A man in California literally coughed up part of his lung after he was hospitalized for heart palpitations.
In a case report from the New England Journal of Medicine, surgeons from the University of California San Francisco Medical Center presented the case of a 36-year-old patient who was admitted to the ICU with chronic heart failure.
Due to his history of poor cardiovascular health, he’d had a pacemaker implanted in case his heart became completely blocked.
However, throughout his first week in the hospital, he coughed up blood and mucus and, during an intense coughing spell, he managed to expectorate an intact cast of the bronchial tree before he died the following week.
It is clear when the patient entered the hospital he was in declining health.
His heart had an ejection fraction (EF), how much blood the left ventricle pumps out with each contraction, of 20 percent. A normal EF is between 50 and 75 percent.
Additionally, he had bicuspid aortic stenosis. After blood is pumped out of the left ventricle, it passes through the aortic valve to circulate throughout the body.
This valve normally has three cusps – or leaflets – but a bicuspid aortic valve is a congenital defect in which the valve only has two cusps.
According to a 2006 study from Emory University School of Medicine, only one to two percent of the US population has this disease.
Because of this defect, it is more prone to stenosis, which is when these passages narrow, meaning the aortic valve often needs to be replaced at a young age.
In the case of this man, he’d had his valve replaced with bioprosthetic valve, which is made from the tissue of animal donors such as calves.
During the week after the man was admitted to the hospital, he was coughing up blood and mucus, increasing the strain on his lungs.
Additionally, doctors needed to increasingly supply him with supplemental oxygen.
It was during a particularly violent coughing spell that he spontaneously coughed up an intact cast of the right bronchial tree.
The trachea and the two primary bronchi are called the bronchial tree. The tubes that make up the bronchial tree distribute air to the lungs.
The right main bronchus in the right lung is wider, shorter and more vertical than the left main bronchus in the left lung. It also divides into three branches while the left divides into two.
Human lungs are too large to fit through the trachea, so it is not possible to cough up an entire lung.
Dr Gavitt Woodard, a general surgery resident at UCSF, said that a cast of the bronchial tree is essentially a clot that takes up the shape of the lung.
‘He slowly bled which filled up the right side of the bronchial tree,’ she told DailyMail.com.
How was he able to cough it up? Dr Woodard says the cast has a spaghetti-like consistency.
‘It’s very soft but it’s displayed the way it is to show the anatomy,’ she said.
In the case of the man, all three segmental branches were coughed up: the upper lobe (blue arrows), the middle lobe (white arrows) and the lower lobe (black arrows).
The patient was immediately intubated and doctors performed a bronchoscopy, which allows doctors to look at the lungs and air passages.
They discovered that the man had a small amount of blood in the basilar branches, which supply oxygen-rich blood, of the right lower lobe.
Two days later, the man was extubated and had no more episodes of coughing up blood or mucus.
But just one week after this, the patient died from heart failure complications, mainly volume overload – when there is too much fluid in the blood – and low cardiac output, which is when there is a low amount of blood the heart is pumping through the circulatory system.
This is not the first time there has been a reported incident of someone hacking up a piece of their lung.
A case report published in the New England Journal of Medicine in January 2012 described the case of a 40-year-old woman in the UK who was suffering from asthma.
– Daily Mail