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CAL­I­FOR­NIA - A man lit­er­ally coughed up part of his lung after he was hos­pi­talised for heart pal­pi­ta­tions.

In a case re­port from the New Eng­land Jour­nal of Medicine, sur­geons from the Univer­sity of Cal­i­for­nia San Fran­cisco Med­i­cal Cen­tre pre­sented the case of a 36-year-old pa­tient who was ad­mit­ted to the ICU with chronic heart fail­ure.

Due to his his­tory of poor car­dio­vas­cu­lar health, he'd had a pacemaker im­planted in case his heart be­came com­pletely blocked.

How­ever, through­out his first week in the hospi­tal, he coughed up blood and mu­cus and, dur­ing an in­tense cough­ing spell, he man­aged to ex­pec­to­rate a se­ries of tubes meant to dis­trib­ute air to his lungs be­fore he died the fol­low­ing week.

It is clear when the pa­tient en­tered the hospi­tal he was in de­clin­ing health. His heart had an ejec­tion frac­tion (EF), how much blood the left ven­tri­cle pumps out with each con­trac­tion, of 20 per­cent. A nor­mal EF is be­tween 50 and 75 per­cent.

Ad­di­tion­ally, he had bi­cus­pid aor­tic steno­sis. After blood is pumped out of the left ven­tri­cle, it passes through the aor­tic valve to cir­cu­late through­out the body.

This valve nor­mally has three cusps - or leaflets - but a bi­cus­pid aor­tic valve is a con­gen­i­tal de­fect in which the valve only has two cusps.

Ac­cord­ing to a 2006 study from Emory Univer­sity School of Medicine, only one to two per­cent of the US pop­u­la­tion has this dis­ease.

Be­cause of this de­fect, it is more prone to steno­sis, which is when these pas­sages nar­row, mean­ing the aor­tic valve of­ten needs to be re­placed at a young age.

In the case of this man, he'd had his valve re­placed with bio­pros­thetic valve, which is made from the tis­sue of an­i­mal donors such as calves. Dur­ing the week after the man was ad­mit­ted to the hospi­tal, he was cough­ing up blood and mu­cus, in­creas­ing the strain on his lungs. Ad­di­tion­ally, doc­tors needed to in­creas­ingly sup­ply him with sup­ple­men­tal oxy­gen.

It was dur­ing a par­tic­u­larly vi­o­lent cough­ing spell that he spon­ta­neously coughed up an in­tact cast of the right bronchial tree.

The tra­chea and the two pri­mary bronchi are called the bronchial tree. The tubes that make up the bronchial tree dis­trib­ute air to the lungs.

The right main bronchus in the right lung is wider, shorter and more ver­ti­cal than the left main bronchus in the left lung. It also di­vides into three branches while the left di­vides into two.

Hu­man lungs are too large to fit through the tra­chea, so it is not pos­si­ble to cough up an en­tire lung.

How­ever, it is pos­si­ble to have such an ex­treme bout of cough­ing that the lung pops through the spa­ces in be­tween the ribs and parts of it are sub­se­quently coughed up.

In the case of the man, all three seg­men­tal branches were coughed up: the up­per lobe (blue ar­rows), the mid­dle lobe (white ar­rows) and the lower lobe (black ar­rows).

The pa­tient was im­me­di­ately in­tu­bated and doc­tors per­formed a bron­choscopy, which al­lows doc­tors to look at the lungs and air pas­sages.

They dis­cov­ered that the man had a small amount of blood in the basi­lar branches, which sup­ply oxy­gen­rich blood, of the right lower lobe.

Two days later, the man was ex­tu­bated and had no more episodes of cough­ing up blood or mu­cus.

But just one week after this, the pa­tient died from heart fail­ure com­pli­ca­tions, mainly vol­ume over­load - when there is too much fluid in the blood - and low car­diac out­put, which is when there is a low amount of blood the heart is pump­ing through the cir­cu­la­tory sys­tem.

This is not the first time there has been a re­ported in­ci­dent of some­one hack­ing up a piece of their lung.

A case re­port pub­lished in the New Eng­land Jour­nal of Medicine in Jan­uary 2012 de­scribed the case of a 40-year-old woman in the UK who was suf­fer­ing from asthma.

Doc­tors at Good Hope Hospi­tal in Birm­ing­ham dis­cov­ered she coughed so hard she her­ni­ated her lung, mean­ing her lung tis­sue pushed through two of her ribs.

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