Man Coughed Up Huge Blood Clot in Perfect Shape of Lung Airway, Leaving Doctors Stunned

Photo byThe New England Journal of Medicine, 2018.

Medical anomalies have long fascinated both doctors and the general public, but few cases are as visually stunning as this one. In 2018, a 36-year-old man, suffering from severe heart failure, managed to cough up a blood clot in the exact shape of his right bronchial tree.

This bizarre event left medical professionals in awe and has since been showcased in The New England Journal of Medicine’s photo series of extraordinary medical conditions.

How the Blood Clot Formed

Dr. Georg Wieselthaler, a transplant and pulmonary surgeon at the University of California, San Francisco, treated the patient, who was in the intensive care unit with end-stage heart failure.

To help his heart pump blood more efficiently, the patient was connected to a ventricular-assist device. But this life-saving device comes with certain risks, one of which is the increased likelihood of blood clot formation due to the turbulence in the pump. To mitigate this, patients are often prescribed blood thinners, but these can sometimes cause issues with clotting in the lungs.

In this case, blood leaked into the patient’s bronchial tree—the network of tubes in the lungs that carry air to and from the body—due to complications from both his heart failure and the blood thinners.

What happened next was highly unusual: the blood pooled in the airways and congealed into a perfect cast of the bronchial tree, which the patient later expelled during a coughing fit.

The Medical Mystery: Why Didn't It Break?

Blood clots are typically fragile, especially when they travel through the body's airways. So, how did this one remain perfectly intact?

The answer might lie in fibrinogen, a protein in the blood that helps stabilize clots. In this case, the patient had elevated levels of fibrinogen due to an infection, which likely made the clot rubbery and resilient enough to withstand the trip up his trachea without breaking apart.

Additionally, the size of the clot may have played a role in its expulsion. Dr. Gavitt Woodard, a clinical fellow in thoracic surgery at UCSF, suggests that because the clot was so large, the patient was able to generate enough force from his right lung to expel it in one piece.

A Rare But Not Unprecedented Event

While this case is extraordinary, it's not entirely without precedent.

Back in 1926, a similar case was recorded in medical literature, where a woman with an airway infection coughed up a cast of her trachea and bronchi. In another case from 2005, a pregnant woman coughed up a smaller bronchial cast made of blood due to a clotting disorder.

Blood clot cast of part of the bronchial tree of a 25-year-old pregnant woman.Photo byEuropean Journal of Cardio-thoracic Surgery, 2005.

The Patient’s Outcome

Though the patient briefly felt relief after coughing up the large blood clot, his condition remained critical. Doctors were able to stop his internal bleeding with a more invasive procedure, but his heart failure had already caused numerous complications. Tragically, the patient passed away a week later.

A Fascinating Glimpse into Human Anatomy

This rare medical occurrence—while tragic—highlights the complexity and beauty of the human body. Though the clot itself was a sign of a body in distress, its structure offers a glimpse into the incredible architecture of the human body.

As Dr. Woodard noted, sharing the image was about celebrating human anatomy and the extraordinary nature of the structures within us.