Coughing Up A Giant Blood Clot

A man coughed up a giant blood clot, but the surprising thing is that it was in the shape of his lung!  Rachael Rettner, a senior writer for Live Science gave all the information regarding this remarkable event in her recent article.

The blood clot the man coughed up was in the shape of his bronchial tree, which is the lung’s branched airway passages.  It isn’t really rare to cough up a blood clot, but this one was quite unusual.  He was being treated for a serious heart condition, as published in The New England Journal of Medicine.  He had chronic heart failure and the heart muscles weren’t pumping enough blood to meet his body’s normal demands.

He was put on a machine called a ventricular assist device since his condition was so severe and the heart then had help pumping the blood.  The machines can also increase the risk of blood clots, so he was prescribed a blood-thinner.  These meds increase the risk of bleeding and also includes coughing up blood.  The patient had several episodes of coughing small amounts of blood, but during an extreme bout of coughing he spit out an intact cast of the right bronchial tree, or a mold cast made of clotted blood in the shape of the lungs branched airway passage.

Dr. Georg Wieselthaler, a heart and lung surgeon at the University of California who treated the patient was astonished and said it was very, very, very rare.  Coughing up bronchial casts of other substances, such as lymph or mucus, is less rare.  As blood is less sticky and sturdy than other substances, a cast made of blood is less likely to hold together when coughed up.

The patient had an infection that increased the levels of a protein called fibrinogen, that helps blood clots to form and higher levels of fibrinogen could have helped his large clot to stay intact when it was coughed up.

The man had no further episodes of coughing up blood, but he did die a week later from complications of heart failure.  The main reason they decided to publish the image was to show the beautiful anatomy of the human body, according to Wieselthaler’s colleague, Dr. Gavitt Woodard, a clinical fellow at UCSF.

Dr Fredda Branyon