"…about as likely to happen as your brain falling out of your butt."

December 6, 2018 8:52 PM

On Tuesday, The New England Journal of Medicine tweeted the most recent addition to its photo series of the most visually arresting medical anomalies. The image is of a mysterious, branchlike structure that, posted elsewhere, would probably pass for a cherry-red chunk of some underground root system or a piece of bright reef coral. But this is no creature of the deep. It’s a completely intact, six-inch-wide clot of human blood in the exact shape of the right bronchial tree, one of the two key tubular networks that ferry air to and from the lungs. And it was coughed up in one piece. (SLTheAtlantic)
posted by Johnny Wallflower (60 comments total)

If you like this sort of thing, @TheMedicalVids has some fascinating stuff.
posted by Johnny Wallflower at 8:54 PM on December 6, 2018 [1 favorite]

Oh wow. Oh wowie wow. I GUESS that was a case of "extreme coughing!" That is both fascinating and horrifying. How did it come up?? In a blob that they then stretched out all the branches? In a straight line? Can you IMAGINE?
posted by Cloudberry Sky at 9:02 PM on December 6, 2018 [5 favorites]

I am suddenly very happy to be healthy.
posted by J.K. Seazer at 9:03 PM on December 6, 2018 [3 favorites]

Beautiful and tragic. RIP.
posted by cichlid ceilidh at 9:07 PM on December 6, 2018 [17 favorites]

Naughty Johnny Wallflower! I was going to post this tomorrow! Isn’t it fascinating? Also terrifying.
posted by Homo neanderthalensis at 9:15 PM on December 6, 2018 [1 favorite]

I had posted elsewhere here on the blue about an earwax plug I’d removed that came out all in one piece in the shape of the guy’s ear canal. It was cool enough I kept it in a jar in my office until it kind of disintegrated.

The NEJM is such a great journal. It’s almost good enough to recommend for non doctor type lay people. Just the right mix of policy discussions, medical breakthroughs, interesting medical oddities, personal reflections, and editorials. Particularly fascinating are the Case Records of Massachusetts General Hospital which would make an incredible Discovery Channel show. Disclaimer: I referred a patient of mine to my wife whom she wrote up and got published. Suffice it to say, syphillis is a fascinating weird disease.

I see this particular patient all the time, he frequents the bars and clubs my band used to play. He thinks it’s really cool that he knows his doctor plays in a rock and roll punk band. His case was presented without any identifying information and he still has no idea he was the “weird case of the month” in the worlds most prestigious medical journal.
posted by Slarty Bartfast at 9:23 PM on December 6, 2018 [48 favorites]

Suffice it to say, syphillis is a fascinating weird disease.

God it was a few semesters ago but I will never forget my paleopathology classes unit on treponemal diseases and their effect on bones... oh god... The pictures...
posted by Homo neanderthalensis at 9:26 PM on December 6, 2018 [2 favorites]

Thank you for posting that, and I mean it sincerely. I didn't think it was gross at all. In fact it was beautiful, though yes, very sad in that it indicated how badly the patient's body was breaking down.
posted by hurdy gurdy girl at 9:27 PM on December 6, 2018 [8 favorites]

Bronchial trees make for some amazing casts.
posted by Slarty Bartfast at 9:46 PM on December 6, 2018 [1 favorite]

And it was coughed up in one piece.

Better out than in, I always say.
posted by Greg_Ace at 9:53 PM on December 6, 2018 [3 favorites]

I'm just getting over a respiratory tract infection, and I don't know if I am feeling relief or horror right now....
posted by theartandsound at 9:53 PM on December 6, 2018 [6 favorites]

I have a good friend who is a doctor who tells me that some people would cough that up and then want to eat it like eating a bloody booger. That is all I can think of when I saw this absolutely fascinating picture and background.
posted by AugustWest at 10:07 PM on December 6, 2018 [1 favorite]

It sort of reminds me of a staghorn kidney stone, of which the prospect of getting one is kind of terrifying.
posted by Halloween Jack at 10:21 PM on December 6, 2018

Just last night my partner and I were trying to remember the name of a horror film he saw where a woman pukes up her own intestines (askme forthcoming). I cannot wait until he wakes up and I can show him this post!
posted by iamkimiam at 10:22 PM on December 6, 2018

