On Tuesday, the New England Journal of Medicine tweeted a recent and bizarre addition to its photo-series of visually-stunning medical anomalies.
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
The photo is baffling " what looks like a strange, red, branched living thing, could easily have passed for red roots, a tree trunk or a deep-red coral in a different context.
But this was a case far from a marine marvel. The object was an intact, complete, six-inch blood clot that somehow took the shape of its maker's bronchioles (small air passages) in the right lung. The person's lungs that shaped the masterpiece coughed it up in one piece, reports.
NEJM's tweet was followed by a string of concerned replies enquiring if the clot was an actual coughed up chunk of lung.
The unnamed patient that coughed up the curious masterpiece was admitted to the ICU with end-stage heart failure, for which his heart was connected to a pump. But these devices have their own risks, the doctors wrote in a published paper.
"You have high turbulence inside the pumps, and that can cause clots to form inside," Dr Georg Wieselthaler, a transplant and pulmonary surgeon at the University of California at San Francisco said.
"So with all these patients, you have to give them anticoagulants to make the blood thinner and prevent clots from forming.
After many days of coughing up clots of smaller sizes, the patient has a deeper, longer cough and spit out the huge, oddly-shaped clot.
After days of coughing up much smaller clots, Dr Wieselthaler's patient bore down on a longer, deeper cough and, relieved, spit out a large, oddly shaped clot, folded in on itself.
As Wieselthaler and his team carefully opened up the bundle and laid it out, they could immediately identify it as a cast of the right bronchial tree just from the number of branches and their alignment. The shapes of his bronchioles were retained perfectly.
"We were astonished. It's a curiosity you can't imagine¦very, very, very rare," Wieselthaler said.
Though his patient felt better soon after coughing up the clot, the fact that the clot was six-inches wide was a clear indication of his severe situation. He was put on a breathing tube his bleeding attended to with surgery, but his heart failure was much too severe to be treated. He died a week after the incident.
But the captivating photo of his bizarre clot has been recognized by many, including Dr Wieselthaler and his team as a stunning glimpse of our own anatomy that we rarely ever encounter.