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A man coughed up this perfectly formed blood clot and anesthetized his doctors



If someone shows you the above picture without context, you probably think that it is an intact blood vessel. Reader is not. It is a perfect occupation of the branched air passages in the right lung of a man who dies of heart failure and was formed from coagulated blood that has accumulated in it.

The man's doctors were absolutely stunned by the thing they published in the New England Journal of Medicine .

First, let's clarify one thing. It's actually not part of his lungs, as some headlines say. It's not possible to cough a lungs (although you can cough so hard that a lung hernia breaks through your ribs, so do not joke, so try.)

Bronchial tree clumps ̵

1; so-called casts – are not uncommon at all. Several blood clots have been reported in recent years. They were coughed in 2010 by a 57-year-old woman with lupus, a 25-year-old pregnant woman and an 80-year-old male

And if you switch to a social image-sharing network (Figure 1) and "bronchial cast" Looking, you will see a variety of casts formed from clotted blood or mucus that accumulate in the lungs of certain medical conditions.

What fascinates this particular cast is not that it happened at all, but that it is absolutely enormous – and the patient coughed it together in one piece without it breaking. [194559007] [19459011BloodClotInset700"width="700"style="width:100%;"/> (Woodward et al./NEJM)[19659003"WorkerStarfish"MeettheMannesGeorgWieselthaler The Atlantic "This is a curiosity you can not imagine – I mean, that's very, very, very rare."

The patient, an anonymous 36-year-old man, coughed while in the terminal acute stage heart failure in the intensive care unit after long-term heart failure.

His doctors connected his heart to a device that could pump blood around his body, but since these devices can also cause blood clots, they had to be continuous To prevent this, administer an infusion of an anticoagulant called heparin.

Apart from coagulation, a necessary part of the body's self-repair system is to prevent blood vessels from causing tiny tears which cause internal bleeding – or, if they occur in the blood vessels that carry blood around the lungs, get into the air passages and accumulate there.

Unfortunately, this is the case of the patient. During the week, after his doctors introduced the Impella device and heparin treatment, he started coughing up smaller blood clots, resulting in an extreme coughing attack that caused him to build a huge mass.

When the doctors unfolded They saw a plaster cast that was so perfect that it clearly identified it as the man's right bronchial tree.

They believe that what held him together might have been a protein called fibrinogen, which is important for coagulation. Although the patient was taking anticoagulants, his infection caused an increased level of fibrinogen in the blood – this could have kept the clot together while he was spitting it out.

Unfortunately, he felt better after the clot came out of his lungs. and coughed no more lumps, the state of his heart was too severe. He died just over a week later from congestive heart failure.

The case was reported in New England Journal of Medicine .


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