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Old 12-06-2018, 10:11 PM
Machine Elf Machine Elf is offline
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man coughs up perfect cast of bronchial tree

In the disgusting-but-amazing department (beware, vivid color photo at link):

Cast of the Right Bronchial Tree

Quote:
Originally Posted by NEJM
During the next week, the patient had episodes of small-volume hemoptysis, increasing respiratory distress, and increasing use of supplemental oxygen (up to 20 liters delivered through a high-flow nasal cannula). During an extreme bout of coughing, the patient spontaneously expectorated an intact cast of the right bronchial tree.
  #2  
Old 12-06-2018, 10:18 PM
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Ummmmm...ewwwwwww???
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Old 12-06-2018, 10:21 PM
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Holy shit. Guy died anyway. How can you get that up?
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Old 12-06-2018, 10:27 PM
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Ummmmm...ewwwwwww???
*looks at link*
*nods in agreement*
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Old 12-06-2018, 10:32 PM
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That is amazing. That poor patient - I can't even imagine how a person would actually be able to cough that out.
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Old 12-06-2018, 10:59 PM
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It's sad he died of course, but holy shit that's amazing.
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Old 12-06-2018, 11:00 PM
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The guy was so young to be having such health problems, I wonder if it was just bad genes or what, either way, poor guy.
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Old 12-06-2018, 11:01 PM
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That is amazing. That poor patient - I can't even imagine how a person would actually be able to cough that out.
Sort of the thoracic version of childbirth.
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Old 12-06-2018, 11:07 PM
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The guy was so young to be having such health problems, I wonder if it was just bad genes or what, either way, poor guy.
I wonder if he was from a lesser-developed country and had rheumatic fever, or some kind of birth defect that wasn't corrected until he was much older than it's normally done in this country. It's very unusual for someone who's 36 to have a valve replacement, in addition to all the other problems he had.

I collect old medical books, and apparently coughing up bronchial casts was not uncommon back in the day when tuberculosis was untreatable.

A question for Qadgop, Dseid, etc.: what would this cast have been made of? Mucus? Mucous membrane? Calcium deposits? I'm curious.
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Old 12-06-2018, 11:10 PM
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I don't think that was a cast of his R bronchial tree, I think he coughed up his R bronchial tree.
  #11  
Old 12-06-2018, 11:14 PM
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I've actually heard of this. It's called plastic bronchitis. It's a known complication of congenital heart disease, among other things. Like kids who have Fontan circulation secondary to being born with only one working ventricle.

Edit: It's called "bronchitis" but it's a problem with the lymph system, not an actual infection.

Last edited by chizzuk; 12-06-2018 at 11:15 PM.
  #12  
Old 12-06-2018, 11:22 PM
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A question for Qadgop, Dseid, etc.: what would this cast have been made of? Mucus? Mucous membrane? Calcium deposits? I'm curious.
It's a blood clot. There's some explanation here:

https://www.theatlantic.com/health/a...d-clot/577480/
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Old 12-06-2018, 11:33 PM
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Baader-Meinhof phenomenon at its finest! The SO of a coworker coughs these up regularly due to an abnormal communication between the lungs and the lymph system. I saw a pic just a few days ago
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Old 12-06-2018, 11:48 PM
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I've actually heard of this. It's called plastic bronchitis. It's a known complication of congenital heart disease, among other things. Like kids who have Fontan circulation secondary to being born with only one working ventricle.

