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Forum Name: Chest symptoms

Question: chest and esophagus pain and blood in spit


 NickR - Fri Dec 08, 2006 2:02 pm

I am a 24 year old male, and I have no history of any serious medical conditions.
However, over the past 6 months I have developed a chronic chest pain. I have had a chest xray, and an echocardiogram - they are both fine. Also, the pain does not subside with acid indigestion tablets. The pain usually increases with stress.
During the past week, I have noticed blood in my phelgm in the morning. I have also had a sore throat and cold the last week. I have absolutely no cough, no fever, and no joint or other bodily pains. There is no blood coming from my nose. I was wondering whether the blood in phlegm was related to my chest pains (given that the chest xray and the echocardiogram was fine).
I do not have health insurance, however I will be going back to the UK in 3 months, and will be covered there. Should I wait until I get back, or see a doctor without health insurance before I go? Also, could this be an ulcer? Thanks for your help, Nick
 Dr. Safaa Mahmoud - Fri Dec 08, 2006 5:09 pm

User avatar Hello,

It would have been more helpful if you described more the character of this pain and if there are other related symptoms or signs. However I would give you a general idea about what it could be.

The chest contains many organs, like the heart, lungs with its pleural covering, esophagus, muscles, ribs, tendons, and nerves. They all can be the source of the pain felt in the chest.

Possible causes include:
- Pleurisy is an inflammation of the pleura, which is a double-layered membrane covers the lungs separating it from the rib cage. Viral infections like flu, are the most common cause of Pleurisy. The pain is felt as sharp pain which get worse by Coughing, sneezing, moving and deep breathing. Auscultation of the chest shows a characteristic sound known as pleural rub.
If you are smoker or allergic then the possibility of having recurrent attacks is high.

- Sometimes Chest pain is not originating from the chest itself; instead it is due to problems in the digestive tract. These problems include IBS, Gastritis and Gastric ulcer, gall bladder disease, GER. Although you mentioned that you have received medicines for indigestion, the possibility is still there.

Coughing up of blood or bloody mucus is mainly from the lungs and throat (respiratory tract) and is usually bright red ( to the contrary of dark Brown color for blood from GI origin).
Having sore throat and cold recently make the possibility of throat or postnasal as they are inflamed and the blood vessels are congested and can easily bled.

Investigations include:
Complete blood count
Coagulation studies such as PT or PTT
Chest x-ray
Chest CT scan

Hope you find this information useful,
Best regards,
 NickR - Fri Dec 08, 2006 8:55 pm

Thank you very much for your quick response.
I will describe the pain in my chest. It is a dull constant sensation, as though a rock was stuck in my rib cage. It does not get worse or better with exercise, however it gets worse with stress. The pain radiates very strongly to my neck and sometimes to my back. Could this be an ulcer, and if it is, can the blood be coming from that? Or would you say that it is more likely that the blood is coming from a sore throat?

Finally, if this is an ulcer, should I get it treated right away, or do you think it can wait until I get back to the UK?
Best, Nick
 NickR - Fri Dec 08, 2006 8:58 pm

ps. I have had the pain for over 6 months...maybe even up to ten months, so I assume that it is less likely to be pleurisy, as that should have healed by now?
 Dr. Safaa Mahmoud - Sat Dec 09, 2006 4:13 am

User avatar Hello,

It could be:

- Of esophageal origin due to Esophagitis which results from many causes including GERD, infections (viral, bacterial) or

In appropriate contraction of the esophageal muscles, they all causes Chest pain that can be severe and sometimes is felt as a lump or tightness in the chest with difficult swallowing.

- of gastric origin
Gastritis is an inflammatory disorder affecting the gastric mucosa.
Causes include:
- Reflux Gastritis: due to exposure to the irritant secretions of the gall bladder and pancreas.
- Infectious Gastritis: commonest is H. pylori.
- Chemical irritants: like NSAIDs.

- Peptic ulcer disease (PUD) is an open sore in the mucosa of the stomach or duodenum.

Patients usually present with burning upper Abdominal pain that increases when the stomach is empty and relieved by Antacids.

Certain foods are known to aggravate these condition, and you better avoid them. These include chocolate, beverages containing caffeine, fatty and fried foods, garlic and onions, spicy and tomato containing foods. In addition smoking is one of he precipitating factors that should be avoided.

Iinvestigations include Upper Endoscopy, and other lab tests that can be recommended by the doctor accordingly.

I advise you to follow with your doctor as soon as possible and discuss with him this information.
Best regards.

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