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Can you cough up a lung? It literally happened

Cast of the Right Bronchial Tree
Cast of the Right Bronchial Tree | Image: NEJM Group

5 months   ago  /  2581

“I nearly coughed up a lung”—There’s probably been a time when we all said this after a lengthy coughing fit. But, is it physically possible?. Here's a case where one person actually coughed his lung out. Read further...

A 36-year-old man was admitted to the intensive care unit with an acute exacerbation of chronic heart failure. His medical history included heart failure with an ejection fraction of 20%, bioprosthetic aortic-valve replacement for bicuspid aortic stenosis, endovascular stenting of an aortic aneurysm, and placement of a permanent pacemaker for complete heart block. An Impella ventricular assist device was placed for the management of acute heart failure, and a continuous heparin infusion was initiated for systemic anticoagulation.

During the next week, the patient had episodes of small-volume hemoptysis, increasing respiratory distress, and increasing use of supplemental oxygen (up to 20 liters delivered through a high-flow nasal cannula). During an extreme bout of coughing, the patient spontaneously expectorated an intact cast of the right bronchial tree. The right bronchial tree consists of three segmental branches in the upper lobe (blue arrows), two segmental branches in the middle lobe (white arrows), and five segmental branches in the lower lobe (black arrows). The patient’s trachea was subsequently intubated, and flexible bronchoscopy revealed a small amount of blood in the basilar branches of the right lower lobe. The patient was extubated 2 days later and had no further episodes of hemoptysis. One week after extubation, he died from complications of heart failure (volume overload and poor cardiac output) despite the placement of the ventricular assist device.

 

 

One of the Redditors explained:

Ejection Fraction is basically how much the heart pumps. The left ventricle is the main pump in the heart and it takes that at its largest volume minus it at its smallest volume and divides that again by the largest volume to get a percentage! 20% is really bad. You want it around 55-70 percent.

When the blood is pumped out of the Left Ventricle it goes through the aortic valve to get to the body, the aortic valve has 3 Cusp (or little flaps, think of them as doors) that open and close to allow the blood to go through. A Bicuspid Aortic Valve is a disease that 1-2% of the population have, in which the aortic valve only has two cusps. It’s more prone to Stenosis (or narrowing of the opening) needing for it to be replaced at a younger age than most people. This gentleman had it replaced with a Bioprosthetic valve. The valve takes animal tissue, from a horse or a cow and they create a valve out of it to be placed in humans.

Endovascular stenting simply put is a non-invasive way to repair an aneurysm he had. His aorta (the artery that takes the blood to the body) had some ballooning somewhere in the body that needed repair.

One week after extubation, he died from complications of heart failure (volume overload and poor cardiac output) despite the placement of the ventricular assist device.

We all know that we can't all win the genetic lottery. Some of us have to work for it the hard way! That's why having a healthy lifestyle leads to a long and healthy life. 

By: Staff writer  /  Source: NEGM

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