Wondering if a doctor might catch sight of this. About 8 months ago I started coughing blood clots (pictured). Ct scan revealed a mass in my right lung.after wash biopsy and bronchoscopy and two week long courses of antibiotics symptoms resolved although the specific site of bleeding was never identified. I was given a diagnosis of pneumonia and told to go on my way.
Cut to last month, same thing but by the time I got another CT scan, the cough had subsided. Pulmonologist theorized I got a cold, coughed hard, and just ruptured something. Told to go on my way.
Just last night I cough up a sizeable splatter of bright red blood. Within 24 hours, it seems to have resolved. Anyone know what the FUCK is going on with me?
Sounds like your capillaries are fucked. Could be anything from high cholesterol to sickle cell anemia though so you're gonna have to fill us in a bit more
Joshua Cooper
What more would you like to know? All my bloodwork seems normal I’m a white male with a normal weight. My only other symptom is like fatigue but that’s beeb a lifelong thing. I also have WPW and SVT (heart conditions) but no structural abnormalities have ever been detected with my heart. The cough has actually returned since writing my initial post.
It’s very stressful.
Jonathan Kelly
I suppose I should have mentioned I’m a former smoker. I know you can throw up your hands and say “there you go” and I get it. But I’d like to be able to proceed with the rest of my life without worrying about this or at least having a better idea of what’s causing it. So far the doctor has not been getting...creative or thorough enough for my liking.
Benjamin Young
Hard to say OP I've had blood clots come out of my nose but I think my heater was drying up the air and when I woke up in the morning I would bleed form my nose. I haven't had that for a few years now. I was scared back when it happened though. Stay active don't sit around too much.
Caleb Young
This is sort of what I'm gravitating to as well. I've known individual which had "brittle" capillaries and arterioles and hemoptysis was the primary symptom (along with nosebleeds). Though that was a specific genetic finding.
How many pack years are we talking about with being a former smoker? Also, define fatigue? Chronic fatigue is not a normal symptom in a young adult male. Do you actually have your bloodwork results, or did the doc just say it was "normal?" If you are examining issues of bleeding then the size and color of red blood cells is important (MCV, MCH), along with total counts, hemoglobin/hematocrit, and reticulocytes (immature red blood cells that are released in higher quantities due to need). If you had acute infections then you'd like see a rise in neutrophils (white blood cells that focus on bacteria), leukocytes (white blood cells in general), and a high ESR (erythrocyte sedimentation rate - how long it takes red blood cells and solids to settle, which is often delayed with inflammation/infection).
James Bennett
I have been pretty sedentary over the past year. I wonder if exercise would actually help. If it were coming from my nose it would have to be getting all the way down into my lung.
Evan Morales
If you can afford to shop around for a doctor, continue to do so; you deserve a doctor who will listen to you and take your concerns seriously (it sounds as though your doctor believes it is nothing and is doing a poor job of convincing you; however, there's a difference between being concerned over nothing and being concerned about coughing up blood; chances are your doctor is an idiot and is/has missed something). It's very unlikely that someone on this board will know how to help you, even if a medfag does stop in.
It's possible that what you're coughing up now is old blood from when you were first sick--the blood in your photo doesn't look particularly fresh, but there also seems to be flesh there--but I find that highly unlikely. If there was a biopsy on the mass in your lung, what was it identified as?
My only other suggestions would be: stay hydrated; lots of hot tea, soup, and hot showers (the steam should help with congestion, which will make it easier for you to breathe); hand-stands with a friend/partner to pound on your back (they do something similar for kids with cystic fibrosis, which helps knock gunk out of their lungs); and maybe adding some more iron to your diet (constant fatigue sounds like anemia).
Good luck, user, and get healthy!
Jason Robinson
Half a pack a day for 8 years, I’m 29. I believe I DO have those results and will try to find them. If I do, I’ll share them in this thread tomorrow if by any chance you stop by I’d appreciate your take. And yeah the chronic fatigue is...not fun. I’ve spent the better part of a decade thinking it’s all bad sleep/some mental issue but perhaps all of this is related. But it is difficult to be taken seriously. The best I ever get is “well do some blood work” and that invariably raises no red flags. Also my chest x Ray was completely clear in the previous instances.
This isn’t old blood sadly, it’s clearly fresh. The consistency seems to vary in each of these episodes, sometimes it’s clearly been In there a while, sometimes not. There was never a direct biopsy done but not cancer cells were picked up in the lavage. I don’t have a low oxygen level or any apparent trouble breathing.
Easton Evans
>adding some more iron to your diet (constant fatigue sounds like anemia).
He said his labs were normal, which a CBC would have shown anemia. Even if he had anemia you don't just give them iron because you need to do a differential for iron deficiency, iron storage, B vitamin deficiency, anemia secondary to disease, hemolytic anemia etc. etc.