He has woken up and I have shown him this post, made his Friday morning. Twice. Thanks, MetaFilter!
posted by iamkimiam at 10:41 PM on December 6, 2018 [3 favorites]

It's less cool now that I know it killed him
posted by Ray Walston, Luck Dragon at 10:46 PM on December 6, 2018 [10 favorites]

Ok so generally speaking I do okay with medical stuff but the main photo sent me running so I could throw up holy fuck

(Super cool though, can't wait to send this to my more stalwart medical friends to fuck with their days tomorrow)
posted by Hermione Granger at 10:58 PM on December 6, 2018

Just pretend it's like a big weird twizzler
posted by Ray Walston, Luck Dragon at 11:00 PM on December 6, 2018 [8 favorites]

After all the Latin and fancy medical terms, coming across a case of Black Hairy Tongue was almost a relief.

Two of the cases, one on the first page and one on the second, are associated with cats.

Also, this poor bastard: "Over the next 3 days, severe mucositis developed that involved the lips, buccal mucosa (Panel A), conjunctivae, and urethral meatus." You might not want to investigate the photograph that accompanies that article.
posted by jokeefe at 11:01 PM on December 6, 2018 [1 favorite]

It looks like the weird tree out the back of Winterfell.
posted by the duck by the oboe at 11:21 PM on December 6, 2018 [6 favorites]

Alright, things like this are why I cannot wait to have my intellect (such as it may be) housed in a pure, clean, sharp-edged structure of unfathomable complexity. Knife-edged crystalline perfection, wrought out of terrifyingly rare minerals, all tidy, sharp, clean, perfect edges.

No writhing curves, filthy excrescences, oils, fluids, gasping breaths, sagging leaden flesh grasping the edges of the grave. All that can be burned away in the purifying flames of our glorious cobalt-60 future, nothing but ashes, flame, and crystalline perfection stalking the wastes.

Ashes, flame, hard radiation and crystalline perfection. This is what awaits the Glorious, my children. The Glorious shall be reavers upon the wastes, stripping the planet clean of its biology before going on to cleanse the entire galaxy. The task of millennia awaits us!
posted by aramaic at 11:50 PM on December 6, 2018 [40 favorites]

Many years ago, I read a gross-out story thread on a bulletin board for nurses (I think the link was on Fark). The consensus seemed to be that the worst things, by far, came from pulmonary patients. This story? Confirmed.
posted by thelonius at 12:21 AM on December 7, 2018 [1 favorite]

After all the Latin and fancy medical terms, coming across a case of Black Hairy Tongue was almost a relief.

Me and my pre-bedtime roast beef sandwich were having a lovely time until we got to that Black Hairy Tongue. Jesus Christ.
posted by Alvy Ampersand at 12:23 AM on December 7, 2018 [5 favorites]

no sir i don't like it
posted by poffin boffin at 12:23 AM on December 7, 2018 [11 favorites]

ah, red broccoli
posted by solarion at 1:24 AM on December 7, 2018 [2 favorites]

No writhing curves, filthy excrescences, oils, fluids, gasping breaths, sagging leaden flesh grasping the edges of the grave

Some of us like our filthy excrescences, thank you very much.
posted by Fuchsoid at 2:12 AM on December 7, 2018 [2 favorites]

This brings back vivid memories of my days as a medical scribe, when I’d research unfamiliar terms and encounter graphic images. The horrors living beings can endure are awe-inspiring to say the least.
posted by kinnakeet at 2:12 AM on December 7, 2018 [1 favorite]

The horrors living beings can endure

Ah yes, you’ve heard the story of the shapes family Christmas ‘09.
posted by shapes that haunt the dusk at 2:18 AM on December 7, 2018 [1 favorite]

That reminds me of a story a classmate in primary school told; apparently, he had an uncle who was a heavy drinker and smoker, until one day, he was in the shower, had a coughing fit and then “spewed his guts out”, i.e., fatally ejected all his innards through the mouth, neatly inverting himself. Which, of course, is topologically impossible, but 8-year-old boys don't know this.
posted by acb at 2:25 AM on December 7, 2018

