Hemoptysis, defined as the expectoration of blood from the lower respiratory tract due to bronchial or pulmonary vascular hemorrhage, ranges from blood-streaked sputum to life-threatening massive hemoptysis. Severity is categorized by volume: mild (<30 mL), moderate (31–100 mL), severe (100–600 mL), and massive (>600 mL). However, life-threatening hemoptysis is not solely volume-based but also influenced by airway obstruction risk and hemodynamic instability.1 It remains a distressing and frequent symptom in pulmonary and cardiovascular diseases. Its causes vary widely, including infections, bronchiectasis, malignancies, autoimmune conditions, and vascular anomalies.2 Tuberculosis (TB) leads the etiological spectrum in developing countries, whereas lung carcinoma and other non-infectious causes dominate in developed regions. Despite medical advancements, hemoptysis contributes significantly to morbidity and mortality, demanding prompt diagnosis and intervention.3 The etiology of hemoptysis evolves with geography and healthcare progress. While TB remains prevalent in low-resource areas, its incidence is declining due to better control programs. Non-tuberculous causes like bronchiectasis, fungal infections, and malignancies are increasingly recognized with better diagnostic modalities. Effective management hinges on accurate cause identification and bleeding site localization. A thorough clinical assessment, including history and examination, is essential for guiding diagnostics. Radiological imaging is crucial in evaluating hemoptysis. Chest radiography, often the first-line tool, is cost-effective but limited in detecting subtle or complex pathology.4 Advanced imaging like Contrast-Enhanced CT (CECT), High-Resolution CT (HRCT), and CT Pulmonary Angiography (CTPA) offer superior detail, helping diagnose bronchiectasis, aspergilloma, malignancy, and vascular abnormalities. CT imaging significantly improves diagnostic accuracy compared to chest X-rays alone, aiding in distinguishing TB, fibrosis, fungal infections, and neoplasms. Combined with bronchoscopy, which enables direct airway visualization and targeted therapies, the diagnostic yield nears 100%.5 Region-specific studies are crucial to identify local clinico-radiological and etiological patterns in hemoptysis. Due to its multifactorial causes and varying severity, a structured diagnostic approach is essential. This study investigates hemoptysis etiology and clinical-radiological features in a tertiary care setting to enhance patient care and outcomes.6

Study Design and Setting: This cross-sectional observational study was conducted over 18 months in the Department of Respiratory Medicine at Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan. It included all patients presenting with hemoptysis, either in the Outpatient Department or during hospitalization, based on predefined inclusion and exclusion criteria. Inclusion Criteria: The study included patients aged 18 years and above who presented with hemoptysis to the Department of Respiratory Medicine at Mahatma Gandhi Medical College and Hospital, Jaipur. Only those who provided written informed consent were enrolled. Exclusion Criteria: Patients who were moribund and unable to undergo necessary investigations were excluded from the study. Statistical Analysis: All relevant data were recorded using Microsoft Excel spreadsheet software, and appropriate statistical analyses were performed accordingly.

