From the Guidelines
For patients presenting with hemoptysis, a CT chest with contrast is recommended as the initial imaging study 1. The use of contrast enhances the detection of vascular abnormalities, masses, and other potential causes of bleeding. If contrast is contraindicated due to renal impairment or allergy, a non-contrast CT chest can be performed, but this may reduce the sensitivity of the study 1. In cases where contrast-induced nephropathy is a concern, consider using a low-osmolar contrast agent and ensuring adequate hydration prior to the study.
Key Points
- CT chest with contrast is the preferred initial imaging study for hemoptysis
- Contrast enhances detection of vascular abnormalities and masses
- Non-contrast CT chest may be used if contrast is contraindicated, but sensitivity may be reduced
- Low-osmolar contrast agent and adequate hydration can help minimize contrast-induced nephropathy risk
Imaging Recommendations
- CT chest with contrast is recommended for both massive and non-massive hemoptysis 1
- CT chest without contrast may be used in patients with poor renal function or life-threatening contrast allergy 1
- There is no added value of CT chest without IV contrast prior to administering contrast in the diagnosis of hemoptysis or in preprocedural planning for BAE 1
From the Research
Indications for CT Scan in Hemoptysis
- A computed tomography (CT) scan of the chest with or without contrast is indicated for patients presenting with hemoptysis, especially in those with high risk for malignancy (>40 years old, >40 pack-year smoking history) and negative chest radiograph 2.
- CT scan is also suggested for initial evaluation in patients with suspicious chest radiograph findings, and in active or ex-smokers, despite a negative chest radiograph 2.
- Contrast-enhanced CT is the preferred technique for evaluating hemoptysis, as it can define the source of bleeding and guide therapeutic arterial embolization procedures 3, 4.
Specific Guidelines for CT Scan Use
- The American College of Radiology (ACR) recommends CT scan in patients with high risk for malignancy and negative chest radiograph, and in patients with massive hemoptysis (>400 mL/24 hours) 2.
- The Korean Clinical Imaging Guideline for Hemoptysis recommends contrast-enhanced chest CT in patients with two risk factors for lung cancer, moderate hemoptysis, or recurrent hemoptysis, and in patients with massive hemoptysis without cardiopulmonary compromise 5.
- A survey of physicians found that 51.3% of respondents suggested CT scan in each patient with non-life-threatening hemoptysis, and 87.1% suggested CT scan in each patient with life-threatening hemoptysis 3.
Role of CT Scan in Diagnostic Work-up
- CT scan is a useful imaging modality for localizing the bleeding site and identifying the underlying cause of hemoptysis 4, 6.
- CT scan can be used to guide therapeutic arterial embolization procedures, which are effective and safe therapeutic methods for managing massive and recurrent hemoptysis 4, 6.