(WHDH) — A man who was admitted to an intensive care unit to be treated for chronic heart failure died days after coughing up a massive blood clot shaped like a bronchial tree, doctors said.

The New England Journal of Medicine reports that a 36-year-old man with a lengthy medical history experienced increasing respiratory distress before shocking doctors at the University of California at San Francisco.

“During an extreme bout of coughing, the patient spontaneously expectorated an intact cast of the right bronchial tree,” an article published in the journal said.

Georg Wieselthaler, a surgeon at the hospital, told The Atlantic that doctors were “astonished” by what they witnessed.

Wieselthaler called the occurrence “very, very, very rare.”

The right bronchial tree consists of three segmental branches in the lung’s upper lobe, two segmental branches in the middle lobe, and five segmental branches in the lower lobe.

The patient’s trachea was intubated and he was extubated two days later. One week later, he died from complications of heart failure.

 

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