Wednesday, 19 December, 2018

Man coughs up startling blood clot shaped like a lung passage

It was evident that his health was declining when the patient was admitted It was evident that his health was declining when the patient was admitted
Carol Daniels | 08 December, 2018, 15:02

It turns out that the 36-year-old patient's condition produced elevated levels of fibrinogen, a protein that can act as a glue to assist the clotting process, which allowed the rubbery "blood sculpture" to escape the man's trachea intact.

On Monday, the New England Journal of Medicine tweeted a startling picture as part of its "Images in Clinical Medicine" photo series, which features photos of medical anomalies.

During the week of the patient's hospitalization, the man had periodic episodes of coughing, which progressed to one extreme coughing fit when he suddenly expelled the unusual clot.

In a case report from the New England Journal of Medicine, the man had been admitted to the University of California San Francisco Medical Center with chronic heart failure. The patient was put on a pump to help maximize blood flow through the body and was administered anticoagulants to make the blood thinner and prevent clots from forming.

However, over the course of a week, the man had started coughing up phlegm and blood, the cough being so severe that he coughed up an intact cast of the right bronchial tree.

The pulmonary surgeon Dr Georg Wieselthaler told The Atlantic when he carefully spread out the clot, realising it was the ideal shape, he was "astonished".

"We were astonished", Wieselthaler said.

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"An Impella ventricular assist device was placed for management of acute heart failure, and a continuous heparin infusion was initiated for systemic anticoagulation".

Wieselthaler called the occurrence "very, very, very rare".

A 2005 report in the European Journal of Cardio-Thoracic Surgery refers to a similar case where a pregnant woman coughed up a less-extensive blood clot cast also in the shape of her bronchial tree.

The patient was extubated 2 days later and had no further episodes of hemoptysis.

Sadly, the patient died a week later from complications of heart failure.

More specifically it's a six-inch-wide, unbroken cast of the right bronchial tree, part of the tubular network that distributes air to the lungs.

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