Table No- 1 Distribution of Patients According to General Physical Examination. General Physical Examination No. of Patients Percentage Pallor 44 44 Icterus 1 1 Cyanosis 4 4 Clubbing 43 43 Lymphadenopathy 23 23 Edema 11 11 The study included 100 patients aged 18–90 years (mean age 53.93 ± 17.15 years), with a male predominance (76%). Most patients were in the 46–60 years age group (32%). On examination, pallor was noted in 44%, clubbing in 43%, lymphadenopathy in 23%, cyanosis in 4%, icterus in 1%, and edema in 11%. The remaining patients showed no such signs. This demographic and clinical profile highlights a predominance of middle-aged males with common signs being pallor and clubbing. The most common chief complaint among patients was cough, reported by 87 patients (87%). Dyspnea was present in 67 patients (67%). Expectoration was noted in 51 patients (51%). Fever was reported by 38 patients (38%). Loss of weight (LoW) was present in 48 patients (48%). Loss of appetite (LoA) was reported in 31 patients (31%). Chest pain was present in 43 patients (43%). Table No- 2 Distribution of Patients According to Sputum Investigations. Sputum Investigations No. of Patients Percentage AFB Not done 34 34 Negative 55 55 Positive 11 11 CBNAAT Not done 50 50 Negative 26 26 Positive 24 24 Pyogenic / Fungal C/S Not done 56 56 Polymicrobial Flora 11 11 Sterile 33 33 Sputum investigations showed that 55% of patients were AFB-negative, 11% AFB-positive, and 34% were not subjected to the test. CBNAAT results were negative in 26%, positive in 24%, and not performed in 50%. Pyogenic/Fungal Culture and Sensitivity revealed polymicrobial flora in 11%, sterile cultures in 33%, and was not conducted in 56% of patients. These findings highlight a varied diagnostic distribution across the investigated tests. Table No- 3 Distribution of Patients According to Chest X-Ray findings. Chest X-Ray findings No. of Patients Percentage Consolidation 41 41 Collapse 16 16 Nodules 25 25 Fibrosis 33 33 Calcified Lesion 22 22 Cavitatory Lesion 16 16 Mass Lesion 17 17 Chest X-ray findings among the study population showed that consolidation was the most common abnormality, present in 41 patients (41%). Fibrosis was observed in 33 patients (33%). Nodules were seen in 25 patients (25%). Calcified lesions were present in 22 patients (22%). Collapse was noted in 16 patients (16%). Cavitatory lesions were identified in 16 patients (16%). Mass lesions were detected in 17 patients (17%). Table No- 4 Distribution of Patients According to CT Pulmonary Angiography. CT Pulmonary Angiography No. of Patients Percentage Infective Changes 3 37.5 Normal 2 25 Attenuation of Superior lobar branch 1 12.5 Pulmonary Sequestration 1 12.5 Soft calcified plaque 1 12.5 Total 8 100 CT Pulmonary Angiography was performed in 8 patients. Infective changes were the most common finding, observed in 37.5% of cases. Normal scans were reported in 25% of patients. Other findings included attenuation of the superior lobar branch, pulmonary sequestration, and soft calcified plaque, each seen in 12.5% of patients. Fibre-optic bronchoscopy was conducted for BAL and biopsy. BAL AFB, CBNAAT, and culture/sensitivity were not performed in 78% of patients. Of those tested, 7% were positive, 8% negative, and 7% showed sterile results. Biopsy was not done in 83% of cases. Among those biopsied, non-small cell carcinoma was found in 4%, squamous cell carcinoma in 3%, adenocarcinoma and small cell carcinoma in 2% each, and other malignancies or atypical findings in 1% each. Table No- 5 Distribution of Patients According to Diagnosis. Diagnosis No. of Patients Percentage Pulmonary Tuberculosis 26 26 Post TB sequelae 20 20 Carcinoma Lung 20 20 Silicosis 8 8 Bronchiectasis 5 5 Pneumonia 5 5 Silico-TB 4 4 Unknown Cause 4 4 COPD 2 2 Diffuse Alveolar Haemorrhage 2 2 Congenital Heart Failure 1 1 DPLD 1 1 Bronchiolitis 1 1 Lung Sequestration 1 1 Among the patients, pulmonary tuberculosis (26%) and post-tuberculosis sequelae (20%) were the most common diagnoses, followed by lung carcinoma (20%). Silicosis (8%) and silico-TB (4%) were also observed. Pneumonia and bronchiectasis each accounted for 5%, while COPD and diffuse alveolar hemorrhage contributed 2% each. Rare cases (1% each) included bronchiolitis, CHF, DPLD, and lung sequestration. The etiology was unknown in 4% of cases.

