The case, as spectacular as it is tragic, was reported by American doctors in the prestigious scientific journal The New England Journal of Medicine in November 2018. At just 36 years old, this patient suffered from severe chronic heart failure. Arriving in intensive care after a sudden worsening of his condition, he showed signs of an acute heart failure requiring emergency treatment.
A young patient with a serious cardiac history
Despite his age, this man had already gone through several major cardiovascular episodes. He had notably undergone surgery for aortic stenosis, a disease which narrows the valve allowing blood to leave the heart. This valve had been replaced by a bioprosthesis.
His medical file also reported heart rhythm disturbances requiring the installation of a pacemaker. A few years earlier, he had also developed an aortic aneurysm, treated with an endovascular prosthesis to avoid a potentially fatal rupture.
Faced with the deterioration of his heart function, the doctors chose to implant a circulatory assistance device in his left ventricle. This device helps the heart pump blood around the body. At the same time, he was given anticoagulant treatment based on heparin to limit the risk of clot formation, a medication which, however, increases the risk of bleeding.
A coughing fit which reveals an extremely rare phenomenon
A few days after hospitalization, the patient began coughing up small amounts of blood during coughing episodes. At the same time, his breathing difficulties worsened and his oxygen requirements gradually increased.
Then an episode occurred that left the caregivers speechless. During a particularly violent coughing fit, the man expelled a huge blood clot whose shape almost perfectly reproduced that of his bronchial tree.
At first glance, the doctors were struck by its appearance. The blood cast followed the ramifications of the bronchi, from the main ones to the smallest, drawing with astonishing precision the anatomy of the respiratory tract.
A blood cast of almost 20 centimeters
Once delicately deployed, the clot measured approximately 18 centimeters long and 14 centimeters wide. Even more impressive, he had retained his structure despite his expulsion, which is exceptional. The authors of the report explain that it was a bronchial cast, an extremely rare phenomenon during which a clot forms directly inside the bronchi before being expelled in a single block.
© NEJM
Photographs published with the medical report very clearly show this faithful reproduction of the bronchial tree, a document which quickly made the rounds in the medical community.
A stabilized state… before a tragic outcome
After this spectacular episode, the healthcare team managed to temporarily stabilize the patient. Unfortunately, this improvement was only short-lived. His chronic heart failure continued to progress unfavorably and his condition gradually deteriorated.
The man ultimately died a week later from complications related to his heart disease.
This clinical case, published in The New England Journal of Medicineremains today one of the most impressive examples of bronchial molding ever documented. It illustrates the extent to which certain complications of cardiovascular disease can take forms that are as rare as they are spectacular.