Modern Health
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Modern Health
@modernHealthMe
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加入时间 Haziran 2023
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In a remarkable and exceedingly rare medical case reported in The New England Journal of Medicine, doctors at the University of California, San Francisco (UCSF) documented a 36-year-old man who spontaneously coughed up an intact blood clot measuring about 6 inches (15 cm) that perfectly replicated the branching structure of his right bronchial tree—the intricate network of airways in the lung.
The patient had been admitted to the intensive care unit for severe, end-stage chronic heart failure. To support his heart function, physicians implanted a ventricular assist device (a mechanical pump) and initiated anticoagulation therapy with blood thinners to prevent device-related clotting. Paradoxically, while these medications lower clotting risk in the device, they heighten the potential for bleeding elsewhere, including into the airways (hemoptysis).
Over several days, the man experienced progressive respiratory distress and episodes of coughing up smaller amounts of blood. Then, during an intense, forceful coughing fit, he expectorated a single, cohesive, tree-like cast composed entirely of clotted blood. The clot had formed within the bronchial passages—likely due to bleeding into the airways—and was expelled whole, preserving the exact anatomical shape of the right lung's bronchial tree with remarkable fidelity.
Bronchial casts are uncommon but occasionally seen with mucus (in conditions like plastic bronchitis) or other materials; however, a blood-based cast retaining such precise, intact branching detail is extraordinarily unusual. Blood clots typically fragment easily, but in this instance, elevated fibrinogen levels—possibly from an underlying infection or inflammatory response—likely contributed to the unusual stability and cohesiveness of the clot, enabling it to hold its form during expulsion.
Despite intensive care efforts, the patient succumbed to complications of his advanced heart failure about a week later. The case, published in 2018, was shared primarily to illustrate this striking clinical phenomenon and to showcase the detailed anatomy of the bronchial tree as revealed by the clot itself.
[Woodard, G. A., & Wieselthaler, G. M. (2018). Cast of the Right Bronchial Tree. The New England Journal of Medicine, 379(22), e44. DOI: 10.1056/NEJMicm1806493]

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