"You have high turbulence inside the pumps, and that can cause clots to form inside", Wieselthalers told The Atlantic.
The right bronchial tree consists of three segmental branches in the upper lobe (blue arrows), two segmental branches in the middle lobe (white arrows), and five segmental branches in the lower lobe (black arrows).
"An Impella ventricular assist device was placed for management of acute heart failure, and a continuous heparin infusion was initiated for systemic anticoagulation".
It turns out that the 36-year-old patient's condition produced elevated levels of fibrinogen, a protein that can act as a glue to assist the clotting process, which allowed the rubbery "blood sculpture" to escape the man's trachea intact.
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However, these medications also increase the risk of bleeding, including coughing up blood. He had chronic heart failure, which means the heart muscle can't pump enough blood to meet the body's normal demands. Fox 10 in Phoenix noted that he'd previously been fitted with a pacemaker.
Over the next week, the patient had periodic coughing fits, hacking up small amounts of blood or blood-stained mucus, the doctors wrote in their published case note.
The six-inch-wide blood clot that was coughed up by an unnamed patient in the near-perfect shape of his right bronchial tree. In other words, it was a mold (cast) made of clotted blood in the shape of the lung's branched airway passages known as bronchi.
After this episode, he ceased coughing up blood, and his tubes were removed a couple days later.
The man died from heart complications a week after coughing up the clot.