When looking at Chest X-rays, the appearance of the pulmonary vessels in the lungs has always intrigued me. The pulmonary artery branches outwards in a series of divisions and subdivisions through trunks and twigs to the periphery of the lung, looking for all the world like an upturned tree with the roots shining against the sky, or like baobab trees in Central Africa where I was raised. The pulmonary vessels tell a lot about the patient’s condition for those who take time to look at them and the appearance of any dilatation, tortuosity, pruning, or irregularity help to make a diagnosis.
The man in this X-ray had a pulmonary haemangioma – a congenital tumour of the blood vessels – in his left lung that produced a clump of tortuous vessels which short-circuited the lung and shunted blood back to the heart. The stress of extra blood returning placed enough strain on the heart to cause heart failure.
In this image I have introduced the silhouette of a huge fig tree stripped of its leaves after a cyclone with the winding branches meandering across the image. The large blood vessels can clearly be seen in the lung fields.