Is It Possible to Cough up a 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? Coughing when accompanied by heart problems or when you cough up blood can be a sign of a serious condition.

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.

The Lung-shaped Blood Clot

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). Bronchial are tree-like structures that have tubes that distribute air to the lungs. The patient 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 Journal of the American College of Cardiology.

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.