Persistent Cough and Black Sputum: When to Seek Further Evaluation

Continuing from the previous article's question?

Hello Doctor, I am the questioner with ID #124564.
Thank you for your detailed explanation in the previous article.
However, I realize that I did not describe some aspects clearly, and I have a few more questions to ask.
I forgot to mention that I have never smoked.
Recently, I have been closely observing the phlegm I cough up.
In the morning, it is dark coffee-colored, and it tends to be darker right after waking up.
At other times, the color is less pronounced.
Two weeks ago, I visited a pulmonologist and had a chest X-ray.
The doctor said my lungs appeared normal.
At that time, I was experiencing black phlegm upon waking and localized chest pain on the right side (the pain is noticeable when pressing on a specific point).
Recently, I have also started to feel some soreness in my right shoulder, and in the last couple of days, I have developed a cough, although it is not constant.

Therefore, Doctor, I would like to ask: I have read that X-rays should not be taken frequently.
Given that I had an X-ray two weeks ago, how long should I wait before getting another one if I still have concerns? I have also come across many articles stating that X-rays cannot fully detect many lung issues, such as early-stage lung cancer or small lung tumors, which can only be identified through a CT scan.
I had a hospitalization for pneumothorax six years ago and underwent imaging at that time.
Would it be appropriate for me to get another scan now due to my current symptoms? The black phlegm upon waking is really troubling me, and I am worried about internal bleeding or a connection to my cough and chest pain.
However, I just saw a pulmonologist two weeks ago, and they did not prescribe any medication for me.
I am hesitant about whether I should seek another consultation.
I sincerely appreciate your response.
Thank you very much!

Xiansheng, 20~29 year old female. Ask Date: 2017/06/22

Dr. Chen Taicheng reply Family Medicine

● You don't need to worry too much about X-rays; having a few dozen in a year is still within a tolerable range.
The radiation dose from a single X-ray is very low (about 0.02 millisieverts), which is more than 50 times lower than the annual acceptable radiation dose of 1 millisievert for the general population (excluding natural background radiation and medical radiation).
(Refer to my previous response #120845)
● A chest CT scan can be considered to check for any pulmonary lesions, such as bronchiectasis (which can also cause hemoptysis and blood-streaked sputum); conditions like bronchitis, pneumonia (from bacterial or atypical infections), and lung abscesses may also present with darker sputum, which can be identified on a CT scan.

● However, it is essential to first determine the source of the black material—whether it originates from the oral cavity, trachea, esophagus, or gastrointestinal tract—so that appropriate treatment can be administered.

● It is still advisable, as mentioned in the previous article, that if it is confirmed not to be an ENT or gastrointestinal issue, then thoracic problems can be evaluated through imaging (including CT scans) or bronchoscopy.
Wishing you good health, Dr.
Chen Tai-Cheng from Taoyuan Hospital Family Medicine Department is concerned about you~

Reply Date: 2017/06/22

More Info

When it comes to persistent cough and the presence of black sputum, it is crucial to understand the underlying causes and when to seek further evaluation. Based on your description, it seems you are experiencing a concerning symptom that warrants attention, especially since you have noted changes in the color and consistency of your sputum, as well as associated symptoms like chest pain and shoulder discomfort.

First, let’s address the black sputum. The presence of dark or black sputum can be indicative of several conditions. In non-smokers, it may be related to environmental factors, such as exposure to pollutants, dust, or certain occupational hazards. It can also be a sign of bleeding in the respiratory tract, which may lead to the sputum appearing darker due to the presence of blood. Given your history of a pneumothorax six years ago, it is essential to consider that any changes in your respiratory symptoms should be evaluated thoroughly.

You mentioned that you had a chest X-ray two weeks ago, which showed no apparent issues with your lungs. While X-rays are a useful initial diagnostic tool, they do have limitations, particularly in detecting early-stage lung conditions, such as small tumors or subtle infiltrates. If your symptoms persist or worsen, particularly with the addition of new symptoms like shoulder pain and persistent cough, it would be prudent to follow up with your healthcare provider.

In terms of the timing for further imaging, it is generally advisable to wait at least a few weeks after an X-ray before repeating it, unless your symptoms significantly worsen or new symptoms arise. In your case, if you continue to experience black sputum, chest pain, or if the cough becomes more frequent or severe, it would be reasonable to request a follow-up evaluation sooner rather than later. A CT scan of the chest may be warranted if your doctor suspects any underlying pathology that was not visible on the X-ray.

Moreover, the fact that you are experiencing localized chest pain that is reproducible upon palpation could suggest a musculoskeletal issue, but it is essential to rule out any pulmonary causes as well. The combination of your symptoms—persistent cough, black sputum, chest pain, and shoulder discomfort—could potentially indicate a more serious condition that requires further investigation.

In summary, while your recent chest X-ray did not show any immediate concerns, the persistence of your symptoms, especially the black sputum and chest pain, suggests that further evaluation is necessary. It would be advisable to consult with your healthcare provider again, discuss your ongoing symptoms, and consider a CT scan for a more detailed assessment of your lungs. Early detection and intervention are key in managing any potential respiratory issues, so do not hesitate to seek further medical advice.

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