Although it resembles a coral, root system, or some other kind of growth, pictured above actually reflects six inches wide blood clot in almost perfect shape right bronchial tree of human lung, Atlantic said on Thursday, even more uncomfortable from & # 39 is the discovery that he was not removed by medical personnel, but actually coughed up by the patient, who was suffering from heart failure.
The picture was released in late November as part of New England Journal of Medicine imaging in clinical medicine series. University of California at San Francisco doctors Gavitt A. Woodard and Georg M. Wieselthaler wrote that it came from his patients in the 36-year-old, who has long struggled with chronic heart failure. The patient reported medical history, including "heart failure with an ejection fraction of 20%, bioprosthesis replacement of the aortic valve bicuspid aortic stenosis, endovascular stenting of aortic aneurysms, as well as the placement of a permanent pacemaker for complete heart block." If the patient is admitted to the intensive care hospitals, they are connected to the pump is designed to help circulate blood throughout the body:
Impella ventricles auxiliary device was placed for management of acute heart failure, as well as continuous infusion of heparin was initiated for systemic anticoagulation. During the next week, the patient had episodes of small & # 39; volume hemoptysis, increased respiratory failure, as well as increased use of additional oxygen (up to 20 liters delivered through a nasal cannula with high capacity). During extreme coughing, the patient spontaneously spit intact throw right bronchial tree.
Later, the patient was extubated and "had no further episodes of hemoptysis," the doctors wrote, but a week later he unfortuntely «died from complications of heart failure (overload of & # 39; volume and poor cardiac output), despite the location of the ventricular assist device."
Over the Atlantic, Wieselthaler said that the use of the pump require anticoagulation, "to make thinner the blood and prevent clots," though it comes with the risk of uncontrolled internal bleeding. In this case, Wieselthaler told the magazine, the blood leaving the heart to stock fresh oxygen in the circulatory system appears to be on the & # 39 combined in the right bronchial tree, clots, and then was thrown out to patients in mixed form:
After Wieselthaler and his team carefully unwrapped it and put it, they found that the architecture in the airways have been preserved so well that they were able to identify him as the right bronchial tree, based solely on the number of branches and their alignment.
Wieselthaler added that one possible way to clot could remain intact and not be broken, there was a high concentration of fibrinogen in the blood plasma protein that helps form clots. The patient had an infection that worsened heart failure, and may have caused the accumulation of fibrinogen in the blood, which leads to more rubber-like clot, he told the Atlantic.
Woodard told the magazine that it is further possible that the size of the clot in fact, may have contributed to his release, as it might give the patient "to generate enough power from the entire right side of the chest to push it up and out. »(Gizmodo to Woodard reached to clarify some questions remain, and we will update this article when we hear back.)
This may seem a bit like a curiosity to see the product of someone's medical misfortunes, but even most physicians may never be able to see something like this. Although there are other conditions which may lead to bronchial casts, including infections and asthmatic conditions or disorders lymphatic flow, which may cause build mucus or lymph fluid, respectively, Wieselthaler emphasized that the size of a virtually unprecedented.
"We were surprised," said Wieselthaler Atlantic. "It's curious, you can not imagine, I mean, it's very, very, very rare."[New England Journal of Medicine via the Atlantic]