Familiar with the phrase "spitting out a lung"? Not really possible, but a man stunned the doctors when he spat a blood clot in the form of a.
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Researchers have recently published shocking findings in the New England Journal of Medicine. In the report, they shared the story of a 36-year-old man admitted to an intensive care unit with aggressive end-stage heart failure.
The patient's heart was immediately connected to a pump designed to aid blood flow through the body, co-author Georg Wieselthaler described in the review. However, the machine may cause clotting, so they used heparin, a drug to thin the blood, to prevent them from forming.
A 36-year-old man was admitted to the ICU with an acute exacerbation of #cardiac insufficiency. After a ventricular assist device was placed and anticoagulation therapy started, hemoptysis developed and he expectorated a cast of the right bronchial tree. https://t.co/QfqeqwWzXt pic.twitter.com/nXW201rjCT
– NEJM (@NEJM) December 3, 2018
Heparin created another problem though. Thicker blood is needed to prevent blood vessels from developing small tears that can cause internal bleeding. Unfortunately, this is exactly what happened to the patient.
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Blood leaked from his lung network to the right lung and then to the bronchial tree. He started to cough smaller clots and ended up spitting out a large, oddly shaped, folded. When the doctors unfurled the ball, it was in the exact shape of the right bronchial tree.
"We were surprised," Wieselthaler told The Atlantic. "It's a curiosity you can not imagine – I mean, this is very, very, very rare."
Few such cases have been documented, including a 34-year-old woman who spat a large piece of membrane in the 1920s and a 25-year-old pregnant woman who swallowed a small bronchial tree mold in 2005.
So why do not the castles separate?
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As for the Wieselthaler patient, he believes the answer is related to fibrinogen, a blood plasma protein that causes cell fragments to form a mass. The patient's infection and heart failure possibly led to a very high concentration of fibrinogen, which left his blood somewhat rubbery and able to remain intact when he coughed.
"Because he was so big, he managed to generate enough force from all over the right side of his chest to push it up and out," added co-author Gavitt Woodard. If the pieces were smaller, she said, "he may not have been able to generate the force."
Although the patient felt immediately better after the clot was out of his system, he died about a week after heart failure complications.
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Despite the grim ending, doctors wanted to show a part of the human body. Woodard said: "recognizing the beautiful anatomy of the human body is the main point of it."
© 2018 Cox Media Group.