Gastric ultrasound is a non-invasive, fast, bedside imaging technique that can estimate gastric volume. Placing a curvilinear ultrasound probe (oriented cephalad-caudad) in the epigastric region shows the gastric antrum (A) adjacent to the left lobe of the liver and superficial to the superior mesenteric artery (SMA), abdominal aorta (Ao), and…
During embryogenesis, the aortic sac is connected to paired dorsal aortae via six symmetrical aortic (Ao) arches, which give rise to major vascular structures. For example, the right and left common carotid arteries originate from the right and left third arches, respectively. The proximal right subclavian artery is formed from…
As part of a comprehensive left ventricular (LV) diastolic assessment, doppler tissue imaging (DTI) of the medial and lateral aspects of the mitral valve (MV) annulus should be performed. In the image below, I have labeled a DTI of the lateral aspect of the MV derived from a mid-esophageal 4-chamber…
Complete (3°) heart block (CHB) occurs when atrial signals do not reach the ventricle; therefore, the atria (P-waves) and ventricles (wide QRS complexes) pace themselves independently of each other. Symptoms can range from fatigue and dyspnea to syncope, chest pain, and sudden cardiac death. CHB can be caused by ischemia,…
A left ventricular (LV) pseudoaneurysm is an LV outpouching devoid of myocardium/endocardium contained by the pericardium and adhesions. As one can imagine, this pathology carries a high risk of rupture and mortality. LV pseudoaneurysms are most commonly linked to myocardial infarction (inferior > anterior) but can also follow open-heart surgery…
Fundoscopy examines the interior, back surface of the eye, including the retina, blood vessels, macula, and optic disc. Before learning pathology, one must first understand the “normal” anatomy of the retina. Let’s use a digital image of my right eye’s retinal structures for this purpose! The visualized field can be…
Persistent left superior vena cava (PLSVC) is a rare (~0.5% of the general population) venous anomaly when the left superior cardinal vein fails to degenerate. This can make entering the right heart from the left upper body (e.g., pacing leads, PA catheters, etc.) more challenging as the PLSVC drains directly…
As a cardiothoracic anesthesiologist, hemostasis, coagulopathy, and blood salvation are important considerations in the operations I’m involved with. Cell Saver is one technique our perfusion team routinely utilizes to facilitate blood conservation. Blood loss on the surgical field is collected, run through a filter, washed, and returned to the patient…
Endovascular aneurysm repair (EVAR) offers many patients a minimally invasive option to address vascular pathologies like aortic aneurysm. By deploying a fabric-covered stent within the aneurysm, blood is rerouted through this conduit thereby excluding the aneurysm sac and preventing further dilation of the aorta. An endoleak occurs when blood flow…
2021 has been another year filled with COVID-related issues centered around the perils of politics mixing with medicine. The omicron variant has now spread through the population and leading to some of the highest spikes of new cases we’ve seen at any point in this pandemic. And right around the…