Recently, The New England Journal of Medicine posted some of the most visually arresting medical anomalies. The image is of a mysterious, branchlike structure, a completely intact, six-inch-wide clot of human blood in the exact shape of the right bronchial tree, one of the two key tubular networks that ferry air to and from the lungs. And it was coughed up in one piece.
The clot is beautiful, and it’s also kind of gross. And even the doctors who treated the 36-year-old man who produced the clot aren’t entirely sure how it could have emerged without breaking.
Dr Georg Wieselthaler, a transplant and pulmonary surgeon at the University of California, says the unnamed patient was initially admitted to the intensive-care unit with aggressive end-stage heart failure. They quickly connected the patient’s struggling heart to a pump designed to help maximize blood flow through the body. But this type of device comes with its own risks. “You have high turbulence inside the pumps, and that can cause clots to form inside, so with all these patients, you have to give them anticoagulants to make the blood thinner and prevent clots from forming.”
These anticoagulants themselves can lead to trouble. In present case, probably the blood eventually broke out of his patient’s pulmonary network into the lower right lung, heading directly for the bronchial tree. After days of coughing up much smaller clots, the patient bore down on a longer, deeper cough and, relieved, spit out a large, oddly shaped clot, folded in on itself. Once doctors team carefully unfurled the bundle and laid it out, they found that the architecture of the airways had been retained so perfectly that they were able to identify it as the right bronchial tree based solely on the number of branches and their alignment.
It’s rare, but not entirely unprecedented. A case study that appeared in The Journal of the American Medical Association back in 1926 describes a 34-year-old woman who was admitted to Rochester Municipal Hospital with an airway infection and coughed out “a large piece of membrane”—a layer of cells and gunk collected by the infection—“which proved to be a cast of the trachea, both bronchi, and several bronchioles.”
“We were astonished,” Wieselthaler says. “It’s a curiosity you can’t imagine—I mean, this is very, very, very rare.”
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