Differential Diagnosis for Cough with Phlegm and Occasional Blood-Streaking, Especially with Colds

• Single Most Likely Diagnosis
  • Acute Bronchitis: This condition is often precipitated by a viral upper respiratory infection (like the common cold) and can lead to a cough that produces phlegm, which may occasionally be blood-streaked due to the irritation and inflammation of the bronchial tubes.
• Other Likely Diagnoses
  • Chronic Bronchitis: Part of chronic obstructive pulmonary disease (COPD), chronic bronchitis involves long-term inflammation of the bronchial tubes, leading to a persistent cough with mucus production, which can sometimes be blood-streaked, especially during exacerbations triggered by colds.
  • Asthma: Asthmatic patients can experience coughing with phlegm production, and in severe cases or during acute exacerbations, the phlegm may be blood-streaked. Colds can trigger asthma symptoms.
  • Pneumonia: Although typically presenting with more severe symptoms like high fever and shortness of breath, pneumonia can cause a cough with phlegm that may be blood-streaked, especially in bacterial pneumonia.
• Do Not Miss Diagnoses
  • Lung Cancer: Although less common, lung cancer can present with a chronic cough and hemoptysis (coughing up blood). It's crucial to consider this diagnosis, especially in smokers or those with a significant smoking history, as it can be life-threatening if not diagnosed and treated promptly.
  • Pulmonary Embolism: While more commonly associated with sudden onset of shortness of breath and chest pain, pulmonary embolism can occasionally present with cough and hemoptysis, making it a critical diagnosis not to miss due to its high mortality rate if untreated.
  • Tuberculosis (TB): TB can cause a chronic cough with phlegm that may be blood-streaked. Given its potential for serious morbidity and mortality, as well as public health implications, TB should be considered, especially in individuals with risk factors such as immunocompromised states or recent travel to endemic areas.
• Rare Diagnoses
  • Bronchiectasis: A condition characterized by damaged, dilated airways, bronchiectasis can lead to a chronic cough with purulent sputum production, which may occasionally be blood-streaked. It's less common but should be considered in patients with recurrent infections or specific risk factors.
  • Cystic Fibrosis: Although typically diagnosed in childhood, cystic fibrosis can present in adulthood with respiratory symptoms including a chronic cough with thick, purulent sputum that may be blood-streaked due to repeated infections and bronchiectasis.
  • Mitral Stenosis: A heart condition where the mitral valve narrows, mitral stenosis can lead to pulmonary congestion and, in severe cases, hemoptysis. It's a less common cause of cough with blood-streaked phlegm but is important to consider, especially in patients with known heart disease.