Question

What is the next investigation to be done in a case with recurrent hemoptysis, normal chest X-ray, and production of purulent sputum?

• A. Spiral CT
• B. HRCT
• C. MRI
• D. Bronchoscopy

Hint:

Normal CXR + purulent sputum + recurrent hemoptysis suggests bronchiectasis; HRCT is the most sensitive test for it.

Answer 1

The Correct Option is B

This question is about choosing the next step in a patient with recurrent hemoptysis, a normal chest X-ray, and purulent sputum, a combination that suggests bronchiectasis hiding behind a normal-looking film.

1. Spiral CT: Better for tracking a bleeding vessel or ruling out clots in the pulmonary arteries, which is not the leading concern when purulent sputum points to chronic airway disease.
2. HRCT: Gives very fine detail of the airway walls and can pick up bronchiectasis, cysts, or early scarring that a normal chest X-ray completely misses. This fits the clinical picture directly.
3. MRI: Air in the lungs gives a poor signal on MRI, so it is a weak tool for lung parenchyma and airway disease.
4. Bronchoscopy: Helpful to look directly at the airway and localize a bleeding point or biopsy a mass, but doctors usually image the chest first with HRCT before going for a scope, unless there is a reason to suspect a proximal tumor.

Since purulent sputum and recurrent hemoptysis with a normal X-ray most often mean bronchiectasis, and HRCT is the most sensitive test for that diagnosis, HRCT is the right next step.

Let's summarize:

• A normal chest X-ray does not rule out bronchiectasis.
• HRCT is the most sensitive imaging test to diagnose bronchiectasis.

So the next investigation of choice is HRCT of the chest.