Man coughs up startling blood clot shaped like a lung passage

Doctors were surprised by the blood clot cast.

Gavitt Woodard/Georg Wieselthaler/New England Journal of Medicine

It’s hard to look away. The image shows a bright red, tree-like object, like something you might see in the dried flowers and branches section of Hobby Lobby. But it’s actually a blood clot, coughed up intact by a patient suffering from heart failure.

Doctors Gavitt Woodard and Georg Wieselthaler of the University of California at San Francisco reported on the unusual occurrence in The New England Journal of Medicine in late November. 

The 36-year-old patient was in intensive care. Doctors placed a ventricular assist device, a heart pump, into him to treat his condition, but he showed signs of respiratory distress. 

“During an extreme bout of coughing, the patient spontaneously expectorated an intact cast of the right bronchial tree,” the doctors say.

This kind of clot isn’t unheard of in patients, but what was unusual was how intact it was. “We were astonished,” Wieselthaler told The Atlantic. “It’s a curiosity you can’t imagine — I mean, this is very, very, very rare.”

A 2005 report in the European Journal of Cardio-Thoracic Surgery refers to a similar case where a pregnant woman coughed up a less-extensive blood clot cast also in the shape of her bronchial tree. The woman recovered and delivered a healthy child. The more recent patient was not as fortunate. He later died of complications of heart failure. 

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