Doctors 'astonished' by what man spat out in extreme coughing fit

WARNING – DISTRESSING IMAGE: A medical journal has shared a shocking case study about a man with chronic heart failure coughing up an “intact cast of the right bronchial tree”.

The 36-year-old man, who had been previously fitted with a pacemaker, had an acute exacerbation of chronic heart failure and was being treated at the intensive care unit at University of California San Francisco (UCSF) Medical Center, Fox 10 reports. 

The New England Journal of Medicine said over the next week the man had increased respiratory distress, needed more supplemental oxygen and had episodes of small-volume hemoptysis, or coughing up of blood. 

The journal explained the clot in the shape of the right bronchial tree was spontaneously spat out intact “during an extreme bout of coughing”.

The man had been coughing up smaller clots in the days prior to coughing up this particular one, the Atlantic reports.

Georg Wieselthaler, a surgeon at the University of California at San Francisco, and his team were “astonished” when they laid the clot out and discovered the cast had kept the architecture of the bronchial tree perfectly, the Atlantic reports.

“It’s a curiosity you can’t imagine—I mean, this is very, very, very rare.”

According to the publication the man coughed up an intact cast of the right bronchial tree during an extreme bout of coughing. Source: The New England Journal of Medicine

“The right bronchial tree consists of three segmental branches in the upper lobe (blue arrows), two segmental branches in the middle lobe (white arrows), and five segmental branches in the lower lobe (black arrows),” the journal explains. 

“The patient’s trachea was subsequently intubated, and flexible bronchoscopy revealed a small amount of blood in the basilar branches of the right lower lobe.”

The man had the tube removed two days later.

He did not have any more episodes of coughing up blood.

However, a week after the tube was removed the man passed away from complications of heart failure.