Numular sputum

Specialty: Respiratory.

• expectoration in the form of coins
• dense globular sputum

Why it occurs

• Active tuberculous cavern (the sputum adopts a round or oval, compact shape, similar to a coin, which flattens at the bottom of the container with water due to its high content of cellular debris and caseum)
• Cylindrical or saccular bronchiectasis in periods of low hydration (accumulation of dense secretions in the bronchiectatic sacs that are expelled in isolation)
• Lung abscess in partial resolution phase (intermittent emptying of small dense purulent locules)
• Advanced chronic obstructive bronchitis (production of compact mucoid plugs that are difficult to expectorate)
• Cavitated pulmonary mycosis (such as histoplasmosis or coccidioidomycosis in chronic cavitary phase)

Initial workup

Serial sputum sputum smear (three consecutive morning samples for Ziehl-Neelsen or auramine-rhodamine staining); Nucleic acid amplification test (GeneXpert MTB/RIF) in sputum; Lowenstein-Jensen culture or automated liquid systems (MGIT); Chest x-ray (search for apical infiltrates or cavitations); High-resolution chest computed tomography (CT).

Standard management

• In case of confirmed tuberculosis: First-line regimen with Rifampicin (10 mg/kg/day), Isoniazid (5 mg/kg/day), Pyrazinamide (25 mg/kg/day) and Ethambutol (15 mg/kg/day) in an intensive phase of two months
• Acetylcysteine (600 mg orally once a day to promote the thinning of very dense mucus in non-tuberculous bronchial pathology).