A 36-year-old Californian man who was admitted to the intensive care unit with chronic heart failure coughed so badly that he cut off a piece of lung. The unidentified patient, whose case was written in the New England Journal of Medicine, was receiving treatment at the Medical Center of the University of California at San Francisco (UCSF) and had previously been equipped with a pacemaker.
In the course of a week, the patient had progressed to cough up phlegm and blood, and during a particularly extreme encounter had moved a piece of a bronchial tube from his right lung.
"The right bronchial tree consists of three segmental branches in the upper lobe, two segmental branches in the middle lobe and five segmental branches in the lower lobe," wrote the authors of the case report. "The patient's trachea was subsequently intubated and flexible bronchoscopy revealed a small amount of blood in the basilar branches of the right lower lobe."
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He was extubated two days later, and he had no further episodes of coughing up blood, but died a week later due to complications of heart failure.