“Not all hemoptysis is tuberculosis—think of other etiologies.” A lesson from a chest clinic in a rural tertiary care center in central India -

Background: The spitting of blood derived from the lungs or bronchial tree owing to pulmonary or bronchial hemorrhage is defined as hemotypsis. Blood expectoration even in small volume gives rise to a worrying symptom, and huge hemoptysis might be a life-threatening event. Hence, hemoptysis of any grade requires detailed examination. Hemoptysis is a broad-spectrum symptom and can be observed in various clinical conditions. Objective: To evaluate the various etiological possibilities in patients of hemoptysis. Material and Methods: We conducted a study on 462 patients attending the Department of Pulmonary Medicine, at a tertiary care center in central India, with complain of hemoptysis. The study was done during the period of June 2011 to December 2014. Patients were then categorized according to their etiologies of hemoptysis after further investigations and follow-ups. Result: Of 462 patients of hemoptysis evaluated, 344 were male and 118 female subjects. From our study, we concluded that sputum AFB-negative posttubercular sequelae (110, 24%) was the leading cause. Similarly, bronchiectasis was found in 92 (20%) subjects; sputum-positive pulmonary tuberculosis, 73 (16%) subjects; chronic obstructive pulmonary disease/emphysema, 46 (10%); chronic bronchitis, 27 (6%); pneumonia, 27 (6%); aspergilloma, 23 (5%); and lung carcinoma, 11 (2.5%). Conclusion: It is clear from the study that pulmonary tuberculosis and its sequelae still holds the leading cause of hemoptysis in our region of study with bronchiectasis being the second most common. Many patients of bronchiectasis are being misdiagnosed as tuberculosis and put on antitubercular treatment. Hence, raising awareness among general physicians is the point of discussion here.