EVALUATION OF PATIENTS WITH HEMOPTYSIS ATTENDING THE DEPARTMENT OF PULMONOLOGY SANTHIRAM MEDICAL COLLEGE

Objective: To evaluate hemoptysis among patients who attended the department of pulmonary medicine, Santhiram medical college and general hospital. Material And Methods: This was a descriptive cross sectional study done on patients with at least one episode of hemoptysis attending to the Department of pulmonary medicine, Santhiram medical college and general hospital from January 2015 to August 2016. All the patients are evaluated by -Chest x-ray pa-view, CT-chest, Sputum for culture and sensitivity, Sputum for KOH mount, Sputum for AFB, Bronchoscopy, Upper airway and nasal examination, Complete blood picture, Coagulation profile, ECG, Complete urine examination, ICTC, 2d-Echo (if necessary).The final diagnosis is noted and the data will be statistically analysed. Results: The age of the patients ranged from 21-75 years with a mean age of 49.42 years. Predominant age group was 41-60 years accounting for 49%.48% had history of smoking and all the smokers in the study were males. Hypertension was the most common associated medical condition (27%) followed by Diabetes Mellitus (22%).Tuberculosis was the most common underlying lung disease from the history (36%).Consolidation was the most common radiographic feature in 39% patients. Suspected clinical diagnosis was made in most of the cases. Tuberculosis was the most common final diagnosis of our study. Out of 34 cases, 21 cases were diagnosed by sputum for AFB and remaining 13 cases were diagnosed with the help of Fibre-optic bronchoscopy. 5 cases out of tuberculosis patients were retro-viral positive. All the retroviral positive cases (5%) were diagnosed as Tuberculosis. Of all the 20 cases of bronchiectasis 16 cases were confirmed by HRCT and remaining 4 showed characteristic clinical features and changes of bronchiectasis on chest radiographs. 13 cases (13%) were diagnosed as lung cancer, out of which 6 cases were squamous cell carcinoma, 2 cases were small cell carcinoma, 2 cases were secondaries in the lung, 1 case was adeno carcinoma, 1 case was poorly differentiated cell carcinoma and 1 case was carcinoid. Pneumonia was present in 9 cases (9%) and bacterial infection was the most common cause. 6 cases (6%) were diagnosed as Chronic bronchitis. All the cases were males with positive history of smoking. Diagnosis was made based on clinical history, chest radiograph, chest CT findings and spirometry. In 5 cases hemoptysis was unexplained by chest radiograph, chest CT and fibre-optic bronchoscopic evaluation and was diagnosed as idiopathic hemoptysis.3 cases (3%) were diagnosed as lung abscess and diagnosis was confirmed by chest CT in all the cases. 1 case was diagnosed as adenoma, 1 case was diagnosed as pulmonary embolism based on CT pulmonary angiogram, chest CT, bilateral lower limb venous colour Doppler, 2D-Echo and 1 case had foreign body. Out of 100 cases, 26 cases had streaky hemoptysis. Mild hemoptysis was present in 38 cases. Moderate hemoptysis was present in 25 cases. Severe hemoptysis was present in 9 cases. Life threatening hemoptysis was present in 3 cases. Out of the 3 cases with life threatening hemoptysis, 2 were sputum positive tuberculosis and 1 had bilateral bronchectasis. Out of the 100 cases 80 cases were managed conservatively. Ventilator support was provided to 19 cases. 1 bilateral bronchiectasis case with recurrent hemoptysis was referred for therapeutic embolization. Conclusion: Tuberculosis was the most common final diagnosis in our study. It is also evident that Squamous cell carcinoma was the most common malignancy surfaced out in our study. Most of the cases presented with mild hemoptysis. Tuberculosis is the most common cause of life threatening hemoptysis.