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.
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