High altitude pulmonary edema (HAPE) typically shows up in otherwise healthy patients after rapid ascent (e.g., mountain-climbing) with subsequent coughing, tachycardia, hypoxemia, and fatigue. These symptoms are often attributed to overexertion or dehydration, but it’s important to recognize the underlying physiology. At its core, altitude exposes the lung to hypoxia…
Silicosis is a chronic, progressive, fibrotic lung disease resulting from prolonged inhalation of respirable crystalline silica particles encountered by individuals working in sandblasting, mining, glass manufacturing, foundry operations, etc. Once inhaled, silica particles deposit deeply within the alveoli, triggering alveolar macrophages to release pro-inflammatory cytokines, thereby inciting persistent inflammation and…
Penetrating atherosclerotic ulcers (PAUs) represent a distinct pathological entity within the spectrum of acute aortic syndromes, characterized by ulceration of atherosclerotic plaque penetrating through the internal elastic lamina into the media of the aortic wall. They typically arise in the setting of advanced atherosclerotic disease, often in patients with a…
A “miliary pattern” on chest x-ray (CXR) is a distinctive finding characterized by numerous small (1-4 mm) nodules, typically uniform in size and distributed throughout both lung fields, resembling millet seeds – hence the term “miliary.” Miliary patterns are most commonly associated with the hematogenous spread of diseases, including infection…
Unilateral cardiogenic pulmonary edema (CPE) accounts for ~2% of pulmonary edema cases and is classically caused by posterior papillary muscle rupture, resulting in acute, severe, eccentric mitral regurgitation. Flow is directed specifically to the right-sided pulmonary veins. This, in turn, overwhelms the lymphatic capacity of the right lung and results…
Right-sided aortic arch (RAA) is a rare (~0.1% of the population) anatomical variation of the aorta’s position and branching pattern. It is associated with congenital heart defects (truncus arteriosus, Tetralogy of Fallot) and chromosomal abnormalities (DiGeorge syndrome, Down syndrome). There are several types of right-sided aortic arch, each characterized by…
Tracheoinnominate fistulas (TIFs) are rare (0.1 – 1% incidence) but potentially life-threatening complications of tracheostomy. A TIF occurs when communication forms between the trachea and the innominate (“brachiocephalic”) artery leading to potentially fatal bleeding and airway compromise. Patients at higher risk for TIFs include those who require prolonged mechanical ventilation,…
Saddle pulmonary embolism (SPE) is a severe and life-threatening condition when a blood clot (embolus) becomes lodged in the main pulmonary artery, blocking blood flow to both lungs. The term “saddle” refers to the shape of the clot, which straddles the bifurcation of the pulmonary artery, resembling a saddle. The…
As a cardiac anesthesiologist and cardiovascular intensivist, I care for many patients with aortic aneurysms in the perioperative setting. Contrast-enhanced CT imaging is traditionally utilized to assess the location and size of the aneurysm and its influence on surrounding structures like compressive mass effect, fistulas, dissection, etc. If the aneurysm…
Typically at end-systole, the interventricular septum (IVS) bows rightward as the left ventricle’s pressure (LV) exceeds that of the right ventricle (RV). However, when the RV is strained (e.g., massive pulmonary embolism), the pressure overload can lead to flattening or even paradoxical bowing of the IVS. In a short-axis view…