Radiographic and Other Studies

1. Chest x-ray. Order PA and lateral views. Up to one third are normal. When abnormal, the most common findings are atelectasis and alveolar, and interstitial parenchymal infiltrates.

Look for tram-track appearance characteristic of bronchiectasis. Obtain inspiratory and expiratory films if foreign body aspiration is a possibility.

2. High-resolution CT scan. Ideal for following up chest x-ray abnormalities. Use contrast to evaluate for vascular lesions.

3. Ventilation-perfusion (V/Q) scan. Obtain if pulmonary embolism is suspected; can be performed in almost all age groups.

4. Bronchoscopy. Consider when bleeding persists or in absence of diagnosis from other studies. Rigid scope is preferred for massive hemoptysis. Obtain lavage specimen for bacteriologic cultures, cytology, and histopathologic studies.

5. Angiography. To evaluate for possible arteriovenous malformation (AVM) and to rule out pulmonary embolus when V/Q scan is equivocal.

6. ECG or echocardiogram. Obtain in patients with suspected cardiac disease.

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