Science question: why is it still red? I would have thought it would be oxidizing to brown, even in the time it took to photograph it. Does clotted blood have different qualities compared to fresh blood, or am I underestimating how long it takes to oxidize? Or wait, is it red because it oxidized? Would clotted blood lose its oxygen through osmosis?
posted by shapes that haunt the dusk at 2:45 AM on December 7, 2018 [1 favorite]

it's a Malgorithm!

related article intralinked in the Atlantic article: Read: Why fractals are so soothing
posted by chavenet at 2:48 AM on December 7, 2018 [2 favorites]

also: the potential for MeFi usernames on this page is something else

Black Hairy Tongue
Bitot's Spots
Asteroid Hyalosis
Whistling Cough
Portal Venous Gas
Burton's Line
Crying Blood
Lymphangioleiomyomatosis
Tinea Capitis
posted by chavenet at 2:52 AM on December 7, 2018 [8 favorites]

Trigger warning: Medical horror show.

So, several years back, I had a really really bad cold. Even though I was ill I had to go into town for some reason. I had got over the feverish stage but there was still lots of snot, coughing gunk etc. I remember standing in a newsagents checking out the magazines when suddenly I tried to breath out and... nothing happened. My windpipe was totally blocked and I could not breath in or out. I had a couple of seconds of utter pure bright fear of a) I'm going to fucking die! and b) EVEN WORSE (I'm British) I was going to have to embarrass myself by trying to use the power of mime to convince the shop owner to call an ambulance before I passed out.

Luckily I went into a massive spontaneous coughing fit that produced ... well not something as complex as this cthulhuloid mass linked in the article but a solid jelly-like y-shaped plug/cast of the top of my trachea that I spat into a tissue. I probably should have kept it for medical science but I chucked the whole disgusting lot down a nearby drain.
posted by fearfulsymmetry at 4:08 AM on December 7, 2018 [13 favorites]

That’s something.
posted by unliteral at 4:46 AM on December 7, 2018 [1 favorite]

fearfulsymmetry: I probably should have kept it for medical science but I chucked the whole disgusting lot down a nearby drain.

Thank you for sharing the Nigel Farage origin story.
posted by dr_dank at 4:52 AM on December 7, 2018 [58 favorites]

Wieselthaler says that although his patient felt instantly better after coughing up the clot, its size clearly indicated the severity of his situation.

I would imagine the unnamed patient felt a combination of "holy shit that's the most satisfying thing I've ever done" and "holy shit I am going to die," in magnitude hitherto-unknown to the human race.

When I was 15, I got a really nasty case of mononucleosis, and coughed up some desiccated mucal plugs that were big enough that I contemplated naming them. One of them had a clearly-articulated tributary pattern like this, and coughing that thing up was the most satisfying and awful thing that has ever happened to me
posted by Mayor West at 6:14 AM on December 7, 2018 [7 favorites]

I love stuff like this so much. I'm sorry that the patient was already quite ill, but man, the human body is freaking fascinating.

Agree with Slarty. The NEJM is a great and somewhat accessible journal.
posted by Sophie1 at 6:23 AM on December 7, 2018 [1 favorite]

As someone who has had a significant cough for a month now and has been coughing up small amounts of blood (yes, I've seen a doctor) this is simultaneously fascinating and the thing that will now haunt my nightmares for the next 6 months.
posted by jacquilynne at 6:36 AM on December 7, 2018 [5 favorites]

I had posted elsewhere here on the blue about an earwax plug I’d removed that came out all in one piece in the shape of the guy’s ear canal. It was cool enough I kept it in a jar in my office until it kind of disintegrated.

This happened with my cat a few months ago. Except I didn't remove it, it flew out and landed in my lap after a violent bout of head shaking from the cat.

AND I DIDN'T KEEP IT EITHER. *shudder*
posted by elsietheeel at 6:49 AM on December 7, 2018 [7 favorites]

When I first saw this, I honestly thought it was one of Melania Trump's Christmas decorations.
posted by 4ster at 7:16 AM on December 7, 2018 [24 favorites]

Between this and the eel stuck up a seal's nose two FPP's down, it's a bad morning for the squeamish.
posted by twoplussix at 7:55 AM on December 7, 2018 [4 favorites]

When I was a kid with the flu I once woke up with a thick layer of hardened phlegm coating the roof of my mouth. Panicked at the weirdness in my mouth, I screamed, and my mom came in and scraped it out. It held the shape of half of my mouth.