Hemoptysis was evaluated through clinical and radiological assessment in this study. Common associated symptoms were cough, fever, and breathlessness. Imaging revealed cavitary lesions, consolidation, and masses. Pulmonary tuberculosis was the leading cause, while malignancies were more prevalent in older, smoking individuals, guiding further diagnostic steps. On examination, pallor and clubbing were noted in 44% and 43% of patients, respectively; lymphadenopathy in 23%, edema in 11%, cyanosis in 4%, and icterus in 1%, while the majority lacked these findings. Kaur H et al7 reported pallor in 84% of patients, indicating anemia or chronic illness, with clubbing in 26% and lymphadenopathy in 20%, suggesting chronic hypoxia, infections, or malignancies. Similarly, Singh A et al8 found clubbing was more prevalent at 61%, pointing to advanced or chronic respiratory disease. These findings reflect the varied clinical presentations and underline the chronic nature of the underlying respiratory conditions. Sputum analysis revealed 55% of patients were AFB-negative, 11% positive, and 34% were not subjected to the test. Similarly, CBNAAT was negative in 26%, positive in 24%, and not performed in 50%. Pyogenic/fungal cultures showed polymicrobial growth in 11%, sterile results in 33%, and were not done in 56% of cases. In a similar study, Selvendran V et al9 found that sputum AFB, CBNAAT, and chest X-rays identified 66.66% of active PTB cases, while 33.33% needed further assessment via CT and bronchoscopy. Bronchial wash CBNAAT confirmed PTB in all remaining cases, highlighting its diagnostic utility when sputum tests were negative. Similarly, Munjal S K et all0 reported AFB positivity in 18.6% and Gene-Xpert detection in 16%, confirming tuberculosis in a subset of patients. These findings underscore the importance of advanced diagnostic tools for accurate PTB detection. In the present study, cough emerged as the predominant symptom, noted in 87% of patients, followed by dyspnea in 67%. Expectoration was documented in 51% of cases, while fever was seen in 38%. Loss of weight and loss of appetite were reported in 48% and 31% of patients respectively. Chest pain was experienced by 43% of the participants. Selvendran V et al9 reported sputum production as the most common symptom (75%), followed by dyspnea (56%), fever (42%), and weight/appetite loss (40%), while chest pain was infrequent (12%). Similarly, Kaur H et al7 found cough with expectoration in 98% of cases, fever in 70%, and breathlessness in 54%. These findings reveal a consistent symptom pattern across studies, emphasizing respiratory complaints like productive cough, dyspnea, and systemic symptoms such as fever and weight loss as key indicators in pulmonary disease presentations. Chest X-ray examination of the study cohort revealed consolidation as the predominant abnormality, observed in 41% of patients. Fibrotic changes were noted in 33%, while nodular lesions appeared in 25%. Calcified lesions were present in 22% of cases, with collapse and cavitatory lesions each seen in 16%. Additionally, mass lesions were identified in 17% of patients. Selvendran V et al9 observed that 36% of patients had normal chest X-rays. Among the abnormal findings, consolidation was most common (29%), followed by nodules or masses (14%), ectatic changes (10%), cavitation (7%), and fibrosis (4%). Similarly, Munjal S K et al10 reported bilateral lung involvement in 62.6% of cases, with cavities seen in 56.5%, reflecting features typical of chronic pulmonary diseases and tuberculosis. These radiographic patterns highlight the diagnostic significance of imaging in evaluating pulmonary conditions. CT Pulmonary Angiography was conducted on 8 patients, with infective changes being the predominant finding, present in 37.5% of cases. Meanwhile, normal imaging was noted in 25% of the patients. Other observations included attenuation of the superior lobar branch, pulmonary sequestration, and soft calcified plaque, each accounting for 12.5% of the cases. Similarly, Joseph T et al11 reported that bronchial angiography performed in 60 patients demonstrated a high positivity rate in bronchiectasis (83.33%) and old pulmonary tuberculosis (70%). Conversely, conditions such as lung abscess, pneumonia, and anticoagulant therapy were associated with low or no diagnostic yield on bronchoscopy and angiography. Pulmonary tuberculosis (26%) was the most common diagnosis, followed by post-TB sequelae and lung carcinoma (20% each), with fewer cases of silicosis, silico-TB, pneumonia, bronchiectasis, and conditions like COPD, DPLD, and others; 4% had unknown etiology. Munjal S K et al10 reported that the majority of patients were diagnosed with post-tuberculosis sequelae (30.2%) and active pulmonary tuberculosis (21.7%), while lung carcinoma (11.6%), pneumonia (10.9%), bronchiectasis, and chronic bronchitis (8.5% each) were also common. Other less frequent diagnoses included aspergillosis, pulmonary embolism, and sarcoidosis (8.5%). Among those tested fiber-optic bronchoscopy-guided BAL (22%), 7% were positive, 8% negative, and 7% sterile. Biopsies (17%) revealed various malignancies, including non-small cell (4%), squamous cell (3%), adenocarcinoma and small cell carcinoma (2% each), with 1% each showing atypical cells or poorly differentiated neoplasms; 4% were negative. Similarly, Bondade K et al12 found BAL and EBB identified TB in 20% via Ziehl-Neelsen staining and CBNAAT, with Pneumococci, Pseudomonas, and fungi in 6.67%, 3.33%, and 13.3% of BAL samples, respectively. EBB also confirmed squamous cell carcinoma in 10% and adenocarcinoma in 6.7%, indicating diverse infectious and malignant etiologies.

This study analyzed the clinico-radiological and etiological profile of hemoptysis in a tertiary care setting to improve diagnosis and management. Tuberculosis, both active and post-tubercular, remained the leading cause, accounting for nearly half the cases. Lung carcinoma emerged as the most common non-tubercular etiology, along with other conditions like bronchiectasis, silicosis, and pneumonia. Most patients were middle-aged to elderly males from rural areas, presenting with symptoms like cough and dyspnea. Radiological and microbiological tools proved crucial in diagnosis. The findings stress a multidisciplinary approach beyond tuberculosis for effective patient care.

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