Is investigation of patients with haemoptysis and normal chest radiograph justified

We read with interest the article by Thirumaran et al .1 They described their experience of 270 consecutive patients referred with haemoptysis and a normal chest radiograph. In their study they found the incidence of respiratory malignancy within this group was 9.6% (26 individuals) and of these 22 were primary lung malignancies. This is slightly higher than the 3–6% incidence previously reported in the literature.2–4 We have delivered a nurse-led clinic for patients referred via the 2 week wait system with haemoptysis and a normal, or non-localising, chest x-ray. Patients were stratified into high risk or low risk groups according to age and smoking history. An algorithm was then devised to guide further investigation …