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What Causes Coughing Up Blood With History Of TB?
Question: Hi,
I was diagnosed with TB at the beginning of 2014 and started on TB antibiotics treatment on the 3rd of January. My main symptoms was coughing up extreme amount of blood among the other TB symptoms. I was originally meant to be on treatment until 3rd July 2014 but when I saw my doctor at the beginning of XXXXXXX he looked at my most recent chest X-Rays which was taken at the end of May and concluded that the TB hasn't completely cleared and extended my treatment for a further 3 months until the 3rd of October 2014.
Although not to the extreme level as before, I'm continuing to cough up blood on and off sometimes dark and sometimes it's bright red mainly when I wake up but also at different times during the day. Is this normal in TB patients even after nearly completing 6 months of antibiotics treatment? How long would me coughing up blood continue for? Does smoking cigarettes have a connection in this?
Thank you!
I was diagnosed with TB at the beginning of 2014 and started on TB antibiotics treatment on the 3rd of January. My main symptoms was coughing up extreme amount of blood among the other TB symptoms. I was originally meant to be on treatment until 3rd July 2014 but when I saw my doctor at the beginning of XXXXXXX he looked at my most recent chest X-Rays which was taken at the end of May and concluded that the TB hasn't completely cleared and extended my treatment for a further 3 months until the 3rd of October 2014.
Although not to the extreme level as before, I'm continuing to cough up blood on and off sometimes dark and sometimes it's bright red mainly when I wake up but also at different times during the day. Is this normal in TB patients even after nearly completing 6 months of antibiotics treatment? How long would me coughing up blood continue for? Does smoking cigarettes have a connection in this?
Thank you!
Brief Answer:
Investigations ASAP
Detailed Answer:
Hi.
Thanks for your query and an nicely put in history.
It is exactly 6 months and you still have hemoptysis, that is coughing up the blood- fresh sometimes and dark at other times.
It is not at all normal for the TB patents to cough up blood after completing 6 months. It will depend upon the fact of what will be found on investigation , that we can comment upon for how long it will continue.
Smoking cigarettes has a direct worst effect on bleeding like this.
I would advise you the following::
*Go for a CT scan of the chest. This is diagnostic for many diseases. (The X-rays give a very good guideline and nothing more).
*Get a Bronchoscopy done. One may find a small hemangioma or granuloma. This will be diagnostic as well as therapeutic. You need a Pulmonologist for this. Bronchoscopic lavage for: malignant cells, AFB cells.
* Upper GI Endoscopy - to make sure that the blood is not vomited ( Hemetemesis) and any other findings as you are under a treatment for so long.
* If the sputum is still expectorated : analysis for AFB and malignant cells.
Investigations ASAP
Detailed Answer:
Hi.
Thanks for your query and an nicely put in history.
It is exactly 6 months and you still have hemoptysis, that is coughing up the blood- fresh sometimes and dark at other times.
It is not at all normal for the TB patents to cough up blood after completing 6 months. It will depend upon the fact of what will be found on investigation , that we can comment upon for how long it will continue.
Smoking cigarettes has a direct worst effect on bleeding like this.
I would advise you the following::
*Go for a CT scan of the chest. This is diagnostic for many diseases. (The X-rays give a very good guideline and nothing more).
*Get a Bronchoscopy done. One may find a small hemangioma or granuloma. This will be diagnostic as well as therapeutic. You need a Pulmonologist for this. Bronchoscopic lavage for: malignant cells, AFB cells.
* Upper GI Endoscopy - to make sure that the blood is not vomited ( Hemetemesis) and any other findings as you are under a treatment for so long.
* If the sputum is still expectorated : analysis for AFB and malignant cells.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Hi Doctor,
Thank you for your reply.
I had a Bronchoscopy on the 24th of December 2013 prior to my doctor diagnosing me with TB. I then had an Ultrasound Bronchoscopy on the 10th of March. All the cell samples that was taken during these 2 procedures came back negative.
I was admitted to the hospital a few times so far this year. The last time I was there which was in April, my left lungs had collapsed (Pneumothorax). While being admitted and receiving treatment for this condition, I did a CT scan and the scan was showing 5 small cavities (cysts) in my left lung.
Could it be that the cavities are still there and this is what is causing me to cough up blood?
Could you also talk a bit about smoking and whether that may be the cause of the hemoptysis and do you think that smoking lessens the effect of the TB antibiotics that I am currently on?
Thank you!
Thank you for your reply.
