Chest 160; OWR

16 Feb

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Whilst not primarily a chest disease, Osler Weber Rendu (Otherwise known as Hereditary hemorrhagic telangiectasia) is a rare genetic condition of the arteries that may manifest anywhere in the body. In this disorder, the switch that controls blood-vessel growth cannot spontaneously turn off. