Is It Possible to Cough up a Lung?

One man's extreme coughing spells led him to cough up something unusual from his lung.

After a terrible coughing fit, you may have said, "I thought I was going to cough up a lung" to describe how intense the fit was. But can you really cough up a lung? Is it physically possible?

A 36-year-old California man came close when he coughed up a blood clot in the shape of his bronchial tree after being hospitalized for heart palpitations. According to a case report published in 2018 in the New England Journal of Medicine, the man was admitted to the ICU at the University of California, San Francisco Medical Center with chronic heart failure.

He had a history of poor cardiovascular health and previously had a pacemaker implanted due to issues with his heart rhythm.

man-coughed-up-lung

The "Lung"

Throughout his first week in the ICU, he regularly coughed up blood and mucus, but one coughing spell was worse than the others. He coughed up a tree-shaped blood clot that had formed a cast of his right bronchial tree (pictured above), which has tubes that distribute air to the lungs. He actually coughed up a gel-like mold of part of his lung.

After the incident, a tube was placed in the patient's throat to allow him to breathe. But he passed away the following week from heart failure complications, including too much fluid in the blood and not enough blood pumping through the body.

History of Poor Lung Health

The patient was already in poor health when he entered the hospital. He had an ejection fraction (EF)—which measures how much blood the left ventricle pumps out with each contraction—of only 20%.

A normal heart's ejection fraction is greater than 55%, usually between 55% and 65%, according to heart failure guidelines from the American College of Cardiology and the American Heart Association.

He also had stenosis of a bicuspid aortic valve, the most common form of congenital heart disease, in which the heart valve (aortic valve) that allows blood to flow from the heart to the rest of the body has only two cusps instead of the normal three.

This defect can cause the valve to become calcified and narrow (stenotic) over time, making it more difficult for blood to flow from the heart to the rest of the body. The patient previously had his aortic valve replaced because of the defect.

The violent coughing spells the man had during his first week in the hospital likely strained his already weak heart and lungs, leading to him coughing up the mold of the bronchial tree, according to the case report.

Is It Possible to Cough up a Lung?

According to Tufts Medical Center, despite the old phrase, it's physically impossible to "cough up a lung." However, if a coughing fit is severe or lasts for an extended period of time, parts of the respiratory system and other areas of the body can be damaged.

Persistent and violent coughing may lead to damaged blood vessels, cracked ribs, and a ruptured diaphragm, among other problems.

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