Sunday , January 17 2021

A patient with heart failure pushes this unusual perfect blood clot into a lung passage



Although it looks like a coral, root system or some other type of growth, the picture above actually shows a wide circle of 15 cm in the almost perfect form of the right bronchial tree of the human liver. of the Atlantic Ocean. Most embarrassing, however, is the revelation that it was not eliminated by medical staff but was actually expelled from a patient suffering from heart failure. The cough.

The photo was published at the end of November as part of the series of Images in Clinical Medicine of the New England Journal of MedicineDoctors Gavit A. Wouddard and George M. Weyfeller of the University of California, San Francisco, wrote that he was coming from a patient, a 36-year-old man who had long struggled with chronic heart failure.

According to the reports, the patient had a medical history that included "heart failure with a 20% ejection fraction, replacement of the bioprosthetic aortic valve for bilateral aortic stenosis, aortic aneurysm, and permanent placement of a pacemaker for a complete heart block"When the patient was admitted to the hospital's intensive care unit, he connected him with a pump designed to help the blood flow in the body:

Image: Image of the pulmonary structure (Wikimedia Commons)

For treatment of acute heart failure, a ventricular Impella implantation device has been placed and a continuous infusion of heparin for systemic anticoagulation has been initiated. In the following week, the patient had episodes of low volume haemoptysis, increased respiratory distress and increased use of supplemental oxygen (up to 20 liters administered through a high-quality nasal cannula). During an extreme coughing attack, the patient spontaneously coughs the intact mold from the right bronchial tree.

The patient is then extruded and "there were no more haemoptysis episodes"Doctors write, but a week later,"dies from complications of heart failure (volume overload and low cardiac radiation) despite the location of the camera support device".

According to the Atlantic Ocean, Wieselthaler said that using the pump requires anticoagulants to "dissolves blood and prevents clotting"Although this causes the risk of uncontrolled internal bleeding, in this case, explains Weiffeller, the blood that leaves the heart supplying fresh oxygen in the bloodstream seems to have accumulated in the right bronchial tree, coagulated and then expelled by the patient in rebellion:

Once Wieselthaler and his team carefully deployed the package, they found that the architecture of the airways was preserved so well that it could be defined as the right bronchial tree based solely on the number of branches and their alignment.

Weizel Thaler added that one possible way for the clot to remain intact instead of falling apart is a high concentration of fibrinogen, a protein in the blood plasma that helps in the formation of clots. The patient had an infection that aggravated heart failure and may have caused fibrinogen to accumulate in the blood, leading to more resemblance clots, explained the Atlantic Ocean.

Wuddard told the magazine that it is also possible that the size of a clot actually contributed to his expulsion as it could allow the patient to "generate enough force from the far right side of his chest to push him up and out. "(Gizmodo tried to contact Woodard to clarify some questions and we will update when we have an answer).

It may seem a little frivolous to study someone's medical misfortune, but most doctors will never have the opportunity to see something like that. While there are other conditions that can cause bronchial seizures, including infections and asthmatic conditions or lymph flow disorders that can cause mucus or lymph fluid build-up, Wieselthaler is clear that the amount of this is unprecedented.

"We were surprised"Wazzler Taylor told the Atlantic Ocean"This is a curiosity you can not imagine; that's it, it's very, very, very rare". [New England Journal of Medicine via the Atlantic]


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