The application of virtual bronchoscopy in the evaluation of hemoptysis: comparative evaluation with real fiberoptic bronchoscopy

Several applications of virtual bronchoscopy (VB) have been described the last three years (1997-2000), but none in patients with hemoptysis. To evaluate the diagnostic aid it might offer, the authors applied VB in patients with hemoptysis and normal or nonlocalising chest X-rays. 16 patients, smokers and nonsmokers, aged 41-77, underwent both fiberoptic bronchoscopy (FOB) and thin section of 3 mm helical computed tomography (CT) of the thorax with simultaneous administration of contrast material. The data were then reconstructed using a virtual endoscopy software system and the results of both methods were evaluated in a double blind fashion. The CT followed with virtual bronchoscopy reconstruction showed bronchiectasis in 6 patients, consolidation in another 6, with generalized stenosis of bronchi in 2 of them and normal findings in 4 of them. The FOB revealed no abnormality in 10 pts (those with no findings in CT, 4 with consolidation and 2 with bronchiectasis in CT), submocosal oedema in 2 (with stenosis in VB) and nonspecific mucosal findings in 4 patients (2 of them had no findings in CT and the other 2 had bronchiectasis). Although FOB is considered as necessary to exclude endobronchial tumor, it was of no value in the authors' patients. If the sensitivity of VB is to be as high in a large number of patients, VB may be proved as a precious potential screening test in patients with hemoptysis able to make the invasive FOB unnecessary in a significant percentage of them.