Edit: It's called "bronchitis" but it's a problem with the lymph system, not an actual infection.
Simple explanation of plastic bronchitis here (no gory pictures) :
https://www.chop.edu/conditions-dise...tic-bronchitis
  #15  
Old 12-07-2018, 12:34 AM
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Quote:
Originally Posted by steatopygia View Post
I don't think that was a cast of his R bronchial tree, I think he coughed up his R bronchial tree.
Quote:
Originally Posted by Riemann View Post
It's a blood clot. There's some explanation here:

https://www.theatlantic.com/health/a...d-clot/577480/
I'm confused. Is that actually part of the bronchial tree or an actual cast of it from clotted blood? As in the blood filled it, clotted and then he hacked out the formed blood clot? Because it looks like he coughed out part of his actual lung.
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Old 12-07-2018, 12:54 AM
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That’s nasty. I’m sure if those were more common, however, there’d be a bronchial cast eating challenge on YouTube.
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Old 12-07-2018, 01:23 AM
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I'm confused. Is that actually part of the bronchial tree or an actual cast of it from clotted blood? As in the blood filled it, clotted and then he hacked out the formed blood clot? Because it looks like he coughed out part of his actual lung.
The Atlantic article posted by Riemann has a great description and explanation:

The clot is beautiful, and it’s also kind of gross. 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.[emphasis added] 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. . . .

Congealed blood is less sturdy and sticky than hardened lymph or mucus, so why didn’t the cast break apart?

. . . the answer might involve fibrinogen, a protein component of blood plasma that essentially acts as the “glue” of a clot by trapping platelets to form a mass. The infection that Wieselthaler’s patient had, in addition to aggravating his heart failure, caused a higher-than-normal concentration of fibrinogen in his blood. It’s possible, Wieselthaler says, that the blood in his airways was unusually rubbery, capable of surviving the bumpy ride up the trachea unscathed.

Last edited by gkster; 12-07-2018 at 01:25 AM.
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Old 12-07-2018, 07:47 AM
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That thing is a museum piece. Maybe they could auction it off to help pay for the funeral.
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Old 12-07-2018, 07:52 AM
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How much of medicine is "Let me help you" vs "Ew, that's so gross/cool, I need to write a paper about it?"
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Old 12-07-2018, 08:06 AM
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Originally Posted by Cub Mistress View Post
The SO of a coworker coughs these up regularly due to an abnormal communication between the lungs and the lymph system.
He goes through that on a "regular basis"?!

I think I'd rather eat a bullet and be done with it.
  #21  
Old 12-07-2018, 09:25 AM
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How much of medicine is "Let me help you" vs "Ew, that's so gross/cool, I need to write a paper about it?"
I work in a medical library, going on 10 years, and going by what I've seen thumbing through the books and journals, pretty much all of it.

ETA: not that they're mutually exclusive. "Let me help you" obviously is the primary concern in most cases, but "I should write this up" seems to always be a thought running in the background. There's someone, somewhere researching pretty much anything and everything at all times.

Last edited by DCnDC; 12-07-2018 at 09:30 AM.
  #22  
Old 12-07-2018, 10:02 AM
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Either they're writing up weird cases or they're inviting in their colleagues and med students to see them.
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Old 12-07-2018, 10:32 AM
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oh just gross, oh just too much to think about...not touching the link but I am very curious of what it looks like, but ewww.
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Old 12-07-2018, 10:42 AM
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If medical professionals did not research and publicize weird cases, we wouldn't have Dr. Lisa (the real-life Dr House) and her colleagues.

Last edited by DPRK; 12-07-2018 at 10:43 AM.
  #25  
Old 12-07-2018, 10:47 AM
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Ah, blood clot art. Fascinating, and sad.
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Old 12-07-2018, 11:05 AM
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oh just gross, oh just too much to think about...not touching the link but I am very curious of what it looks like, but ewww.
It looks just like half of this, but very red, and not drawn (link is an illustration).

https://i.pinimg.com/originals/79/5b...08abbbc052.jpg

Personally I don't find it disgusting at all, but I see gross medical stuff all the time. We always warn the new employees, "Whatever you do, do NOT thumb through the dermatology books. Trust me."


.

