Intermittent Blood in Sputum: Causes and When to Seek Help

Q: Intermittent Blood in Sputum: Causes and When to Seek Help

Hello： 1. <br>A follow-up chest X-ray can be performed; if hemoptysis persists, a bronchoscopy may be considered. <br>Please consult a pulmonologist. <br>2. <br>If the focus is solely on the lungs, a low-dose computed tomography (CT) scan can be done (but it will be out-of-pocket

Occasional blood in the sputum?

At the end of August, I started to have some brownish sputum, sometimes with a few blood spots.
I consulted an ENT specialist who performed an endoscopy and found that my throat and nasopharynx were normal.
A week later, I began to experience a sore throat, and my tonsils became swollen.
Upon revisiting the ENT, I was diagnosed with pharyngitis and noted the presence of pus in the nasopharynx.
I was prescribed some antibiotics.
During that time, I had blood-streaked sputum almost every day, which was thick and slightly yellow, but I did not have a cough, and there was no blood in my nasal discharge—only in the sputum.
This condition persisted for about a week and a half, until mid-September.
Since then, I have had episodes every 5 to 6 days where I suddenly cough up sputum with blood streaks, but the amount is not significant.
Sometimes after sneezing, the amount of blood is slightly more.
I still do not have a cough, and there is no blood in my nasal discharge.
At the end of September, I had a chest X-ray, which reported everything as normal.

1.
From the end of August until now, it has been over a month, and I am unsure if this qualifies as intermittent hemoptysis.
I am a bit worried about lung cancer.
What tests should I undergo now, and which specialty should I consult?
2.
If a CT scan of the lungs is necessary, can I have a low-dose CT scan? I am concerned about radiation exposure.
Thank you.

Ting, 20~29 year old female. Ask Date: 2017/10/06

Dr. Zhou Ziguang reply Pulmonology

Hello: 1.
A follow-up chest X-ray can be performed; if hemoptysis persists, a bronchoscopy may be considered.
Please consult a pulmonologist.
2.
If the focus is solely on the lungs, a low-dose computed tomography (CT) scan can be done (but it will be out-of-pocket).
The downside is that the blood vessels and mediastinum may not be as clearly visualized, and the appropriate choice should be determined by a physician.

Reply Date: 2017/10/06

More Info

Intermittent blood in sputum, especially when it has persisted for over a month, can understandably cause concern, particularly regarding serious conditions such as lung cancer. However, it is essential to approach this situation with a clear understanding of potential causes and the appropriate steps to take.

Causes of Blood in Sputum
1. Infections: The presence of blood in sputum can often be attributed to respiratory infections, such as bronchitis or pneumonia. In your case, the initial throat inflammation and subsequent antibiotic treatment suggest that an infection could have been a contributing factor.

2. Chronic Conditions: Conditions like chronic bronchitis or chronic obstructive pulmonary disease (COPD) can also lead to intermittent blood in sputum, especially in individuals with a history of smoking or exposure to irritants.

3. Pulmonary Issues: More serious conditions, such as pulmonary embolism, tuberculosis, or lung cancer, can also cause hemoptysis (coughing up blood). However, these are less common, especially in younger individuals without significant risk factors.

4. Nasal or Throat Sources: Since you have had issues with your throat and nasal passages, it is possible that the blood is originating from these areas rather than the lungs. Conditions like nasal polyps, sinus infections, or even severe allergies can lead to blood-tinged sputum.

When to Seek Help
Given that you have experienced this symptom intermittently for over a month, it is advisable to seek further evaluation. Here are some recommendations:
1. Consult a Pulmonologist: Since your symptoms involve sputum and potential lung issues, a pulmonologist would be the most appropriate specialist to consult. They can perform a thorough evaluation, including a detailed history and physical examination.

2. Imaging Studies: A chest X-ray is a good initial step, but if your symptoms persist, a low-dose CT scan of the chest may be warranted. Low-dose CT scans are designed to minimize radiation exposure while still providing detailed images of the lungs. Discuss your concerns about radiation with your doctor; they can explain the risks and benefits based on your specific situation.

3. Further Testing: Depending on the findings, your doctor may recommend additional tests, such as sputum analysis, bronchoscopy, or even blood tests to rule out infections or other underlying conditions.

Conclusion
While the presence of intermittent blood in sputum can be alarming, it is crucial to approach the situation methodically. Given your history of throat inflammation and the recent normal chest X-ray, it is possible that the blood is not originating from the lungs but rather from the upper respiratory tract. However, persistent symptoms warrant further investigation to rule out more serious conditions.

Make an appointment with a pulmonologist to discuss your symptoms in detail. They can guide you through the necessary diagnostic steps and help alleviate your concerns. Remember, early detection and intervention are key to managing any potential health issues effectively.

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