Coughing out blood is definitely an alarming sight, but it is not unheard of. A man in California coughed out a blood clot so defined, it was an intact cast of the bronchial tree in his lungs.

Acute Heart Failure

A report describes a 36-year-old man who was admitted to the intensive care unit and was being treated for acute heart failure. The man’s medical history revealed chronic heart problems and even had a permanent pacemaker in place for complete heart block.

The doctors decided to place him on a ventricular assist device, which can help his heart to pump blood but may also increase the risks for blood clotting. As such, they gave him blood thinning medications, which in turn increased the risks for bleeding.

Intact Blood Clot

In the week that followed, the man experienced increased respiratory distress and needed increased use of supplemental oxygen. He had several bouts of cough, and during a particularly extreme cough, he coughed out a blood clot that was an intact cast of the right bronchial tree. It was so intact and detailed that it consisted of three segmental branches in the upper lobe, two segmental branches in the middle lobe, and five segmental branches from the lower lobe.

Evidently, this is a very rare incidence, especially since blood is less sticky and is unlikely to hold together. However, the patient had an infection that increased his fibrinogen levels. Fibrinogen is a protein that helps to form blood clots, and higher levels of it allowed the man’s blood clot to remain intact when he coughed it out.

Heart Failure Death

The patient was intubated but extubated again two days later. Although he no longer coughed out blood and he was already on ventricular assist device, he eventually died one week after the extubation due to complications brought about by heart failure.

The case is published in the New England Journal of Medicine.