Monday, 27 May, 2019

Doctors amazed after man coughs up blood clot of lung bronchial tree

Pixabay- kalhh  New England Journal of Medicine               
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Gustavo Carr | 07 December, 2018, 21:07

Earlier this week the New England Journal of Medicine tweeted a photo of what looked like a attractive piece of bright red coral to their 545,000 followers.

It came from a 36-year-old man with end-stage heart failure who spat out the medical anomaly in one piece during a coughing fit in hospital.

He had been hooked up to a ventricular assist device - used to help circulate blood around the body - and administered anti-coagulation therapy (blood thinners).

The patient had a violent coughing fit in hospital a week after surgery to fit him with a pacemaker in case his heart became blocked.

Measuring six inched in length, the clot maps out a near-perfect map of the right bronchial system of the lung.

However, anticoagulants can cause problems if a breach occurs in the blood-vessel network, which happened in this extraordinary case; blood broke out of the patient's pulmonary network into his lower right lung.

Along with blood and mucus, he brought up a his left bronchial tree - a series of tubes that distribute air to his lungs.

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Dr Wieselthaler carefully spread out the coughed-up clot, realising it was the flawless shape.

"We were astonished", Wieselthaler said.

Reports say the man had a rare ejection fraction deficiency (which relates to how much blood is pumped with each contraction), which meant his organ was operating at around 50 percent less than the normal rate.

While doctors still aren't 100 per cent sure how the clot stayed completely intact on its way up the man's throat, Dr Wieselthaler suspected it was because the man had more fibrinogen in his blood.

After coughing up the bronchial tree, doctors immediately intubated him and performed a bronchoscopy, but he later died from heart failure complications ('volume overload and poor cardiac output'), despite the placement of the ventricular assist device.

The man coughed up the right bronchial tree.

The 25-year-old mum went on to recover fully and delivered a healthy, full-term baby soon after.