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