A patient with heart failure spits this unusual blood clot unusual in the form of a pulmonary passageway



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Although it looks like a coral, a root system or some other kind of growth, the photo above shows a 15-centimeter clot in the near-perfect form of the right bronchial tree of a human lung, he said Thursday. Atlantic. However, the most uncomfortable is the revelation that it has not been eliminated by medical staff, but actually expelled by a patient suffering from heart failure. Cough

The photo was published late November as part of the series Images in Clinical Medicine of the New England Journal of Medicine. Doctors Gavitt A. Woodard and Georg M. Wieselthaler, of the University of California, San Francisco, wrote that she came from her patient, a 36-year-old man who had long struggled with chronic heart failure.

According to reports, the patient had a medical history that included "cardiac failure with a 20% ejection fraction, bioprosthesis aortic valve replacement for bicuspid aortic stenosis, aortic aneurysm, and definitive pacemaker placement for complete cardiac block"When the patient was admitted to the hospital's intensive care unit, they connected him to a pump designed to help blood circulate throughout the body:

Image: Pulmonary structure image (Wikimedia Commons)

An Impella ventricular assist device was placed for the treatment of acute heart failure and a continuous infusion of heparin was initiated for systemic anticoagulation. During the following week, the patient presented episodes of small volume hemoptysis, increased respiratory discomfort and increased use of supplemental oxygen (up to 20 liters administered through a high-flow nasal cannula). During an extreme coughing attack, the patient spontaneously coughed an intact cast of the right bronchial tree.

The patient was subsequently extubated and "he had no further episodes of hemoptysis", The doctors wrote, but a week later"died of complications of heart failure (volume overload and low cardiac output) despite the placement of the ventricular assist device"

According to The Atlantic, Wieselthaler said that the use of the pump requires anticoagulants to "dilute blood and prevent clots"In this case, Wieselthaler explained, the blood leaving the heart to supply itself with fresh oxygen in the circulatory system appears to have accumulated in the right bronchial tree, coagulated and then expelled by the patient into a revolt:

Once Wieselthaler and his team carefully implanted the "package," they discovered that the architecture of the airways had been so perfectly conserved that they could identify it as the right bronchial tree based only on the number of branches and their alignment.

Wiesel Thaler added that a possible way for the clot to remain intact, instead of breaking, was a high concentration of fibrinogen, a blood plasma protein that helps form clots. The patient had an infection that worsened heart failure and may have caused a buildup of fibrinogen in the blood, resulting in a more viscous clot, The Atlantic explained.

Woodard told the magazine that, in addition, it is possible that the size of the clot actually contributed to his expulsion, since it could have allowed the patient to "generate enough force from the entire right side of his chest to push it up and down. out". "(Gizmodo tried to contact Woodard to clarify some issues, and we will update when we have an answer).

It may seem a bit frivolous to study someone's medical misery, but most doctors will never have the opportunity to see something like that. Although there are other conditions that can cause bronchial drains, including infections and asthmatic conditions or lymphatic flow disorders that can cause an accumulation of mucus or lymphatic fluid, Wieselthaler has been clear in that the size of this is unprecedented.

"We were surprised"Wieselthaler told The Atlantic."It's a curiosity you can not imagine; that is, this is very, very, very rare" [New England Journal of Medicine via the Atlantic]

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