Get a second opinion from a different pulmonary doc. Did you have any weird effects from smoking outside of the normal cough etc? Stuff like discoloration of fingertips or toes, darkened skin?
You will need to explain how you feel that the mental issues, poor sleep, and fatigue relate? Does this have a specific onset? How long has it been going on? Is this before or after your current challenges? Anyone ever complain about you snoring? Are your SVT bouts stable or have you needed medication or cardioversion in the past to go back into a normal rhythm? Do you take any meds? Supplements? Any past medical history or family history that should be noted?
Aaron Allen
Crack doctor here. If your ct scan already revealed a mass on your Chest CT scan, why the fuck would your doctor diagnose you with pneumonia? And what was the bronchoscopy result? I advise having that mass biopsied. Any symptoms of difficulty in breathing and weight loss?
Joshua Diaz
Underwent two cardiac ablations for the SVT which brought symptoms under control. Still occasionally have arrhythmias but I can stop them when I do. The only other noticeable issue is GERD which was a recent diagnosis. But the blood is definitely coming from an airway.
Because the mass disappeared and wasn’t even detectable in my third ct scan for the 2nd bout of hemoptysis. Originally it was too deep in my lung to get a sample during the bronchoscopy.
I appreciate all the advice here. It’s looking like my best bet would be to simply get a second opinion.
Joshua Miller
And no to everything. The only family history is stroke and prostate cancer.
(I’m not sure if these percentages are useful) all this was done at the same time as the initial bronchoscopy coughing episode months ago. No subsequent blood work was ever done.
Benjamin Hughes
Nothing here strikes me as super off base. Neutrophils by % are elevated, though without the absolute counts one can't really put together a full picture. A higher neutrophil % and count would be evidence for a bacterial infection like pneumonia. Also, each lab does their own thing with computation so they normally will attach normal values for how they compute the various labs.
MCV is basically the size of your red blood cells.
MCH is the amount of hemoglobin within them. Bound hemoglobin causes the rusty color in blood, so if it would be low you'd have paler than normal RBCs.
Hemoglobin is just the total amount in an amount of blood fluid.
Hematocrit takes a look at the amount of blood solids (cells) vs. liquid (plasma) portion. This can be important in looking at things like dehydration.
Neutrophils are white cells which specialize in attacking bacteria. Lymphocytes, on the other, hand are cells which mostly are part of adaptive defense. These include things like your B-cells (which produce antibodies after turning into plasma cells), T-Helper/Killer T cells, and Natural Killer (NK) cells.
Josiah James
I really appreciate you weighing in. My pulmonologist called and recommended immediately going to the ER if this happens again. I’m out of state at the moment so I’d get raped by expenses if I did that now. So I dunno. Short of them getting really creative we’re going to just repeat what was already done and see if they can identify it with another bronchoscopy.
Elijah Peterson
You may have HHT. t. cardio-thoracic surgeon
Levi Ward
No problem. That said, I would get a second opinion as another physician might have a different perspective. However, I will also mention that you should cut your pulmonary team some slack as long as they are following proper procedure. Sometimes there isn't going to be a direct answer or finding early on.
Hemoptysis (blood in sputum) is a sign, but it isn't a disease in and of itself. It can be the result of a disease process, but there are many conditions in which this sort of sign can be seen. By doing a biopsy, CT, and CXR (chest x-ray) they've likely ruled out a lot of the conditions that could immediately kill you (e.g. lung cancer, pulmonary embolism, active TB).
Things like walking pneumonia or a chronic lung infection are possibilities, along with vessel integrity issues. The 2nd and 3rd stage of pneumonia is characterized by bloody coughs then purulent (nasty infected) discharge. This is called red and grey hepatization.
It can be more difficult to conclusively determine vessel defects or genetic conditions because they require a higher level of suspicion and more nuanced testing. Often there should be a family history already present.
Easton Baker
My tendency to introduce the idea that this may not be a straight forward matter a la Are we met with a middling response. His feeling is that the only way to really get a handle in this is to get a camera on the bleed when it’s happening, I only have a week or so window to do so each time. Thus, we have the emergency room but he IS totally confident that it isn’t cancer, seems sound given two totally clear ct scans of the chest.
Robert Harris
Well there you go. You have a plan of action. It might be good to make sure your pulmonary doc has privileges at a certain hospital so he can step in if you have to go to the ED. That is if you have multiple hospital systems. Just make sure to keep him in the loop the instant it would happen again, and even see if there is a way to contact if you were to end up with hemoptysis during an evening or weekend. This could be getting his personal number or that of a PA or NP colleague who can also guide the plan of care.
Kayden Howard
tuberculosis?
Bentley Roberts
He already had a CXR/CT and I'd imagine a culture/PPD would have been one of the first things for rule out of TB.