I had a Bronchoscopy on the 24th of December 2013 prior to my doctor diagnosing me with TB. I then had an Ultrasound Bronchoscopy on the 10th of March. All the cell samples that was taken during these 2 procedures came back negative.
I was admitted to the hospital a few times so far this year. The last time I was there which was in April, my left lungs had collapsed (Pneumothorax). While being admitted and receiving treatment for this condition, I did a CT scan and the scan was showing 5 small cavities (cysts) in my left lung.
Could it be that the cavities are still there and this is what is causing me to cough up blood?
Could you also talk a bit about smoking and whether that may be the cause of the hemoptysis and do you think that smoking lessens the effect of the TB antibiotics that I am currently on?
Thank you!
Brief Answer:
Yes , the cavities.
Detailed Answer:
Thanks again for a good feed-back.
Cell samples came back negative is a good thing for ruling out cancer, that is what dreaded me, as is the CT scan; I too am a bit relieved to know the findings.
The findings of the CT of left pneumothorax with collapsed lung and 5 small cavities on the same side. ( one of the 'blebs' must have been ruptured to cause pneumothorax). Cavities remain like that and as you are suspecting rightly are the reasons for hemoptysis.
With such findings on CT and your symptoms, smoking is going to be one of the most important reasons ( if you still do) of delayed healing and the complications thereupon.
There are no studies to see whether the smoking lessens the effect of ATT ( anti-tubercular treatment). It surely is a contributing factor.
One of the indications of lobectomy ( removal of the affected lobe with the cavities) is persistent hemoptysis. Please discuss this with your treating Doctor.
Al the best for an early recovery and complete cure.
Yes , the cavities.
Detailed Answer:
Thanks again for a good feed-back.
Cell samples came back negative is a good thing for ruling out cancer, that is what dreaded me, as is the CT scan; I too am a bit relieved to know the findings.
The findings of the CT of left pneumothorax with collapsed lung and 5 small cavities on the same side. ( one of the 'blebs' must have been ruptured to cause pneumothorax). Cavities remain like that and as you are suspecting rightly are the reasons for hemoptysis.
With such findings on CT and your symptoms, smoking is going to be one of the most important reasons ( if you still do) of delayed healing and the complications thereupon.
There are no studies to see whether the smoking lessens the effect of ATT ( anti-tubercular treatment). It surely is a contributing factor.
One of the indications of lobectomy ( removal of the affected lobe with the cavities) is persistent hemoptysis. Please discuss this with your treating Doctor.
Al the best for an early recovery and complete cure.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Hi Doctor,
Thank you for your reply which has eased my mind somewhat.
So, I mentioned I saw my doctor at the beginning of XXXXXXX when he looked at my most recent chest X-Ray which was taken at the end of May, and concluded that he would extend my treatment for a further 3 months until the 3rd of October 2014.
When I talked to him about the cavities that they saw on the CT scan while I was admitted to hospital in April, he said he can't see nothing on this chest X-Ray at this time.
I then thought the cavities had disappeared by itself based on the fact that I had 1 big cavity in my right lung a couple of months before April when I was admitted to the hospital again and this 1 bigger cavity which formed had disappeared by itself.
I think that there might be 3 main possibilities:
1) The chest X-Ray didn't give the doctor a clear picture on whether the 5 small cavities were still there in my left lung.
2) The cavities had disappeared since I left hospital in April and my chest X-Ray at the end of May was right. Now maybe new cavities has formed which we don't know about since I last saw my doctor at the beginning of XXXXXXX
3: Something other than cavities is causing the hemoptysis.
I am trying to give up smoking from this morning to see if the hemoptysis improves but do you think that smoking has a direct effect on me continuing to cough blood.
I'm also curious, is respiratory functions your area of expertise?
Thank you doctor and I appreciate all your help.
Thank you for your reply which has eased my mind somewhat.
So, I mentioned I saw my doctor at the beginning of XXXXXXX when he looked at my most recent chest X-Ray which was taken at the end of May, and concluded that he would extend my treatment for a further 3 months until the 3rd of October 2014.
When I talked to him about the cavities that they saw on the CT scan while I was admitted to hospital in April, he said he can't see nothing on this chest X-Ray at this time.
I then thought the cavities had disappeared by itself based on the fact that I had 1 big cavity in my right lung a couple of months before April when I was admitted to the hospital again and this 1 bigger cavity which formed had disappeared by itself.
