In a case report from the New England Journal of Medicine, surgeons from the University of California San Francisco Medical Center presented the case of a 36-year-old patient who was admitted to the ICU with chronic heart failure.
Due to his history of poor cardiovascular health, he'd had a pacemaker implanted in case his heart became completely blocked.
However, throughout his first week in the hospital, he coughed up blood and mucus and, during an intense coughing spell, he managed to expectorate an intact cast of the bronchial tree before he died the following week.
It is clear when the patient entered the hospital he was in declining health.
His heart had an ejection fraction (EF), how much blood the left ventricle pumps out with each contraction, of 20 percent. A normal EF is between 50 and 75 percent.
Additionally, he had bicuspid aortic stenosis. After blood is pumped out of the left ventricle, it passes through the aortic valve to circulate throughout the body.
This valve normally has three cusps - or leaflets - but a bicuspid aortic valve is a congenital defect in which the valve only has two cusps.