Although you can’t physically cough up a lung, you can cough hard enough to sustain injuries, such as cracking your ribs or rupturing your diaphragm.

After a long coughing fit, you might joke about it by saying something along the lines of, “Wow! I almost coughed up a lung.”

Is it possible to cough up a lung? Since your trachea, also called the windpipe, is too small for one of your lungs to fit through, the answer is, no matter how violently you cough, no.

While it is physically impossible to cough up a lung, you can cough out a lung. A 2012 article in the New England Medical Journal describes a woman coughing so hard that her lung was pushed between two of her ribs.

The 40-year-old patient had asthma and had been coughing markedly for two weeks. Apparently, the coughing was vigorous enough to herniate her right lung by rupturing an intercostal muscle between two of her lower ribs.

Although you are not going to cough up a lung, you can sustain other injuries from frequent and violent coughing, such as:

Coughing up blood

Sustained coughing can result in blood in your lungs which can be coughed up. It typically appears as small amounts of bright red blood or phlegm and saliva streaked with blood. Along with persistent coughing, this could also be the sign of a chest infection.

Muscular pain

Strong pressure is generated every time you have a coughing fit. This pressure can strain muscles and cause pain. It follows that prolonged coughing can result in chronic pain.

Damaging small blood vessels

Fine blood vessels, such as those in your nose, eyes, and anus, can burst under the pressure of violent coughing.

Damaging throat tissue

The tissues of your throat can become inflamed due to a chronic cough. Sustained coughing can also lead to throat infections that can spread to other areas of your body.

Cracking ribs

Although a rib fracture caused by chronic coughing is more likely in people with lower bone density, it can happen to people with normal bone density. The ribs most likely to crack under the pressure of coughing are the fifth through ninth, and they are most likely to crack on the side.

Rupturing your diaphragm

When you cough, your ribs are pushed downward and inward. At the same time, your diaphragm is pushed upward. The combination of these opposing actions can result in a diaphragmatic rupture.

Coughing can be traced to numerous causes. Some of the underlying conditions that could be the reason for your coughing could include:

If you have an unexplained cough that has been present for more than a couple of weeks, see your doctor.

Get emergency medical care if, along with the cough, you have other symptoms that suggest an underlying condition. These symptoms might include:

After a particularly vigorous coughing fit, repeating the old joke about coughing up a lung might get you a laugh. But that’s all it is: a joke that’s possibly funny because the suggestion is so outlandish.

It is not physically possible to cough up a lung, but there are a number of ways that violent coughing can hurt your body, from coughing up blood to cracking your ribs.

If you’ve had a persistent cough for more than a few weeks, call your doctor.