Is Coughing Up Blood Related to Neck Tumors? Your Symptoms

Is coughing up blood related to neck tumors?

Hello Doctor: I am a 53-year-old female.
Last year, I had a soft mass in my nasopharynx, and when I coughed, I expelled a blood clot for three consecutive days.
I went to Chang Gung Memorial Hospital for a nasal ultrasound, but the doctor said nothing was found.
I then visited a pulmonologist for a bronchoscopy, which also did not reveal any issues.
Still feeling uneasy, I went to Taichung Veterans General Hospital to see an ENT specialist, but they could not determine the cause either.
I have since felt some phlegm above my larynx, which I cough up as purulent and odorless.
This symptom has persisted for nearly a year.
However, today it recurred, and I coughed up some small blood clots and blood-tinged sputum.
Which specialty should I consult to investigate the cause of these symptoms? Additionally, I had a 2 cm tumor removed from my neck eleven years ago, and in the past year, new tumors have developed measuring 2.2 cm and 1.5 cm, along with some small nodular tumors.
Doctors have said they are benign.
Could the hemoptysis be related to the neck tumors? I hope you can reply amidst your busy schedule; I would greatly appreciate it!

cherry, 50~59 year old female. Ask Date: 2002/09/22

Dr. Yang Wenda reply Pulmonology

Dear Ms.
Cherry,
In response to your inquiries, please find the following information:
1.
Regarding the neck mass, the physician has indicated that it is benign.
However, it is advisable to have regular follow-ups with your doctor.
The neck mass is not connected to the nasopharynx or the airway, and therefore, it is unrelated to your hemoptysis symptoms.
2.
Concerning the hemoptysis, the first step is to rule out issues from the oral cavity (such as gum bleeding) and the nasopharynx (which has been confirmed as normal by two ENT specialists).
The primary source of concern would then be the airway (bronchial issues).
If the chest physician at Chang Gung Memorial Hospital has confirmed no abnormalities through chest X-rays and bronchoscopy, significant pulmonary diseases (such as tumors or bronchial tuberculosis) have likely been excluded.
The most probable causes of bleeding at this point may be mild bronchiectasis or rupture of microvessels within the trachea.
If you experience hemoptysis, it may be appropriate to temporarily use hemostatic agents.
Additionally, it is recommended to maintain a light diet, avoiding fried and spicy foods (such as ginger and sesame oil), especially those containing alcohol or traditional Chinese herbal supplements (like Angelica, Si Wu Decoction, or Ba Zhen Decoction).
Avoid consuming excessively hot soups, and take care to prevent constipation and insomnia.
Certain fruits, such as longan, lychee, durian, and cherries, are considered "heaty" and may potentially trigger the rupture of fragile microvessels.
Furthermore, sweet foods can increase mucus production, leading to more forceful coughing, which may elevate pressure in the thoracic cavity and result in microvascular rupture and bleeding.
Currently, it is known that you do not have significant thoracic or nasopharyngeal diseases, so you can be reassured.
Regular follow-up examinations every three to six months are sufficient.
Please consider the above lifestyle and dietary recommendations, and your hemoptysis symptoms should gradually resolve.

Reply Date: 2002/09/22

More Info

Coughing up blood, also known as hemoptysis, can be a concerning symptom and may have various underlying causes. In your case, the relationship between coughing up blood and the neck tumors you mentioned is a valid concern, especially given your medical history.
Firstly, it’s important to note that the presence of neck tumors, particularly if they have been evaluated and deemed benign, is generally not directly linked to coughing up blood. The tumors you described, which have been monitored over the years, are likely not the source of your hemoptysis. The neck tumors, especially if they are not located in the respiratory tract or directly affecting the surrounding tissues, typically do not cause bleeding in the lungs or airways.

The symptoms you are experiencing, including coughing up blood and the presence of phlegm, could be related to several other conditions. Given that you have already undergone evaluations by specialists in otolaryngology (ear, nose, and throat specialists) and pulmonology (chest specialists), it is crucial to consider other potential causes. Common causes of coughing up blood include:
1. Bronchitis: Chronic bronchitis can lead to inflammation and irritation of the airways, which may cause blood to appear in the sputum.

2. Bronchiectasis: This condition involves the abnormal widening of the bronchi, which can lead to recurrent infections and bleeding.

3. Pulmonary Infections: Infections such as pneumonia or tuberculosis can cause hemoptysis.

4. Lung Tumors: Although you have been evaluated for lung issues, it is essential to rule out any potential lung tumors or lesions that may not have been detected in previous imaging studies.

5. Vascular Issues: Conditions that affect the blood vessels in the lungs, such as pulmonary embolism or arteriovenous malformations, can also lead to coughing up blood.

Given your ongoing symptoms and the recurrence of hemoptysis, it would be advisable to seek further evaluation. A comprehensive approach may include:
- Repeat Imaging: A chest CT scan may provide more detailed information about the lungs and airways than a standard X-ray or bronchoscopy.

- Pulmonary Function Tests: These tests can help assess your lung function and identify any underlying respiratory issues.

- Referral to a Hematologist: If there is a concern about bleeding disorders, a hematologist can evaluate your blood coagulation status.

In terms of which specialty to consult, continuing with a pulmonologist would be prudent, as they specialize in lung-related issues and can provide a thorough evaluation of your respiratory symptoms. Additionally, if you have any concerns about the neck tumors, discussing these with an oncologist or a head and neck surgeon may be beneficial, especially if there are changes in size or symptoms associated with them.

In summary, while your neck tumors are likely not the cause of your coughing up blood, it is essential to pursue further investigation into your respiratory symptoms. A multidisciplinary approach involving pulmonology and possibly oncology will help ensure that all potential causes are thoroughly evaluated. Regular follow-ups and monitoring of your symptoms are crucial, and maintaining open communication with your healthcare providers will aid in managing your health effectively.

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