A 36-year-old man dying of heart failure coughed up a six-inch-wide blood clot resembling, almost perfectly, the right bronchial tree of a lung. The clot was completely intact and his doctors aren’t exactly sure how it even happened.
The anonymous patient was being treated for acute end-stage heart failure in the ICU when he coughed up the bronchial tree clot, also known as a cast.
An image of the clot and a description of what led to the cast’s appearance was published by the man’s doctors in the New England Journal of Medicine in late November.
While the image does look eerily similar to a lung, it isn’t one. Despite the old adage, it is thankfully not possible to cough up a lung. According to doctors, “During an extreme bout of coughing, the patient spontaneously expectorated an intact cast of the right bronchial tree.”
The image of the man’s clot is certainly startling but it turns out clots resembling bronchial trees have been previously reported (and photographed). Thanks to Science Alert, you can view the following bronchial tree clots:
Coughed up by a 25-year-old pregnant woman in 2005.
Coughed up by a 57-year-old-woman with lupus in 2010.
Coughed up by a 80-year-old man in 2015.
There are, however, two glaring differences between the casts noted above and November’s headline worthy cast. The 36-year-old man’s cast is enormous compared to any previously recorded example and he somehow managed to cough it up in one piece without it breaking.
The man’s doctor, Georg Wieselthaler, told The Atlantic that the team of doctors was “astonished.”
“It’s a curiosity you can’t imagine – I mean, this is very, very, very rare.”
The 36-year-old man landed in the ICU after a long history of heart failure. After a series of procedures including valve replacement, stenting, a pacemaker, an Impella ventricular assist device and the medication required including a continuous heparin infusion, he experienced “episodes of small-volume hemoptysis, increasing respiratory distress, and increasing use of supplemental oxygen.” Despite medication, the ventricular assist device, and additional procedures, the man’s heart failure was too severe and as a result, he died just over a week later.
Photo credit: (Woodward et al./NEJM)