We're heading towards winter, at least in the Northern Hemisphere, which means cozy jumpers, industrial snowfall, and the inevitable onslaught of the common cold. People from Yekaterinburg to Yellowstone can look forward to wiping runny noses and coughing up things that definitely ought to stay down.
As this mucusy tradition reaches its zenith, it’s not uncommon to hear people talk about “coughing up a lung”. Normally, that’s just a figure of speech – but for one person this year, it proved to be a gruesomely accurate turn of phrase.
In a bizarre case reported in the New England Journal of Medicine last week, a 36-year-old man managed to “spontaneously expectorate” an intact cast of 10 branches of his bronchial tree. Basically, he coughed up a model, made from his own coagulated blood, of the inside of his lung.
Now, it’s fair to say this guy wasn’t exactly the picture of health in the first place. He had already previously suffered a heart failure so severe that only one-fifth of the blood in his heart was being pumped into his body – a normal amount is around three times that figure. He suffered from aortic stenosis – another serious heart problem, where the valve opening between the heart and the aorta, the body’s main artery, becomes too narrow to let blood flow easily. This, in turn, was the result of a congenital defect that left his aortic valve with two cusps instead of three – a condition for which he had undergone surgery to fit a bioprosthetic replacement. And as well as the new valve, he also had a pacemaker, which he needed after a complete heart block had blocked the nerve impulses that told his heart to beat properly.
After arriving in the ICU, this collection of cardiac gadgetry got a new addition. Doctors fitted a device to help his heart pump enough blood into his body, and administered heparin, an anticoagulant used to treat blockages in arteries.
Unfortunately, things got even worse. In the days after his operation, the poor patient grew more and more reliant on oxygen administered by his doctors. He started coughing up blood, and experienced increasing respiratory distress – meaning fluid was leaking out of the blood vessels in his lungs, and into the tiny air sacs that would normally oxygenate the blood. And then, during what the medical report describes as “an extreme bout of coughing”, out it came: a complete, intact cast of the bronchial tree of his right lung.
Unsurprisingly, people were astonished by the pulmonary sculpture.
After the cast came out, doctors quickly intubated the patient’s windpipe and examined his airways using a camera attached to a flexible tube. Although there was a small amount of blood left in the lower branches of the lung, within two days the patient had stopped coughing up blood, and doctors took the tube out of his throat.
But unfortunately, this story doesn’t have a happy ending. Despite these promising signs, the patient eventually died just a week later – but not, amazingly, because of the gigantic blood statue he’d recently forced out of his lungs.
It seems there’s no escaping your medical history, and what brought this patient down was the very thing that had plagued his entire life. His heart’s inability to pump enough blood overloaded it with liquid, and his eventual cause of death was given as complications from heart failure.
So long, anonymous cougher. Your tale, and your right bronchial trees, will live on.
