No, you can't really "cough up a lung." But according to a new case report in the latest New England Journal of Medicine, it's possible to get uncomfortably close.
Two days of chest pain drove a 40-year-old woman to Good Hope Hospital in Birmingham, United Kingdom, for relief. The woman had asthma, and had been coughing especially hard for two weeks. When examining her, doctors noticed some cracking, popping sounds coming from her right midaxillary line -- or the right side of her torso. Further examination with the use of X-ray revealed that the woman had coughed so hard -- she'd herniated her lung. (You can see photos, if you must, here.)
"While she didn't technically cough up her lung, she coughed out her lung, through her ribs," explains Dr. Rachel Vreeman, and assistant professor of pediatrics at Indiana University School of Medicine. Vreeman didn't treat this patient, but as the co-author of "Don't Cross Your Eyes ... They'll Get Stuck That Way!" she was more than willing to give her expert opinion on the strange case. "It's so unusual to have this happen that it would merit this case report -- unusual, but possible, apparently."
The woman's lung tissue slipped through the space between two of her ribs -- the ninth intercostal space, to be exact. It's actually somewhat similar to a NEJM case study from last month, in which a woman's body "swallowed" one of her breast implants while she was doing Pilates -- in that case, the woman's implant slipped between two of her ribs and was sent into her pleural cavity, or the space between her lungs. (Maybe those two should form a support group.)
In the case of the herniated lung, it's possible that she had some sort of defect explaining why the area between her ribs was particularly vulnerable. But even so, "it really must have been some intense coughing," says Vreeman, adding that there are occasional reports of violent coughing fits causing similarly strange and terrible things. Whooping cough patients may hack so hard that a lung collapses, for example. But it gets worse.
"There are reports -- it's incredibly rare -- of people who have had their spleens ruptured because of coughing," Vreeman says. "There also are occasional reports of people who -- and this is a gross one as well -- some people are more prone to having their eyeballs coming out of their sockets -- there are a few reports of people having problems with that from bad vomiting or coughing."
Surprisingly, Vreeman says in many of these cases, these people didn't have any underlying health problems that would explain these extreme happenings -- the ruptured spleens, the popped-out eyeballs. It's often simply a case of coughing way, way too hard, she says.
"Coughing, in and of itself, is not bad -- it keeps the lungs clear by not allowing things to build up," whether it's phlegm or dust or whatever, Vreeman explains. "But it's when you're coughing in a really violent way -- you should, by all means, see a doctor."