An 87-year-old man entered the emergency room suffering from severe shortness of breath as a result of inhaling thick smoke from a forest fire for several hours. After examination, doctors found something unexpected inside his airways.
What they saw was like a scene from a science fiction movie: thick black plugs resembling tree branches, blocking the trachea and lungs.
Black Gunk Found in Man's Lungs Exposes an Even Darker Side of Wildfire Smoke
of this case were published last week in the New England Journal of Medicine, where doctors in China put the man on a ventilator immediately upon arrival because he could barely take short, shallow breaths, and his blood oxygen level was dangerously low.
After inhaling smoke from a forest fire for several hours, an 87-year-old man presented to the ED with difficulty breathing. He rapidly developed respiratory failure, and a flexible bronchoscopy revealed bronchial casts from inhalation of particulate matter from the smoke. Read… pic.twitter.com/Q9FZxSyUYy
After examination, they diagnosed him with "plastic bronchitis," a rare and acute disease. The obstructions are medically known as "bronchial casts."
These molds are composed of mucus and cellular material, and have a rubbery consistency similar to caulk. Their natural color is white, brown, or beige, but in this case, they turned black due to the smoke.
This disease usually appears in children with congenital heart disease, or in those who suffer from lymphatic fluid flow disorders.
The body's lymphatic system is responsible for absorbing excess fluid from organs and returning it to the bloodstream. However, when this fluid doesn't flow properly, it can leak into the airways, leading to the formation of these tree-twig-like structures.
Symptoms include: shortness of breath, difficulty breathing, chest pain, fever, and a prolonged wet or dry cough.
The casts take the shape of the "trachobronchial tree" inside the lungs, which are the airways that branch out like the inverted branches of a tree. When the casts form inside them, they come out in a shape that perfectly matches these branches.
The danger of this disease lies in the fact that its early symptoms resemble those of asthma, often leading to misdiagnosis. If left untreated, it can cause severe respiratory distress that may result in death.
To detect the casts, doctors use bronchoscopy (a tube with a camera inserted into the airways), CT scans, or MRI scans. These casts are then dismantled and removed.
To pinpoint the exact location of the leak, doctors may inject a special blue dye into the body's largest lymphatic vessel, in a procedure known as "blue bronchoscopy".
The good news is that the overall prognosis for this disease is good if it is detected and treated early. In the case of the 87-year-old man, he spent one week in the hospital receiving treatment for the pneumonia he had contracted. When he returned for a follow-up appointment two weeks later, his breathing had completely returned to normal.
