Ever heard the phrase “coughed up a lung”? Well, this isn’t actually a coughed up lung, because that would be impossible, but rather a blood clot formed in the exact shape of a man’s lung passage.

This article is also really gross – consider this a disclaimer.

In lovely clinical medical terms, “during an extreme bout of coughing, the patient spontaneously expectorated an intact cast of the right bronchial tree”.

This was the explanation attached to an image on Twitter shared by The New England Journal of Medicine, showing a six-inch-wide blood clot in the shape of a patient’s right bronchial tree on November 23, reports Inverse.

The creator of the cast, a 36-year-old man admitted to the ICU for heart failure, died a week after the photo was taken, due to medical complications.

The NEJM regularly drops medical images not safe for the squeamish, but this blood clot took the Internet’s breath away.

Just to be clear, that image above is what the man in question coughed up, perfectly intact.

What makes this particular specimen special is the material that it’s made out of. Blood is less likely than other materials to achieve this shape, so here’s how it happened, according to medical professionals:

When the human body is running properly, bronchi are pathways for the oxygen you breathe in and the carbon dioxide you expel. Like an upside down tree, the web of branches spindles out into smaller bronchioles that are closed at the tips by alveoli, where your bloodstream carries red blood cells to pick up and drop off oxygen and carbon dioxide.

In the case of the unfortunate patient, there was much more than air in his bronchi. When he was admitted to the ICU, doctors hooked him to a ventricular assist device, called an Impella, that helps maintain blood flow. But the turbulence of the world’s smallest heart pumps can cause clots, so the doctors countered the effect by giving the man an anticoagulant to thin his blood.

The anticoagulant comes with a price — with thinner blood, the body has trouble patching up any breaks or fissures that open internally. In this case, the patient’s blood made its way to his right bronchial tree, leaving him coughing small clots for days.

Doctors reckon that an infection caused the patient to produce a higher concentration of fibrinogen, a protein found in blood plasma that acts as “glue”, which then provided the hardness to keep the shape of the blood clot intact.

Gross.

My apologies if you read this before eating lunch.

[source:inverse]