Blood-Streaked Mucus: Causes and Diagnostic Approaches

Nasal discharge with blood streaks?

The symptoms have been present since February 9th.
Upon waking up, I feel like there is a lump of fluid stuck in my nasopharynx that is difficult to expel.
It is easier to bring it up into my mouth and spit it out, which often contains blood streaks (bright red).
Throughout the day, I constantly feel thick fluid in my left nasal cavity and have a persistent urge to swallow.
Occasionally, I notice a metallic taste in my mouth.
I have visited four hospitals for endoscopic examinations (Veterans General Hospital, Taoyuan Chang Gung Memorial Hospital, Linkou Chang Gung Memorial Hospital, and a general clinic), and the doctors reported no significant abnormalities.
The physician at Veterans General Hospital assisted in taking a biopsy of the swollen area in the nasopharynx, which turned out to be benign.
Initially, I thought the bleeding might be due to excessive nose blowing or sniffing causing nasal injury, but I have since switched to using a nasal irrigator to flush out the thick mucus, and I still see blood streaks being expelled.
Is there any examination that can accurately and directly identify the source of the bleeding?

Huang Xinhuai, 30~39 year old female. Ask Date: 2021/04/27

Dr. Zheng Jueyi reply Otolaryngology

Hello, if a biopsy and endoscopic examination have been performed and the source of bleeding remains undetected while the bleeding continues, it is recommended to follow up at the hospital for further evaluation.
The physician will determine if additional imaging studies are necessary.
Wishing you safety and health.
Sincerely, Dr.
Cheng Jue-Yi, Director of the Department of Otolaryngology, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2021/04/27

More Info

Understanding blood-streaked mucus can be concerning, especially when it persists over time. The symptoms you're experiencing, such as the presence of blood-streaked mucus, a sensation of thick mucus in the nasal passages, and a blood-like taste, warrant careful evaluation. Given that you've already undergone multiple examinations, including endoscopy and biopsy, and the results have shown no significant abnormalities, it’s essential to consider a few potential causes and further diagnostic approaches.

Possible Causes
1. Nasal Trauma or Irritation: Even if the initial examinations did not reveal significant issues, repeated trauma from vigorous nose blowing or suctioning can lead to small blood vessels in the nasal mucosa breaking, resulting in blood-streaked mucus. This can happen even with gentle nasal irrigation if the mucosa is already inflamed or sensitive.

2. Chronic Rhinosinusitis: This condition can cause thick mucus production and inflammation of the nasal passages. The inflammation can lead to the rupture of small blood vessels, especially if there is significant congestion or pressure.

3. Allergic Rhinitis: Allergies can lead to chronic inflammation and irritation of the nasal passages, which may also contribute to the symptoms you're experiencing.

4. Infection: While your biopsies have returned benign, a lingering infection (viral or bacterial) could still cause inflammation and bleeding. Conditions like sinusitis can lead to post-nasal drip, which may present as blood-streaked mucus.

5. Vascular Malformations: Rarely, vascular malformations in the nasal cavity can lead to recurrent bleeding. These may not always be visible on initial examinations.

6. Systemic Conditions: Conditions such as hypertension or bleeding disorders can also contribute to nasal bleeding. If you have a history of such conditions, they should be considered.

Diagnostic Approaches
Since you've already had several examinations, here are some additional steps you might consider:
1. CT Scan of the Sinuses: A CT scan can provide a more detailed view of the sinuses and nasal passages, helping to identify any structural abnormalities, chronic sinusitis, or other issues not visible through endoscopy.

2. Nasal Cauterization: If a specific bleeding point is identified during an endoscopic examination, cauterization may be performed to prevent further bleeding.

3. Allergy Testing: If allergies are suspected, testing can help identify specific allergens that may be contributing to your symptoms.

4. Referral to an Otolaryngologist (ENT Specialist): If you haven't already, consider seeing an ENT specialist who can provide a more comprehensive evaluation and possibly perform more specialized tests.

5. Follow-Up Biopsy or Imaging: If symptoms persist, a repeat biopsy or imaging may be warranted to ensure that no new issues have developed since your last examination.

Conclusion
Persistent blood-streaked mucus can be distressing, and while initial examinations have not revealed significant issues, it is crucial to continue investigating the underlying cause. Consider discussing the possibility of a CT scan or further specialized tests with your healthcare provider. Additionally, maintaining a gentle approach to nasal hygiene and avoiding trauma to the nasal passages can help minimize irritation. If symptoms worsen or new symptoms arise, seek immediate medical attention. Your health and peace of mind are paramount, and persistent symptoms should always be thoroughly evaluated.

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