![]() ![]() It’s rare, but not entirely unprecedented. “It’s a curiosity you can’t imagine-I mean, this is very, very, very rare.” Once Wieselthaler and his team carefully unfurled the bundle and laid it out, they found that the architecture of the airways had been retained so perfectly that they were able to identify it as the right bronchial tree based solely on the number of branches and their alignment. After days of coughing up much smaller clots, Wieselthaler’s patient bore down on a longer, deeper cough and, relieved, spit out a large, oddly shaped clot, folded in on itself. In Wieselthaler’s case, blood eventually broke out of his patient’s pulmonary network into the lower right lung, heading directly for the bronchial tree. But for someone taking anticoagulants, the body can’t efficiently patch things up if any part of this tight blood-vessel network is breached, and things can spiral out of control. ![]() Usually, if small fissures occur in this network, the body’s clotting agents show up to slap some circulatory duct tape on them until they heal. In a healthy person, oxygen-starved blood leaving the heart travels an intricate network of capillaries through the lungs for an oxygenating pit stop by the airways. These anticoagulants themselves can lead to trouble. “So with all these patients, you have to give them anticoagulants to make the blood thinner and prevent clots from forming.” “You have high turbulence inside the pumps, and that can cause clots to form inside,” Wieselthaler says. But this type of ventricular-assist device comes with its own risks. Wieselthaler quickly connected the patient’s struggling heart to a pump designed to help maximize blood flow through the body. Georg Wieselthaler, a transplant and pulmonary surgeon at the University of California at San Francisco, says the unnamed patient was initially admitted to the intensive-care unit with aggressive end-stage heart failure. But even the doctors who treated the 36-year-old man who produced the clot aren’t entirely sure how it could have emerged without breaking. The tweet received a slew of replies from those frightened that the photo showed an actual coughed-up lung, which is about as likely to happen as your brain falling out of your butt. ![]() The clot is beautiful, and it’s also kind of gross. It’s a completely intact, six-inch-wide clot of human blood in the exact shape of the right bronchial tree, one of the two key tubular networks that ferry air to and from the lungs. The image is of a mysterious, branchlike structure that, posted elsewhere, would probably pass for a cherry-red chunk of some underground root system or a piece of bright reef coral. On Tuesday, The New England Journal of Medicine tweeted the most recent addition to its photo series of the most visually arresting medical anomalies. ![]()
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