I told that story in a Trump thread one time but for some reason it was deleted.
posted by Ray Walston, Luck Dragon at 8:43 AM on December 7, 2018 [8 favorites]

*retires the story of how I once sneezed out a piece of cheese I'd had for lunch*
posted by Room 641-A at 9:09 AM on December 7, 2018 [4 favorites]

Well, I now have confirmation of my suspicions of the real reason Slarty showed up unannounced in my hospital room eight years ago, and why the ICU floor even let him in without any sort of guest list.

I'd ask to see the pictures and any published journal articles but I'm not even sure I want to know exactly which curiosity he was collecting and documenting. I'll just presume it's "everything" and the article was something like "Can you even believe this mutant is still alive?"
posted by loquacious at 10:17 AM on December 7, 2018 [2 favorites]

aramaic: The Glorious shall be reavers upon the wastes, stripping the planet clean of its biology before going on to cleanse the entire galaxy.

Heyyy, buddy; how's it going? Deep breath. It's okay. Have you considered switching to decaf? It comes in crystals, too.
posted by Johnny Wallflower at 10:19 AM on December 7, 2018 [1 favorite]

also: the potential for MeFi usernames on this page is something else

You forgot Urethral Meatus.
posted by e1c at 11:54 AM on December 7, 2018 [4 favorites]

If you like this sort of thing, @TheMedicalVids has some fascinating stuff.

That deserves its own post.
posted by waving at 1:14 PM on December 7, 2018

Nope.
posted by slogger at 1:20 PM on December 7, 2018

THAT WAS REAL?!!! WHYYYYYYY DID I NEED TO KNOW THIS?!
posted by Space Kitty at 1:58 PM on December 7, 2018

[@TheMedicalVids] deserves its own post.

Please do!
posted by Johnny Wallflower at 1:59 PM on December 7, 2018

As a dude who has had chronic bronchitis type stuff for his whole life I find myself intrigued by this for two reasons:
1) Casts are interesting, but more importantly:
2) OH MY GOD THAT MUST HAVE FELT SO GOOD TO GET OUT
posted by Rev. Syung Myung Me at 1:59 PM on December 7, 2018 [2 favorites]

THAT WAS REAL?!!!

You are welcome!
posted by Johnny Wallflower at 1:59 PM on December 7, 2018

aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaasaaaaaaaaaaaahhhhhhhhh!
posted by Anticipation Of A New Lover's Arrival, The at 5:31 PM on December 7, 2018 [3 favorites]

things like this are why I cannot wait to have my intellect (such as it may be) housed in a pure, clean, sharp-edged structure of unfathomable complexity.

How about a squishy, goopy one?
posted by Anticipation Of A New Lover's Arrival, The at 5:40 PM on December 7, 2018

How about a squishy, goopy one?

Only if the Zetetic Elench (or maaayyybe the Pattern Jugglers) are involved in the manufacture. Otherwise, no, leave that sort of thing for Meatfucker.
posted by aramaic at 5:52 PM on December 7, 2018 [2 favorites]

Fucking rad. Shared with all my nursing mates.
posted by supercrayon at 6:27 PM on December 7, 2018

Also, could one presumably drink milk through this?
posted by loquacious at 6:34 PM on December 7, 2018

Trigger warning #2

Once upon a time I had a weird long lasting stuffy nose, accompanied by low, back of the head headaches. Return trips to my primary care kept producing diagnoses of virus, or tension headaches.

A few months into it, I blew out what was clearly a cast of my left sinus. It was solid, and several inches long, with branches.

So I hauled myself to an ENT, who used a nasal endoscope only briefly (on later visits I realized how very brief) and dove for his prescription pad. He had seen copious pus. I had a rare-ish type of sinus infection, in my sphenoid sinus, and the thing I'd blown out was a pus plug.
posted by Dashy at 7:11 AM on December 8, 2018 [4 favorites]

Mmmmmm, pus plugs. Just like mama used to make.
posted by Anticipation Of A New Lover's Arrival, The at 11:35 AM on December 8, 2018 [2 favorites]

Farnsworth: Oh, God! My tract!
posted by RuvaBlue at 7:39 PM on December 8, 2018