Unexplained Coughing Up Blood and Chest Pain: Seeking Answers

Q: Unexplained Coughing Up Blood and Chest Pain: Seeking Answers

Hello： I believe the relevant examinations you have undergone are sufficient. <br>The conclusion is that there is mild bronchiectasis or bronchitis, and the hemoptysis caused by either condition may be due to microvascular rupture, typically resulting from severe coughing or inad

Hemoptysis and chest pain of unknown origin?

Hello Dr.
Yang, I have a 15-year smoking history but have quit smoking.
I currently have several symptoms that I would like to consult with you about.

1.
Chest Pain: Since mid-September, I have experienced slight discomfort and pain in my right chest that varies with changes in posture.
It is not very noticeable during the day, but it becomes quite pronounced when I lie flat to sleep.

2.
Cough: I started experiencing a severe dry cough in mid-October due to a cold, which included coughing up blood-tinged sputum.
I visited an ENT department at a major hospital, where I was diagnosed with acute bronchitis.
After medication, the severe coughing improved, but I have since developed a persistent phlegm in my airways, with frequent coughing up of phlegm, which has not improved to this day.

3.
Hemoptysis and Blood-tinged Sputum: In mid-November, I suddenly coughed up about 30 cc of bright red blood and rushed to the emergency department of a major hospital.
X-rays and bronchoscopy showed no abnormalities.
In early December, I noticed blood-tinged sputum again.

4.
Tightness and Pain in the Neck and Shoulders, Dizziness, and Poor Balance: I consulted a neurologist, who initially diagnosed the symptoms as being caused by anxiety.

For these symptoms, I have visited various major medical centers in Taipei for examinations.
The tests I have undergone include: low-dose computed tomography (CT) twice, chest X-rays four times, bronchoscopy twice, gastroscopy, abdominal ultrasound, blood tests, sputum tests, and urine tests, all of which showed no abnormalities.
One physician noted mild bronchiectasis on the low-dose CT scan, but other pulmonologists disagreed.
However, I continue to experience coughing up phlegm and chest pain.

I would like to ask Dr.
Yang what my symptoms might indicate and what further medical advice you would recommend for my situation.

Willaim, 30~39 year old female. Ask Date: 2015/12/31

Dr. Yang Wenda reply Pulmonology

Hello: I believe the relevant examinations you have undergone are sufficient.
The conclusion is that there is mild bronchiectasis or bronchitis, and the hemoptysis caused by either condition may be due to microvascular rupture, typically resulting from severe coughing or inadvertently consuming foods that promote blood circulation and dilate microvessels, such as dishes cooked with alcohol, sesame oil, ginger, or traditional Chinese medicine (like herbal stewed pork ribs, angelica shrimp, four-herb chicken, sesame oil chicken, or lamb stew), as well as spicy foods, etc.
I recommend that you pay more attention to the aforementioned foods and use cough suppressants or expectorants when coughing, and prepare hemostatic medications if necessary.
There is no need for further examinations at this time! Best wishes!

Reply Date: 2015/12/31

More Info

Hello, thank you for reaching out with your concerns regarding your health. Based on the symptoms you've described, including persistent coughing with blood, chest pain, and a history of smoking, it is crucial to approach this situation with caution and thoroughness.

Firstly, the presence of blood in your sputum (hemoptysis) is a significant symptom that should not be overlooked. While you have undergone various tests, including X-rays and bronchoscopy, which returned normal results, it is essential to consider that some conditions may not be immediately apparent on these tests. Chronic bronchitis, especially in former smokers, can lead to persistent cough and sputum production, and it may also cause intermittent hemoptysis due to irritation and inflammation of the bronchial tubes.

Your description of chest pain that worsens when lying down could indicate several possibilities, including gastroesophageal reflux disease (GERD), which can mimic cardiac pain, or musculoskeletal issues, especially given your history of neck and shoulder tension. However, it is also essential to rule out any cardiac issues, particularly since you have a history of smoking, which increases the risk of cardiovascular diseases.

