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ACR Appropriateness Criteria® Hemoptysis

Jeudy, Jean MD*; Khan, Arfa R. MD; Mohammed, Tan-Lucien MD; Amorosa, Judith K. MD§; Brown, Kathleen MD; Dyer, Debra Sue MD; Gurney, Jud W. MD; MacMahon, Heber MB, BCh**; Saleh, Anthony G. MD†† ‡‡; Vydareny, Kay H. MD§§Expert Panel on Thoracic Imaging

doi: 10.1097/RTI.0b013e3181e35b0c
Web Exclusive Content—Appropriateness Criteria Review

Hemoptysis is defined as the expectoration of blood originating from the tracheobronchial tree or pulmonary parenchyma, ranging from 100 mL to 1 L in volume over a 24-hour period. This article reviews the literature on the indications and usefulness of radiologic studies for the evaluation of hemoptysis. The following recommendations are the result of evidence-based consensus by the American College of Radiology Appropriateness Criteria Expert Panel on Thoracic Radiology: (1) Initial evaluation of patients with hemoptysis should include a chest radiograph; (2) Patients at high risk for malignancy (>40 y old, >40 pack-year smoking history) with negative chest radiograph, computed tomography (CT) scan, and bronchoscopy can be followed with observation for the following 3 years. Radiography and CT are recommended imaging modalities for follow-up. Bronchoscopy may complement imaging during the period of observation; (3) In patients who are at high risk for malignancy and have suspicious chest radiograph findings, CT is suggested for initial evaluation; CT should also be considered in patients who are active or exsmokers, despite a negative chest radiograph; and (4) Massive hemoptysis can be effectively treated with either surgery or percutaneous embolization. Contrast-enhanced multidetector CT before embolization or surgery can define the source of hemoptysis as bronchial systemic, nonbronchial systemic, and/or pulmonary arterial. Percutaneous embolization may be used initially to halt the hemorrhage before definitive surgery.

*Department of Radiology, University of Maryland Medical Center, Baltimore, MD

Department of Radiology, Long Island Jewish Medical Center, New Hyde Park

††New York Methodist Hospital, The Institute for Asthma and Lung Disease, Brooklyn, NY

‡‡The American College of Chest Physicians, Northbrook, IL

Cleveland Clinic Foundation, Imaging Institute, Cleveland, OH

§Department of Radiology, Robert Wood Johnson Medical School, New Brunswick, NJ

Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA

Department of Radiology, National Jewish Health, Denver, CO

Department of Radiology, University of Nebraska, Omaha, NE

**Department of Radiology, University of Chicago Hospital, Chicago, IL

§§Department of Radiology, Emory University School of Medicine, Atlanta, GA

This article is a summary of the complete version of this topic, which is available on the ACR website at Practitioners are encouraged to refer to the complete version.Reprinted with permission of the American College of Radiology.

Reprints: Jean Jeudy, MD, 1020 Park Ave., Apt 507, Baltimore, MD 21201-5643 (e-mail:

The American College of Radiology (ACR) seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria® through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply society endorsement of the final document.

© 2010 Lippincott Williams & Wilkins, Inc.