The role of fiberoptic bronchoscopy in patients with hemoptysis and a normal chest roentgenogram.

We reviewed the charts of 478 patients who had fiberoptic bronchoscopy (FOB) performed for evaluating hemoptysis with a normal chest roentgenogram. FOB provided a definite diagnosis of endobronchial lesion in only 10 patients (2.1%): bronchogenic carcinoma in 2 patients, bronchial adenoma in 1 patient, tracheal cancer in 1 patient, foreign body in 3 patients and endobronchial tuberculosis in 3 patients. FOB neither visualized tumor mass nor localized the bleeding site in 300 (95.8%) of 313 patients with mild hemoptysis. However, the bleeding site could be localized by FOB in 56% of the patients (n = 165) if the bleeding amount exceeded 60 ml/day. In conclusion, in patients with hemoptysis and normal chest roentgenograms, routine FOB may not rule out airway malignancy. In contrast, it is a good diagnostic tool for localizing the bleeding site if patients present with moderate amount of hemoptysis.