Last edited by DCnDC; 12-07-2018 at 11:07 AM.
  #27  
Old 12-07-2018, 11:20 AM
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If medical professionals did not research and publicize weird cases, we wouldn't have Dr. Lisa (the real-life Dr House) and her colleagues.
Dr Lisa Sanders, who has a regular column in the New York Times Magazine. I look forward to reading it each week. And yes, that column inspired the TV show House, MD.
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Old 12-07-2018, 11:38 AM
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man coughs up perfect cast of bronchial tree

I'd be more impressed by "man coughs up cast of Perfect Strangers."
  #29  
Old 12-07-2018, 11:55 AM
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It's quite possible the coughed-up bloot clot also contained mucoid and cellular elements and had begun to organize (i.e. with ingrowth of fibroblasts and small blood vessels), explaining why it held together while being expelled.*

While people don't "cough up a lung", it's possible to cough hard enough to herniate out a segment of lung between your ribs (do not try this at home).

"The woman's lung tissue slipped through the space between two of her ribs -- the ninth intercostal space, to be exact. It's actually somewhat similar to a NEJM case study from last month, in which a woman's body "swallowed" one of her breast implants while she was doing Pilates -- in that case, the woman's implant slipped between two of her ribs and was sent into her pleural cavity, or the space between her lungs. (Maybe those two should form a support group.)"

https://www.nbcnews.com/healthmain/w...says-1C6436935

*one hopes this specimen was preserved for future study by eager med students.
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Old 12-07-2018, 12:01 PM
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I'd be more impressed by "man coughs up cast of Perfect Strangers."

Of course not. Don't be ridiculous.
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Old 12-07-2018, 12:08 PM
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Mine are usually more greenish.
  #32  
Old 12-07-2018, 01:05 PM
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Mine are usually more greenish.
TMI.
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Old 12-07-2018, 01:23 PM
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I would have to think that one reason it maintained its shape so well is because it did some serious damage on its way up.
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Old 12-07-2018, 02:58 PM
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Originally Posted by Jackmannii View Post
It's quite possible the coughed-up bloot clot also contained mucoid and cellular elements and had begun to organize (i.e. with ingrowth of fibroblasts and small blood vessels), explaining why it held together while being expelled.*

While people don't "cough up a lung", it's possible to cough hard enough to herniate out a segment of lung between your ribs (do not try this at home).

"The woman's lung tissue slipped through the space between two of her ribs -- the ninth intercostal space, to be exact. It's actually somewhat similar to a NEJM case study from last month, in which a woman's body "swallowed" one of her breast implants while she was doing Pilates -- in that case, the woman's implant slipped between two of her ribs and was sent into her pleural cavity, or the space between her lungs. (Maybe those two should form a support group.)"

https://www.nbcnews.com/healthmain/w...says-1C6436935

*one hopes this specimen was preserved for future study by eager med students.
I've coughed enough (pneumonia) to injure my ribs. I had no idea you could also end up pinching your lungs. Good to know.
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Old 12-07-2018, 03:47 PM
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I guess I am not understanding. Was that a picture of the guys actual bronchial tree or something that was inside his bronchial tree? And how was it a solid thing? Amazing to know the human body can do these things.
Oh, and Sunny I knew someone who cracked their neck coughing. It was an actual fracture. She, too had pneumonia.
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Old 12-07-2018, 03:55 PM
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I guess I am not understanding. Was that a picture of the guys actual bronchial tree or something that was inside his bronchial tree? And how was it a solid thing?
Blood filled that much of his lung and congealed, like Jell-O in a mold; violent coughing knocked it loose, up his trachea and out of his mouth. I'm certain it was every bit as unpleasant as it sounds and more.
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Old 12-07-2018, 04:16 PM
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Ah, blood clot art. Fascinating, and sad.
I find it very upsetting that you instantly recognize this as a thing.