The ongoing symptoms of dizziness and balance issues, along with neck and shoulder pain, could indeed be related to anxiety, as suggested by your neurologist. However, it is also worth considering that these symptoms could be linked to cervical spine issues or even vestibular disorders, which can cause dizziness and balance problems.

Given your extensive history and the persistence of your symptoms, I recommend the following steps:
1. Follow-Up with a Pulmonologist: Since you have already seen multiple specialists, it may be beneficial to revisit a pulmonologist who specializes in chronic respiratory conditions. They may consider additional tests, such as a high-resolution CT scan of the chest, which can provide more detailed images of the lung structures and help identify any subtle abnormalities that may have been missed.

2. Consider a Cardiac Evaluation: Given your chest pain and smoking history, a thorough cardiac evaluation is warranted. This could include an electrocardiogram (ECG), echocardiogram, or even a stress test to assess your heart's function.

3. Gastroenterology Consultation: If GERD is suspected, a gastroenterologist can perform an upper endoscopy to evaluate for esophageal issues that could be contributing to your symptoms.

4. Physical Therapy: For your neck and shoulder pain, physical therapy may help alleviate tension and improve your overall posture, which could, in turn, reduce some of your symptoms.

5. Mental Health Support: If anxiety is a contributing factor, consider seeking support from a mental health professional. Cognitive-behavioral therapy (CBT) and other therapeutic approaches can be beneficial in managing anxiety and its physical manifestations.

6. Lifestyle Modifications: Continue to focus on a healthy lifestyle, including a balanced diet, regular exercise, and stress management techniques such as mindfulness or yoga, which can help improve both physical and mental health.

In summary, while your tests have returned normal results, the persistence of your symptoms warrants further investigation. It is crucial to maintain open communication with your healthcare providers and advocate for your health until you find the root cause of your symptoms. Please do not hesitate to seek a second opinion if you feel your concerns are not being adequately addressed. Your health is paramount, and it is essential to ensure that all potential causes are thoroughly explored.

Similar Q&A

Understanding Cough and Chest Pain: When to See a Specialist

I have high blood pressure and elevated blood sugar levels. Starting on November 26, I caught a cold, initially experiencing symptoms such as a runny nose, sneezing, nasal congestion, and a sore throat. By November 27, the sore throat had resolved, but I began to cough and produc...

Dr. Guo Hongyi reply Pulmonology
Hello, the public. Online consultations are not available. We still recommend that you visit the thoracic medicine outpatient clinic in person. Thank you for your inquiry.

Understanding Chest Pain and Cough: Seeking Effective Treatment Options

Hello, Doctor. Since around the middle of last year, I have been experiencing severe coughing at night/midnight, which I initially thought was due to an unresolved cold (I returned from Europe at the end of March with a cold, and after taking two or three packets of medication, I...

Dr. Huang Yiwen reply Pulmonology
Dear K: I apologize for the delayed response due to the holiday. Based on your symptom description, it is likely that you have atypical asthma. However, the treatment approach needs to be adjusted. You can start with inhaled corticosteroids for control, or you may visit the outpa...

Understanding Chest Pain and Coughing Up Blood: A Guide for Smokers

Hello, doctor. A family member at home has recently started experiencing coughing, and they have a smoking history of about 12 years. However, the severity of the cough seems quite concerning. They have previously coughed so severely that it led to intense pain in the right chest...

Dr. Yang Wenda reply Pulmonology
Coughing, chest pain, and hemoptysis are respiratory symptoms that warrant a visit to a physician for a chest X-ray to rule out more serious pulmonary conditions. Severe nighttime coughing may be related to increased bronchial sensitivity. It is advisable to avoid cold or cooling...

Understanding Cough and Chest Pain: Insights from Pulmonary Medicine

Hello doctor, my mother started coughing around the 20th of last month and now her speech is reduced to a whisper. She is currently speaking with little strength. She has been visiting clinics for treatment and was referred to a larger hospital last week. Initially, her family ph...

Dr. Zhou Ziguang reply Pulmonology
Hello: Based on what has been mentioned, the most important factor may still be the results of the CT scan, which will help determine if further examinations are necessary. The report should be available in 1-2 days. If you need to see a doctor urgently, you can inquire with the ...