# man coughs up perfect cast of bronchial tree
**URL:** https://boards.straightdope.com/t/man-coughs-up-perfect-cast-of-bronchial-tree/825729
**Category:** Miscellaneous and Personal Stuff I Must Share
**Created:** [December 7, 2018, 3:11am UTC](https://boards.straightdope.com/t/man-coughs-up-perfect-cast-of-bronchial-tree/825729 "2018-12-07T03:11:49Z")
**Posts on this page:** 20
**Page:** 1
### Author:  [@Machine\_Elf](https://boards.straightdope.com/u/Machine_Elf)
#### Post date: [December 7, 2018, 3:11am UTC](https://boards.straightdope.com/t/man-coughs-up-perfect-cast-of-bronchial-tree/825729/1 "2018-12-07T03:11:49Z")
In the disgusting-but-amazing department (beware, vivid color photo at link):
[Cast of the Right Bronchial Tree](https://www.nejm.org/doi/full/10.1056/NEJMicm1806493)
> [@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.
:eek:
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### Author:  [@The\_Stainless\_Steel\_Rat](https://boards.straightdope.com/u/The_Stainless_Steel_Rat)
#### Post date: [December 7, 2018, 3:18am UTC](https://boards.straightdope.com/t/man-coughs-up-perfect-cast-of-bronchial-tree/825729/2 "2018-12-07T03:18:07Z")
Ummmmm…ewwwwwww???
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### Author:  [@Beckdawrek](https://boards.straightdope.com/u/Beckdawrek)
#### Post date: [December 7, 2018, 3:21am UTC](https://boards.straightdope.com/t/man-coughs-up-perfect-cast-of-bronchial-tree/825729/3 "2018-12-07T03:21:03Z")
Holy shit. Guy died anyway. How can you get that up?
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### Author:  [@running\_coach](https://boards.straightdope.com/u/running_coach)
#### Post date: [December 7, 2018, 3:27am UTC](https://boards.straightdope.com/t/man-coughs-up-perfect-cast-of-bronchial-tree/825729/4 "2018-12-07T03:27:16Z")
> [@The\_Stainless\_Steel\_Rat](#):
>
> Ummmmm…ewwwwwww???
_looks at link_
_nods in agreement_
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### Author:  [@Sunny\_Daze](https://boards.straightdope.com/u/Sunny_Daze)
#### Post date: [December 7, 2018, 3:32am UTC](https://boards.straightdope.com/t/man-coughs-up-perfect-cast-of-bronchial-tree/825729/5 "2018-12-07T03:32:30Z")
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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### Author:  [@alphaboi867](https://boards.straightdope.com/u/alphaboi867)
#### Post date: [December 7, 2018, 3:59am UTC](https://boards.straightdope.com/t/man-coughs-up-perfect-cast-of-bronchial-tree/825729/6 "2018-12-07T03:59:08Z")
It’s sad he died of course, but holy shit that’s amazing.
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### Author:  [@pool](https://boards.straightdope.com/u/pool)
#### Post date: [December 7, 2018, 4:00am UTC](https://boards.straightdope.com/t/man-coughs-up-perfect-cast-of-bronchial-tree/825729/7 "2018-12-07T04:00:40Z")
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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### Author:  [@dogbutler](https://boards.straightdope.com/u/dogbutler)
#### Post date: [December 7, 2018, 4:01am UTC](https://boards.straightdope.com/t/man-coughs-up-perfect-cast-of-bronchial-tree/825729/8 "2018-12-07T04:01:39Z")
> [@Sunny\_Daze](#):
>
> 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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### Author:  [@nearwildheaven](https://boards.straightdope.com/u/nearwildheaven)
#### Post date: [December 7, 2018, 4:07am UTC](https://boards.straightdope.com/t/man-coughs-up-perfect-cast-of-bronchial-tree/825729/9 "2018-12-07T04:07:14Z")
> [@pool](#):
>
> 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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### Author:  [@steatopygia](https://boards.straightdope.com/u/steatopygia)
#### Post date: [December 7, 2018, 4:10am UTC](https://boards.straightdope.com/t/man-coughs-up-perfect-cast-of-bronchial-tree/825729/10 "2018-12-07T04:10:12Z")
I don’t think that was a _cast_ of his R bronchial tree, I think he coughed up his R bronchial tree.
