What at first seemed like a normal cough was really a rare, life-threatening condition. (Photo: Getty Images)
When Utah-based urgent care physician Easton D. Jackson, MD, saw a 14-year-old boy for a garden-variety concern, he didn’t think much of it.
“He had a little cough, was a little short of breath,” Jackson tells Yahoo Health. “It was persistent over the previous few weeks, but everything else was good. His vitals were good.”
Jackson and his resident doctor did a basic round of tests, all of which came back clean. Since the boy’s family had sub-saharan origins, they also tested for tuberculosis. With a TB test, it’s standard to follow-up in clinic two weeks later.
The test was negative, and the teen was doing well when he came back to the office — also when his mother handed Jackson a container with a disconcerting, branch-like mass in it.
Here it is:
(Photo: Courtesy of Easton D. Jackson, MD)
“It looked almost like a cast, but it was soft and rubbery, almost like seaweed. He’d coughed it up,” Jackson says. “I asked him if he felt okay, and he said, ‘Oh, yeah, I’m feeling much better.’”
Nonetheless, Jackson had never seen or heard of anything like that — and felt it required further probing. He did a chest x-ray and a CT scan on the boy. “I also called a pulmonologist and six other doctors in the clinic,” Jackson says. “No one had any idea.”
Finally, Jackson logged into SERMO, a global social network of over 340,000 doctors that crowdsources their insights on everything from routine advice for the medical community to complex and highly rare cases. Before shipping the weird mass off to the lab, he took a picture of it and posted it to the site.
Over the course of a few days, 231 doctors from the United States and United Kingdom weighed in with 16 potential diagnoses via SERMO. Within just a few hours, though, one doc had it pegged: Fontan-Associated Plastic Bronchitis. Commonly occurring in patients with a history of congenital heart disease who’ve had Fontan surgeries, leaking fluid from the lymphatic system fills the airways and creates a plug, which can make it increasingly difficult to breathe.
“While pulmonary may help, he needs to see cardiology urgently for plastic bronchitis following Fontan surgeries…please give them a call and ask whoever is on call for the weekend when they can see him (or have him admitted),” wrote the cardiologist with the million-dollar answer.
This rare condition didn’t just pop up once, though. A few others shared the cardiologist’s guess. “I agree that this is very concerning for plastic bronchitis,” wrote a pediatrician with pulmonary expertise. “We see this very frequently in our hospital especially in patients with congenital heart disease…I agree with [the first to diagnose plastic bronchitis] that he should be seen by cardiology ASAP.”
Yet another doctor chimed in with a harrowing story. “[I had] a little 3 year old patient of mine who died from this recently,” she wrote. “Mother had shown her doctors a cast she had coughed up while in the hospital for respiratory symptoms post Fontan, but sent her home without recognizing the diagnosis. She died a few days later.”
Jackson didn’t wait. He got his patient into see a cardiologist. “He’d actually had a history of heart surgeries that his mother hadn’t mentioned in the first visit,”Jackson explains.
Three weeks later, his teenage patient is doing well and getting treatment.
Plastic bronchitis is rare, but a person with the condition often coughs up a developing cast. However, those masses frequently return within days – and can cause suffocation. “Around 40 percent or so can have sudden respiratory arrest,”Jackson says.
Medical crowdsourcing is just one example of how healthcare is becoming more and more collaborative. “I’m a family medicine doctor, and I work with 115 doctors in 30 specialties, and I see all their patients,” Jackson says. “It’s easy for me to walk upstairs or call whoever the attending physician is for information. But with SERMO, too, most of the doctors are really good and they’re pretty focused. And where else are you going to get 340,000 opinions that quickly?”
With conditions and treatment plans becoming increasingly specialized, a team of doctors working together can really help nail the best course of care for each patient — or save a life in an instant, with an assist from technology.
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