A patient has daily hemoptysis for more than 2 mos and other than that is asymptomatic. A CXR was done and ruled out with PNA, was given antibiotic for 2 weeks but hemoptysis didn't go away and a repeat CXR was done and another antibiotic was given and only after a month that a CT scan and biopsy was done and found out that she has a lung tumor size is smaller than a golf ball. Would the kind of symptom presented require a CT scan be done right after the first CXR is doubtful of PNA? So an immediate treatment is done? Or the process was just right? Just a question I encountered on an exam. Hoping for your reply. Thanks.
When, in the order of things, a CT scan should be done will depend upon the appearance of a chest X-ray abnormality.
The approach to daily haemoptysis for two months should include a Chest X-ray and bronchoscopy. It is fair to say that haemoptysis is almost never the sole or even the most prominent sign of ordinary bacterial infection. It can however be the first sign of tuberculosis and fungal infection; for this reason, the sputum should be examined for infectious agents, including TB and fungi. Tumors, bronchiectasis and vascular malformations not uncommonly present with haemoptysis and one must proceed with caution, especially with biopsies of these lesions.
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