Value of fiberoptic bronchoscopy and angiography for diagnosis of the bleeding site in hemoptysis.

We evaluated 36 patients during active hemoptysis and compared the diagnostic yield of different procedures. Twenty-seven patients (75%) had one or more previous episodes of hemoptysis, most of which were not massive. Fiberoptic bronchoscopy was performed in 25 patients, and the bleeding site was identified in 17 (68%). The likelihood of localizing the bleeding site was significantly higher with early versus delayed fiberoptic bronchoscopy (91% versus 50%). Bronchial arteriography was performed in all 36 patients; positive arteriographies were observed in 20 cases (55.5%). Arteriography was positive in only 2 of the 8 cases in which fiberoptic bronchoscopy did not localize the site of bleeding. Bronchial artery embolization was successfully performed in 10 patients. However, the bleeding recurred within the first week after embolization in 2 patients, and 1 of them died.