Cast of Right Bronchial Tree Expectorated by a Patient
The picture shows the intact cast of right bronchial tree expectorated by a 36-year-old male patient with a history of chronic heart failure, stenting of aortic aneurysm, valve replacement of bicuspid aortic valve, and permanent pacemaker placement for complete heart block. The patient was admitted to intensive care unit due to acute complication of chronic heart failure. The patient was managed by continuous infusion of heparin and insertion of ventricular assist device. The patient had hemoptysis and respiratory distress which was managed by supplemental oxygen. However, during a severe bout of cough, the patient expectorated an intact cast of right bronchial tree. On this cast of right bronchial tree, all segmental branches are prominent. Blue arrows show three segmental branches of upper lobe. The branches of middle lobe are indicated by white arrows. Black arrows show five segmental branches of lower lobe. Patient was intubated. Flexible bronchoscopy demonstrated blood in basilar branches of right lower lobe. Patient was extubated once hemoptysis was relieved. However, patient died a week later due to poor cardiac function and volume overload. Source https://www.nejm.org/doi/full/10.1056/NEJMicm1806493