Blood Without a Source: A Diagnostic Challenge in Recurrent Oropharyngeal Bleeding

Oropharyngeal bleeding may be difficult to distinguish from hemoptysis when the source of blood is not apparent, potentially prompting extensive evaluation for pulmonary or gastrointestinal causes. This report describes an 82-year-old woman who experienced recurrent episodes of bright red blood mixed with saliva over approximately two weeks, without associated coughing or vomiting. Initial evaluation did not identify a bleeding source, and the episodes resolved spontaneously before otolaryngologic examination. Flexible nasolaryngoscopy revealed mild nasal mucosal irritation without active bleeding or an identifiable lesion. Prominent pulsation of the posterior pharyngeal wall raised suspicion for a retropharyngeal carotid course, although this finding was not confirmed by vascular imaging. Minor mucosal trauma was considered a possible explanation, but the exact source of bleeding remained undetermined. This case highlights the importance of localizing unexplained oral bleeding and recognizing potential vascular anatomical variants during examination of the posterior pharynx.