I think that there might be 3 main possibilities:
1) The chest X-Ray didn't give the doctor a clear picture on whether the 5 small cavities were still there in my left lung.
2) The cavities had disappeared since I left hospital in April and my chest X-Ray at the end of May was right. Now maybe new cavities has formed which we don't know about since I last saw my doctor at the beginning of XXXXXXX
3: Something other than cavities is causing the hemoptysis.
I am trying to give up smoking from this morning to see if the hemoptysis improves but do you think that smoking has a direct effect on me continuing to cough blood.
I'm also curious, is respiratory functions your area of expertise?
Thank you doctor and I appreciate all your help.
Brief Answer:
CT scan for follow-up
Detailed Answer:
Thanks for your appreciation.
IF your Doctor has decided to ask you to take a further course of ATT, he must have his reasons to tell you so.
Cavities seen on the CT can never be same or seen on X-ray.
The finding on the CT Scan and X-rays can not be compared anytime. So a review should be done by the similar investigation. Well formed cavities can not disappear as they have been lined by fibrosis and will always be seen on CT scan, albeit smaller and better.
If the cavity is disappearing, it means it was a bleb that is air cavity only.
To further answer your query I have copy-pasted here>>>
I think that there might be 3 main possibilities:
1) The chest X-Ray didn't give the doctor a clear picture on whether the 5 small cavities were still there in my left lung.
*The cavities have to judged only by the comparable CT scans and not on the X-ray at all.
2) The cavities had disappeared since I left hospital in April and my chest X-Ray at the end of May was right. Now maybe new cavities has formed which we don't know about since I last saw my doctor at the beginning of XXXXXXX
* Again- only a CT scan can help.
3: Something other than cavities is causing the hemoptysis.
* Exactly- this is what I already noted in the answers in the beginning. Cancer being one that has to be ruled out.
I am trying to give up smoking from this morning to see if the hemoptysis improves but do you think that smoking has a direct effect on me continuing to cough blood.
** You still are in a dilemma.
Just stop and stop.
I'm also curious, is respiratory functions your area of expertise?
** Well, I am a practicing as a General Surgeon and also an ENT Surgeon ( lucky to have 2 post-graduate specialties ) and have exposure in Thoracic surgeries - Thoracoscopy and thoracic procedures- the commonest are for TB; and we work in an area where TB is very rampant)
So carry on the treatment.
For the best outcome in TB
*Maintaining good hemoglobin and serum proteins.
* Chest Physiotherapy
*Avoidance of pollution of any sort
*Multi-vitamins
These factors help.
CT scan for follow-up
Detailed Answer:
Thanks for your appreciation.
IF your Doctor has decided to ask you to take a further course of ATT, he must have his reasons to tell you so.
Cavities seen on the CT can never be same or seen on X-ray.
The finding on the CT Scan and X-rays can not be compared anytime. So a review should be done by the similar investigation. Well formed cavities can not disappear as they have been lined by fibrosis and will always be seen on CT scan, albeit smaller and better.
If the cavity is disappearing, it means it was a bleb that is air cavity only.
To further answer your query I have copy-pasted here>>>
I think that there might be 3 main possibilities:
1) The chest X-Ray didn't give the doctor a clear picture on whether the 5 small cavities were still there in my left lung.
*The cavities have to judged only by the comparable CT scans and not on the X-ray at all.
2) The cavities had disappeared since I left hospital in April and my chest X-Ray at the end of May was right. Now maybe new cavities has formed which we don't know about since I last saw my doctor at the beginning of XXXXXXX
* Again- only a CT scan can help.
3: Something other than cavities is causing the hemoptysis.
* Exactly- this is what I already noted in the answers in the beginning. Cancer being one that has to be ruled out.
I am trying to give up smoking from this morning to see if the hemoptysis improves but do you think that smoking has a direct effect on me continuing to cough blood.
** You still are in a dilemma.
Just stop and stop.
I'm also curious, is respiratory functions your area of expertise?
** Well, I am a practicing as a General Surgeon and also an ENT Surgeon ( lucky to have 2 post-graduate specialties ) and have exposure in Thoracic surgeries - Thoracoscopy and thoracic procedures- the commonest are for TB; and we work in an area where TB is very rampant)
So carry on the treatment.
For the best outcome in TB
*Maintaining good hemoglobin and serum proteins.
* Chest Physiotherapy
*Avoidance of pollution of any sort
*Multi-vitamins
These factors help.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Prasad
Answered by
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