If someone showed you the picture above without context, you would probably think it was an intact blood vessel. Readers, it's not. It is a perfect cast of branched air passages in the right lung of a man dying of heart failure, formed from the coagulated blood that accumulated in him.
The man's doctors were absolutely shocked at the thing, which they New England Journal of Medicine.
First let's get one thing straight. It's not really part of your lung, as some news headlines are claiming. It is not possible to cough a lung (although you may cough so hard that a herniated lung through your ribs. This is not fun, so try to avoid it).
In fact, bronchial tree clots – called castles – are not uncommon. Several blood clotting cylinders have been reported in recent years – spat by a 57-year-old woman with lupus in 2010, a 25-year pregnant woman in 2005 and an 80-year-old man in 2015..
And if you move to the social network for sharing medical images and look for "bronchi," you will see a variety of molds, formed from coagulated blood, or mucus that accumulates in the lungs under certain medical conditions.
What makes this particular cast so intriguing is not that it happened, but that it's absolutely huge – and the patient coughed at once, without breaking.
"We were astonished," said the man's doctor, Georg Wieselthaler. The Atlantic. "It's a curiosity you can not imagine – I mean, this is very, very, very rare."
The patient, an anonymous man of 36 years, spat the mold while being treated for acute end-stage heart failure in the ICU after a long history of heart failure.
Your doctors have linked your heart to a device to help pump blood around your body. But because these devices can also cause blood clots, they needed to give him a continuous infusion of an anticoagulant called Heparin to prevent it from happening.
Except that coagulation is a necessary part of the body's self-repair system, working to prevent blood vessels from developing small tears that result in internal bleeding – or, if they occur in the blood vessels carrying blood around the lungs, leak to the inside of the body. tickets and accumulating there.
Unfortunately, this is what happened to the patient. Throughout the week, after his doctors implemented the Impella device and heparin treatment, he began to expel smaller blood clots, culminating in an extreme coughing attack, during which he created a gigantic mass.
When the doctors unfolded, they saw such a perfect cast that they could clearly identify him as the man's right bronchial tree.
They think that what kept it together could have been a protein called fibrinogen, which is vital to the coagulation process. Although the patient was taking anticoagulants, his infection caused a high level of fibrinogen in the blood – this could have held the clot while he coughed.
Unfortunately, though he felt better after the clot had left his lungs and there were no more clots, his heart condition was very severe. He died a little more than a week after complications of heart failure.
The case was reported in the New England Journal of Medicine.