男子将“支气管树”咳了出来，终生难忘的好图片

一名36岁男子因慢性心力衰竭急性加重住进ICU病房，住院期间，间断出现咯血。

在一次剧烈的咳嗽中，病人自发地咳出了完整的右侧支气管树样形状的血栓，也就是支气管里面的血凝块。右支气管树由上肺叶三个节段支(蓝色箭头)、中肺叶两个节段支(白色箭头)和下肺叶五个节段支(黑色箭头)组成。

大家想要的英文原文来了，有兴趣的看看

A 36-year-old man was admitted to the intensive care unit with an acute exacerbation of chronic heart failure. His medical history included heart failure with an ejection fraction of 20%, bioprosthetic aortic-valve replacement for bicuspid aortic stenosis, endovascular stenting of an aortic aneurysm, and placement of a permanent pacemaker for complete heart block. An Impella ventricular assist device was placed for management of acute heart failure, and a continuous heparin infusion was initiated for systemic anticoagulation. During the next week, the patient had episodes of small-volume hemoptysis, increasing respiratory distress, and increasing use of supplemental oxygen (up to 20 liters delivered through a high-flow nasal cannula). During an extreme bout of coughing, the patient spontaneously expectorated an intact cast of the right bronchial tree. The right bronchial tree consists of three segmental branches in the upper lobe (blue arrows), two segmental branches in the middle lobe (white arrows), and five segmental branches in the lower lobe (black arrows). 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. The patient was extubated 2 days later and had no further episodes of hemoptysis. One week after extubation, he died from complications of heart failure (volume overload and poor cardiac output) despite placement of the ventricular assist device.

新英格兰杂志的链接如下：https://www.nejm.org/doi/full/10.1056/NEJMicm1806493