Unexplained Left Chest Pain: Causes and Concerns Explored - Pulmonology

Unexplained pain in the left chest?

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Hello Dr.
Yang, I would like to express my sincere gratitude for your patient response to another question.
I do not smoke or drink alcohol, but I have been experiencing chronic post-nasal drip and gastroesophageal reflux.
I have been on cholesterol medication for a long time, have low physical activity, and my blood pressure is slightly lower than normal.
I have several symptoms I would like to consult you about:
Symptom 1: Chest Pain - I experience frequent, unexplained pain in the left chest area, near the center, which has persisted for three years.
The pain can be described as a dull ache (which is continuous but sometimes more pronounced) or as sharp, intense stabbing pains that last for a few seconds and can occur frequently within a ten-minute period.
I feel this dull ache or sudden stabbing pain while talking, laughing, being excited, or even while lying in bed or sitting on the couch.
The pain does not seem to be triggered by specific movements, and it is mostly localized to the same area.
I do not usually experience significant shortness of breath, except when the sharp stabbing pains occur, which makes me hesitant to take deep breaths.
This pain does not feel like the burning sensation or discomfort associated with acid reflux; therefore, I consulted a gastroenterologist to confirm.
The results of an endoscopy showed only mild esophagitis and gastritis, and all biopsy results were normal, so the doctor concluded that there are no significant issues with my stomach that would cause such chest pain.
I also consulted other specialists related to chest pain:
1.
Pulmonology: I underwent a high-resolution CT scan of the lungs, but due to my history of urticaria, no contrast agent was administered during the examination.
The doctor stated that the scan showed clean lungs with no lesions, indicating that my lungs are essentially normal.
The doctor suggested that the chest pain could be due to neuralgia or pleuritis, and it may also be related to the heart.

2.
Internal Medicine: I had X-rays, an electrocardiogram, and a stress test, all of which returned normal results.
To date, the cause of my chest pain remains undetermined.
Symptom 2: Coughing and Sneezing with Blood-tinged Mucus - I have been experiencing this for about three years.
Almost every night, I have a habit of coughing once or twice due to an itchy throat, but it is not severe or persistent; usually, drinking water alleviates it.
Most of the time, it is a dry cough without phlegm, and even when there is phlegm, it is usually a small amount of yellowish mucus.
Sometimes, I feel like there is phlegm in my throat that I cannot expel.
During one sneeze, I accidentally discovered that my mouth and teeth were covered in fresh blood, with the amount of blood being about a teaspoon (mixed with saliva).
Since then, I have almost always noticed blood-tinged mucus or spots after sneezing, and it has become more severe, as even a couple of coughs at night due to throat itchiness now exhibit the same symptoms.
Notably:
1.
When standing or sitting, I rarely experience blood-tinged mucus or spots when coughing, but it occurs when sneezing.
2.
Immediately after coughing, if I spit, I notice blood spots and streaks, which mostly happen at night, and coughing is rarely accompanied by phlegm; conversely, during the day, coughing rarely results in bleeding.
3.
After sneezing, if I spit immediately, I see blood spots and streaks.
Even when I cannot sneeze, my saliva still shows blood-tinged mucus and spots.
4.
When I am not coughing or sneezing, I have never noticed any bleeding when I intentionally spit, and I rarely have bleeding gums while brushing my teeth.
5.
Usually, after coughing or sneezing, spitting a few times results in no blood spots or streaks.
I would like to ask the doctor what could be causing my chest pain.
Some doctors have expressed concern about potential heart issues and arranged for hospitalization for further examination.
After a few days of observation, the conclusion was that aside from elevated hemoglobin levels, my heart rate, blood pressure, and even the electrocardiogram were normal.
The pulmonologist reviewed the CT scan report and deemed my lungs normal, so they did not request sputum tests or further bronchoscopy, believing my chest pain is likely not related to the lungs.
Do I need to undergo bronchoscopy? Since my coughing and sneezing with blood occurred during the period of chest pain, I have also seen an ENT specialist three times and undergone nasal endoscopy three times, with no signs of wounds, inflammation, or nasopharyngeal cancer detected.
Therefore, I would like to ask if my coughing and sneezing with blood are related to my chest pain.
If it is due to microvascular rupture, why does bleeding not occur when I cough while sitting or standing, but only when I feel an itchy throat at night and cough a couple of times? Although saliva always shows blood spots, streaks, and blood-tinged mucus after sneezing.

I apologize for my limited understanding of diseases and the many questions I have.
Despite consulting several specialists, I have yet to find the cause of my condition or a treatment method, and this issue has severely impacted my life, family, and work.
I am reaching out for help and appreciate your patience and careful reading and response.
Wishing you good health, and may everyone be healthy! Good people will be rewarded!

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Mr. Li, 40~49 year old female. Ask Date: 2017/04/13