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Old 12-07-2018, 06:44 PM
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Blood filled that much of his lung and congealed, like Jell-O in a mold; violent coughing knocked it loose, up his trachea and out of his mouth. I'm certain it was every bit as unpleasant as it sounds and more.
Ugh. Gross me out the back door. Poor man.
  #39  
Old 12-07-2018, 09:43 PM
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Ugh. Gross me out the back door. Poor man.
Life ain't pretty. It's fortunate that we can get somewhat desensitized to it, or we could never cope. But get too desensitized, and we lose our empathy for suffering.

Who the fuck came up with this whole life thing, anyway???
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Old 12-07-2018, 11:21 PM
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I didn't click the article in the OP, because I didn't want to see the picture. But it happened to turn up in my Facebook feed.

Though I've seen worse pictures in my feed, and I actually found it kind of fascinating - I'd just as rather not see it again.

Last edited by EmilyG; 12-07-2018 at 11:22 PM.
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Old 12-07-2018, 11:43 PM
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I could never work in the medical field. I don't think I'd ever get used to those things. I respect anyone who does though.
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Old 12-08-2018, 07:32 PM
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It looks just like half of this, but very red, and not drawn (link is an illustration).

https://i.pinimg.com/originals/79/5b...08abbbc052.jpg

Personally I don't find it disgusting at all, but I see gross medical stuff all the time. We always warn the new employees, "Whatever you do, do NOT thumb through the dermatology books. Trust me."


.
I collect old medical books, and once had a book with pictures that were even grosser than anything in dermatology, and that's why I don't have it any more. I'll spoiler the title because it could potentially trigger some people.

SPOILER:
It was from the 1940s and was titled "Fetal And Neonatal Death." Most of the pictures were from miscarriages and the deformities seemed unique, but others were of term infants. Before I went back to school, I worked with an elderly woman who had had a second-trimester miscarriage many years before, and the fetus was so perfect, they wanted to put him on display at a medical school. Some people were totally grossed out at the idea, but I thought it was wonderful that she could turn this sad event into something positive, especially because they probably don't get very many perfect-looking babies from miscarriages.

I have another book, even older than that, titled "Extrauterine Pregnancy" and it's not that gross.
  #43  
Old 12-08-2018, 09:29 PM
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I wonder if he was from a lesser-developed country and had rheumatic fever, or some kind of birth defect that wasn't corrected until he was much older than it's normally done in this country. It's very unusual for someone who's 36 to have a valve replacement, in addition to all the other problems he had.
Jeez! I'll say...I was gaping when I read the part where the poor fellow had a pacemaker and a VAD installed.
  #44  
Old 12-08-2018, 09:47 PM
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He goes through that on a "regular basis"?!

I think I'd rather eat a bullet and be done with it.
Mine were sea green and didn't go beyond the first branching. My solution topped eating a bullet: regular flu and pneumonia shots. Less messy.
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Old 12-09-2018, 12:17 AM
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Who the fuck came up with this whole life thing, anyway???
Seriously! Not only is it expensive, it's 100% fatal!
  #46  
Old 12-09-2018, 01:39 PM
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In the disgusting-but-amazing department (beware, vivid color photo at link):

Cast of the Right Bronchial Tree



So THATíS where the White House got the idea for this yearís decorations!
  #47  
Old 12-09-2018, 02:11 PM
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I can't tell if that's the collest or the most disgusting thing I've seen all day. Maybe both.
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Old 12-10-2018, 01:04 PM
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Thank you for sharing that.
It was informative, intriguing, fascinating even.

and it should serve as nightmare fodder for the next several days, possibly weeks.
  #49  
Old 12-10-2018, 01:38 PM
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Let me get out my list of links I never plan on clicking.

Okay, there's goatse, two girls one cup, pimple popping.

Add man coughs up perfect cast of bronchial tree to the list.

Alright, I'm done here.
  #50  
Old 12-10-2018, 08:34 PM
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So this guy's cast, and plastic bronchitis, aren't the same type of lung cast.

I've now learned more in the past few days about a topic (lung casts) that I didn't know existed before. And that I somewhat wish I could forget.
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