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A 36-year-old man has died after suffering from chronic heart failure and coughing so severely that he spit out a bright red blood clot perfectly shaped like the airway passages of his right lung’s bronchial tree.

The unidentified patient was receiving treatment in the intensive care unit at the University of California San Francisco Medical Center, according to a Nov. 29 article in the New England Journal of Medicine.

During the week of his hospitalization, the man’s cough progressed to producing up blood and phlegm. During a rather extreme hack, he coughed up “an intact cast of the right bronchial tree,” the article stated.

“The right bronchial tree consists of three segmental branches in the upper lobe, two segmental branches in the middle lobe, and five segmental branches in the lower lobe,” the journal’s authors wrote, “The patient’s trachea was subsequently intubated, and flexible bronchoscopy revealed a small amount of blood in the basilar branches of the right lower lobe.”

The man was extubated two days after the incident and suffered no further instances of coughing up blood.

He died one week later due to complications of heart failure, the journal reported.