Imaging in hemoptysis patients Latest Guideline by KSTR

The Korean Society of Radiology and the Korean Society of Thoracic Radiology KSTR have proposed a new clinical imaging guideline for adult patients with hemoptysis.

The guideline published in the Korean Journal of Radiology was prepared through the consensus of a development committee, working party, and an advisory committee. The guideline proposal process was based on evidence-based clinical imaging guideline proposed by the development committee.

Hemoptysis is spitting blood from the respiratory tract due to various causes that range from blood tinged sputum to massive blood loss. The causes include benign diseases such as bronchiectasis, acute bronchitis, chronic bronchitis, tuberculosis, diffuse interstitial lung disease, and pulmonary venous malformation or malignant disease such as lung cancer and idiopathic. Therefore, appropriate screening test and complete medical examinations are required.

Key Recommendations:

• Chest radiography is suggested for initial evaluation in all adult patients with hemoptysis.


• Contrast-enhanced chest CT scan is recommended to diagnose the cause of hemoptysis in all adult patients with hemoptysis and who have two risk factors for lung cancer (> 40 years old and > 30 pack-year smoking history).


• Contrast-enhanced chest CT scan is recommended to diagnose the cause of hemoptysis in all adult patients with moderate hemoptysis (> 30 mL/24 hours) or recurrent hemoptysis.


• Contrast-enhanced chest CT scan should also be considered in adult patients with massive hemoptysis (> 400 mL/24 hours) and preserved cardiopulmonary function.

Consideration of Recommendation

Performing chest radiography as a screening test in all such patients is useful in terms of low radiation exposure, lateralization of bleeding site, and as a screening test for lung disease.

Regardless of the amount of hemoptysis, chest CT is recommended in patients who have two risk factors for malignancy (> 40 years old and > 30 pack-year smoking history). Chest CT has the benefit to detect hidden lung cancer that cannot be detected by chest radiography; however, caution is advised due to radiation exposure.

CT is very useful for the simultaneous detection of the bleeding site and cause of bleeding in patients with moderate (> 30 mL/24 hours) or recurrent hemoptysis. In Korea, it is commonly associated with inflammatory diseases that include active tuberculosis and tuberculosis sequelae. In these cases, chest radiography has several limitations in the evaluation of the bleeding site. CT is therefore very useful for the exact evaluation of bleeding size and causative disease.

Bronchial artery embolization is considered a treatment option for patients with massive, moderate, or recurrent hemoptysis. CT performed before embolization shows a detailed anatomy of both the bronchial artery and pulmonary artery, helps guide the procedure and can reduce the procedure time. CT before embolization has significant benefits that outweigh radiation hazards.

Contrast-enhanced CT could have hazards related to the iodine contrast media. We should follow the consultation guide for contrast media that indicates the benefits of contrast media versus the harm from iodine before choosing to use contrast media.

For further reference follow the link: https://doi.org/10.3348/kjr.2018.19.5.866