Doctors don't know how this huge blood clot came out of a person's lungs

Tuesday, The New England Journal of Medicine posted an image as part of their series on medical anomalies. They posted an enormous blood clot that came out of someone’s lungs.

A 36-year-old man was admitted to the ICU with an acute exacerbation of chronic #heartfailure. After a ventricular assist device was placed & anticoagulation therapy initiated, hemoptysis developed, and he expectorated a cast of the right bronchial tree. https://t.co/QfqeqwWzXt pic.twitter.com/nXW201rjCT
— NEJM (@NEJM) December 3, 2018

A 36-year-old man was admitted to the ICU with an acute exacerbation of chronic #heartfailure. After a ventricular assist device was placed & anticoagulation therapy initiated, hemoptysis developed, and he expectorated a cast of the right bronchial tree.

That’s a lot of words to say “this dude literally coughed up part of his lungs.”

The clot is from the right bronchial tree, which is one of the two parts of your lungs that take air in and out of them… And the thing was coughed up in one single piece.

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A rare event

Haley Weiss writes in The Atlantic:

Georg Wieselthaler, a transplant and pulmonary surgeon at the University of California at San Francisco, says the unnamed patient was initially admitted to the intensive-care unit with aggressive end-stage heart failure. Wieselthaler quickly connected the patient’s struggling heart to a pump designed to help maximize blood flow through the body. But this type of ventricular-assist device comes with its own risks. “You have high turbulence inside the pumps, and that can cause clots to form inside,” Wieselthalers says. “So with all these patients, you have to give them anticoagulants to make the blood thinner and prevent clots from forming.”

In Wieselthaler’s case, 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, Wieselthaler’s patient bore down on a longer, deeper cough and, relieved, spit out a large, oddly shaped clot, folded in on itself. Once Wieselthaler and his 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.

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

Wieselthaler went on to explain that the likely reason this blood clot was able to come out of the patient in one piece may be due to
fibrinogen. Fibrinogen is a protein in blood plasma that acts as “glue” for blood clots by trapping platelets.

The infection that Wieselthaler’s patient had, in addition to aggravating his heart failure, caused a higher-than-normal concentration of fibrinogen in his blood. It’s possible, Wieselthaler says, that the blood in his airways was unusually rubbery, capable of surviving the bumpy ride up the trachea unscathed.

Like my wife always says: Human bodies are horrifying.

What I think is most interesting about the clot is the fractal nature of it. Basically, a fractal is something that maintains the same shape/pattern as you zoom in/out on it. Sort of like this thing I put together a while back:

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It’s something that’s extremely common in nature, from snowflakes to shorelines to blood vessels to galaxies. The clot is sort of beautiful… in its own disgusting way. Unfortunately, the man died a week later due to complications of heart failure.

It can feel boorish to admire a by-product of the complete breakdown of a human body. But the photo is captivating because the clot’s structure shows a part of every human body, a biological filigree anyone can appreciate as a part of themselves, too. That’s why Woodard and her mentor shared the photo in the first place: “Recognizing the beautiful anatomy of the human body is the main point of it,” she says.

Cover image: New England Journal of Medicine via Twitter