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Man bites bariatric blood clots as part of his lung

BOSTON – A picture and a story on a medical trip last week gets a lot of attention. The New…

BOSTON – A picture and a story on a medical trip last week gets a lot of attention.

The New England Journal of Medicine published a story about a 36-year-old man who had a blood clot in the lung and when it appeared, it looked like a part of his lung. Here’s the story:

A 36-year-old man was admitted to intensive care with an acute exacerbation of chronic heart failure. His medical history included heart failure with a 20% rejection fraction, bioprosthetic aortic valve replacement for bicuspid aortic stenosis, endovascular stent of an aortic aneurysm, and placement of a permanent pacemaker for complete heart block.

An impella ventricular auxiliary device was placed for management of acute heart failure and a continuous heparin infusion was initiated for systemic anticoagulation. During the next week, the patient had episodes of low volume hemoptysis, increased respiratory distress and increased use of extra oxygen (up to 20 liters delivered through a high-flow nasalcanyl).

During an extreme cure of cough, the patient spontaneously expended an intact cast of the right bronchial tree.

The right bronchial tree consists of three segments of the upper lobes (blue arrows), two segments of the middle body (white arrows) and five segments of the lower lobes (black arrows). The patient’s trachea was then intubated, and flexible bronchoscopy revealed a small amount of blood in the basilar branches of the right lower lobes.

The patient was extubated 2 days later and had no further episodes of hemoptysis. One week after extubation, he died of complications of heart failure (volume overload and poor cardiac output) despite the position of the ventricular auxiliary device.

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