Doctors at the University of California, San Francisco documented a striking case in which a patient coughed up a substantial blood clot shaped like a bronchial tree. The case was reported in a prestigious medical journal, the New England Journal of Medicine, underscoring a rare and dramatic pulmonary event.
The patient was a 36-year-old man who arrived at the hospital in critical condition due to deteriorating heart failure. In an effort to support his failing heart, clinicians connected him to a ventricular assist device, a mechanical pump designed to aid circulation. While these devices can improve organ perfusion, they also introduce an elevated risk of clot formation. To mitigate that danger, the medical team prescribed anticoagulant therapy to reduce the chance of clots forming in the bloodstream.
Anticoagulants, however, carry a tradeoff. They heighten the risk of bleeding, including the possibility of coughing up blood. In this case, the patient experienced several episodes of coughing with minor amounts of blood, but nothing out of the ordinary until a severe coughing spell occurred. During that episode, he expelled a large, organized blood clot accompanied by airway branches resembling a miniature bronchial tree. This dramatic expulsion did not immediately relieve the clinical tension; after the event, the patient did not experience additional episodes of hemoptysis, but his overall condition ultimately worsened due to complications linked to his underlying heart failure and the aftereffects of prolonged critical illness.
These events highlight a known, though uncommon, sequence where blood clots can form under anticoagulation and potentially be shaped or solidified by the dynamic forces of coughing. The report notes that the episode occurred in the context of an infection that raised levels of fibrinogen, a protein involved in clot formation. Higher fibrinogen levels can promote clot stability, which in turn may help large clots persist during episodes of forceful coughing. In this case, the combination of a mechanical circulatory support device, systemic anticoagulation, an infectious inflammatory milieu, and vigorous coughing created a unique set of conditions leading to the expulsion of the clot and its distinctive appearance fatally tied to the patient’s ultimate decline from heart failure complications.