Breathing: A Sigh of Relief (medical report)

A cough led to a cast—a bronchial cast—for (or rather from) the patient described in this medical report.

Cast of the Right Bronchial Tree,” Gavitt A. Woodard and Georg M. Wieselthaler, New England Journal of Medicine, vol. 379, November 29, 2018, p. 2151. (Thanks to Emily Willingham for bringing this to our attention.) The authors, at the University of California, San Francisco, explain:

“A 36-year-old man was admitted to the intensive care unit with an acute exacerbation of chronic heart failure. His medical history included heart failure with an ejection fraction of 20%, bioprosthetic aortic-valve replacement for bicuspid aortic stenosis, endovascular stenting of an aortic aneurysm, and placement of a permanent pacemaker for complete heart block. An Impella ventricular assist device was placed for management of acute heart failure, and a continuous heparin infusion was initiated for systemic anticoagulation. 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.”

The relief did not last long. The patient died a week later.

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