In a patient with hemoptysis and a normal CXR with a high index of suspicion for lung cancer, bronchoscopy or CT chest should be done first?

• CT chest in this setting can show lesions that are not visible in CXR thus helping us to concentrate on segments where the lesion is anticipated.
• It can also show mediastinal nodes and we can plan for Wang needle aspiration if feasible.
• If a lesion is seen on CT and even if bronchoscopy is negative w/u should not stop.
• CT is insensitive in demonstrating early mucosal abnormalities, bronchitis, squamous metaplasia etc which can only be detected by bronchoscopy.

My recommendation: Do CT chest first followed by bronchoscopy.

Ref: Radiolgy.189(3):677-80,1993.

Return to Diagnosis