A patient with heart failure chews up the unusual perfect blood clot in the form of a pulmonary transit


Although it looks like a coral, a root system or some other type of growth, the photo above actually shows a 15-cm-wide blood clot in the almost perfect form of the right bronchial tree of a human lung, the Thursday declared. Atlantic. However, the most uncomfortable is the revelation that it is not eliminated by the medical staff, but in fact expelled by a heart failure heart failure. Coughing

The photo was published in November November as part of the series of pictures in Clinical Medicine of the New England Journal of Medicine. Doctors Gavitt A. Woodard and George Wizalhaler from the University of California in San Francisco wrote that it came from his patient, a 36-year-old man who has long struggled with chronic heart failure.

According to reports, the patient has a medical history that includes "Heart failure with an ejection fraction of 20%, Bioprosthetic aortic valve replacement for bicuspid aortic stenosis, aortic aneurysm, and permanent pacemic placement for whole heart block"When the patient is admitted to the intensive care unit of the hospital, they connected him to a pump designed to help the blood circulation over the body:

Image: Image of the Pulmonary Structure (Wikimedia Commons)

An impelpa ventricular assisted device was set for the treatment of acute heart failure and a continuous infusion of heparin was initiated for systemic anticoagulation. During the following week, the patient had episodes of small band hemoptysis, increased respiratory need and increased use of supplemental oxygen (up to 20 liters administered by a high-flow nasal cannula). During an extreme coughing attack, the patient spontaneously copies an intact mold from the right bronchial tree.

The patient is subsequently exhausted and "He has no more episodes of hemoptysis"The doctors wrote, but a week later,"Disease of heart failure complications (volume overload and low cardiac output), despite placement of the ventilated instrument device"

According to the Atlantic, Vizelhaler said that the use of the pump requires anticoagulants for "Thin blood and prevent log of forming"Although it carries the risk of uncontrolled internal bleeding, in this case, the bloodthirsty blood transmitting the heart to provide fresh oxygen in the circulatory system seems to have accumulated in the right bronchial tree, coagulated, and then expelled The patient in a revocation:

Once Vizelhaler and his team carefully deployed "package," they concluded that the architecture of the Airways was so well-preserved that they could identify it as the right bronchial tree based on the number of branches and their alignment.

Weigh tholler added that one possible way the clot could remain intact, instead of breaking down, was a high concentration of fibinogen, a protein in blood plasma that helps form the log. The patient has an infection that exhibits heart failure and may have an accumulation of fibinogen in the blood, resulting in a more elastic clot, the Atlantic explains.

Woodard tells the magazine that, in addition, it is possible that the size of the logic has actually been subjected to expulsion because it may allow the patient to "sufficiently sufficient force of a complete right side of his chest to push it up and out "(Gizmodo tried to contact Woodard to explain some questions, and we will update when we have a response).

It may seem a little easier to learn something of a medical disaster, but most doctors will never have the opportunity to see something like this. While there are other conditions that can cause bronchial drainage, including infections and asthmatic conditions or disorders of the lymphatic flow that can cause an accumulation of mucus or lymphatic fluid, it is clear that the size of this is unprecedented.

"We are surprised"Wizelthal told the Atlantic."There is a new one that you can not imagine; That is, it's very, very, very rare" [New England Journal of Medicine via the Atlantic]

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