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### Author:  [@chizzuk](https://boards.straightdope.com/u/chizzuk)
#### Post date: [December 7, 2018, 4:14am UTC](https://boards.straightdope.com/t/man-coughs-up-perfect-cast-of-bronchial-tree/825729/11 "2018-12-07T04:14:26Z")
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.
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### Author:  [@Riemann](https://boards.straightdope.com/u/Riemann)
#### Post date: [December 7, 2018, 4:22am UTC](https://boards.straightdope.com/t/man-coughs-up-perfect-cast-of-bronchial-tree/825729/12 "2018-12-07T04:22:43Z")
> [@nearwildheaven](#):
>
> 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:
> **[Doctors Aren’t Sure How This Even Came Out of a Patient](https://www.theatlantic.com/health/archive/2018/12/bronchial-blood-clot/577480/)**
>
> Somehow, a man coughed up an intact blood clot shaped like a lung passage.
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### Author:  [@Cub\_Mistress](https://boards.straightdope.com/u/Cub_Mistress)
#### Post date: [December 7, 2018, 4:33am UTC](https://boards.straightdope.com/t/man-coughs-up-perfect-cast-of-bronchial-tree/825729/13 "2018-12-07T04:33:58Z")
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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### Author:  [@EmilyG](https://boards.straightdope.com/u/EmilyG)
#### Post date: [December 7, 2018, 4:48am UTC](https://boards.straightdope.com/t/man-coughs-up-perfect-cast-of-bronchial-tree/825729/14 "2018-12-07T04:48:42Z")
> [@chizzuk](#):
>
> 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-diseases/plastic-bronchitis](https://www.chop.edu/conditions-diseases/plastic-bronchitis)
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### Author:  [@FloatyGimpy](https://boards.straightdope.com/u/FloatyGimpy)
#### Post date: [December 7, 2018, 5:34am UTC](https://boards.straightdope.com/t/man-coughs-up-perfect-cast-of-bronchial-tree/825729/15 "2018-12-07T05:34:47Z")
> [@steatopygia](#):
>
> I don’t think that was a _cast_ of his R bronchial tree, I think he coughed up his R bronchial tree.
> [@Riemann](#):
>
> It’s a blood clot. There’s some explanation here:
>
> [How a Huge Blood Clot Took the Shape of a Lung Passage - The Atlantic](https://www.theatlantic.com/health/archive/2018/12/bronchial-blood-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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### Author:  [@octopus](https://boards.straightdope.com/u/octopus)
#### Post date: [December 7, 2018, 5:54am UTC](https://boards.straightdope.com/t/man-coughs-up-perfect-cast-of-bronchial-tree/825729/16 "2018-12-07T05:54:14Z")
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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### Author:  [@gkster](https://boards.straightdope.com/u/gkster)
#### Post date: [December 7, 2018, 6:23am UTC](https://boards.straightdope.com/t/man-coughs-up-perfect-cast-of-bronchial-tree/825729/17 "2018-12-07T06:23:18Z")
> [@FloatyGimpy](#):
>
> 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.\*
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### Author:  [@Two\_Many\_Cats](https://boards.straightdope.com/u/Two_Many_Cats)
#### Post date: [December 7, 2018, 12:47pm UTC](https://boards.straightdope.com/t/man-coughs-up-perfect-cast-of-bronchial-tree/825729/18 "2018-12-07T12:47:48Z")
That thing is a museum piece. Maybe they could auction it off to help pay for the funeral.
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### Author:  [@ivylass](https://boards.straightdope.com/u/ivylass)
#### Post date: [December 7, 2018, 12:52pm UTC](https://boards.straightdope.com/t/man-coughs-up-perfect-cast-of-bronchial-tree/825729/19 "2018-12-07T12:52:58Z")
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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### Author:  [@Jasmine](https://boards.straightdope.com/u/Jasmine)
#### Post date: [December 7, 2018, 1:06pm UTC](https://boards.straightdope.com/t/man-coughs-up-perfect-cast-of-bronchial-tree/825729/20 "2018-12-07T13:06:12Z")
> [@Cub\_Mistress](#):
>
> 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”?! :eek:
I think I’d rather eat a bullet and be done with it. ☹
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