelled as normal only when two physicians of the department concurred. Results The final diagnosis arising out of fibreoptic bronchoscopy is shown below : Total cases examined Tracheo-bronchitis Pulmonary tuberculosis Bronchogenic carcinoma (adeno-carcinoma) No finding Discussion 28 6 Fibreoptic bronchoscopy is a valuable diagnostic tool and its indications are well defined 1 Haemoptysis of unknown origin is a recognised clinical entity despite repeated efforts at establishing the aetiology of haemoptysis, which do not succeed beyond 33% 2 - The diseases commonly responsible for idiopathic haemoptysis include bronchogenic carcinoma, chronic bronchitis, pulmonary tuberculosis and endobronchial granuloma. In Jackson's series of 48 cases 2 ' only in 4 cases could the cause of haemoptysis be established by fibreoptic bronchoscopy. The frequency and nature of diseases underlying idiopathic haemoptysis vary with age of the patient, amount of apparent haemoptysis and prevalence of various respiratory diseases in that country. However, we 2 1 Department of Tuberculosis & Respiratory Diseases, K.G.'s Medical College, Lucknow. Correspondence : Dr. B.K. Khanna, Professor and Head of Department of TB and Resspiratory Diseases, K.G.'s Medical. College, Lucknow-226 003.
B.K KHANNA AND S.K. SHARMA also succeeded in establishing the correct diagnosis by fibreoptic bronchoscopy in 32.8% (9 out of 28 cases) which is comparable to the other studies conducted elsewhere 3 ' 455 With the advent of newer techniques, especially CAT Scan of thorax, the diagnostic success of non-invasive procedures is bound to increase. However, these procedures being very costly may not be within the reach of all the cases in developing countries. For all unlabelled cases, periodic follow up is the only available alternative, the duration of follow up varying with the circumstances 5 References 1. Seaton, A., Seaton, D. and Leitch, A.G.: Crofton and Douglas's Respiratory Diseases, 4th Edition 1989, Oxford University Press, Delhi. 2. Jackson, C.V., Savage, P.J. and Quinn, D.L. ; Role of fibreoptic bronchoscopy in patients with haemoptysis and a normal chest roentgenogram, Chest; 1985, 87, 142. 3. Somner, A.R., Hillis, B.R,, Douglas, A.C., Marks, B.L. and Grant, I.W. Value of Bronchoscopy in clinical practice. : Brit. Med Jl.; 1958, 2: 1079. 4. Johnson, R.N., Lockhart, W., Ritchie, R.T. and Smith, D.H. : Haemoptysis, Brit. Med. JL; 1960, 1, 592. 5. Crofton, J. and Douglas, A. : Respiratory Diseases, 1983, 3rd Edition, Blackwell Scientific Publications London.
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B.K KHANNA AND S.K. SHARMA<br />
also succeeded in establishing the correct<br />
diagnosis by fibreoptic bronchoscopy in 32.8% (9<br />
out <strong>of</strong> 28 cases) which is comparable to the other<br />
studies conducted elsewhere 3 ' 455<br />
With the advent <strong>of</strong> newer techniques,<br />
especially CAT Scan <strong>of</strong> thorax, the diagnostic<br />
success <strong>of</strong> non-invasive procedures is bound to<br />
increase. However, these procedures being very<br />
costly may not be within the reach <strong>of</strong> all the cases<br />
in developing countries. For all unlabelled cases,<br />
periodic follow up is the only available<br />
alternative, the duration <strong>of</strong> follow up varying with<br />
the circumstances 5<br />
References<br />
1. Seaton, A., Seaton, D. and Leitch, A.G.: Cr<strong>of</strong>ton<br />
and Douglas's Respiratory Diseases, 4th Edition<br />
1989, Oxford University Press, Delhi.<br />
2. Jackson, C.V., Savage, P.J. and Quinn, D.L. ;<br />
Role <strong>of</strong> fibreoptic bronchoscopy in patients with<br />
haemoptysis and a normal chest roentgenogram,<br />
Chest; 1985, 87, 142.<br />
3. Somner, A.R., Hillis, B.R,, Douglas, A.C.,<br />
Marks, B.L. and Grant, I.W. Value <strong>of</strong><br />
Bronchoscopy in clinical practice. : Brit. Med Jl.;<br />
1958, 2: 1079.<br />
4. Johnson, R.N., Lockhart, W., Ritchie, R.T. and<br />
Smith, D.H. : Haemoptysis, Brit. Med. JL; 1960,<br />
1, 592.<br />
5. Cr<strong>of</strong>ton, J. and Douglas, A. : Respiratory<br />
Diseases, 1983, 3rd Edition, Blackwell Scientific<br />
Publications London.
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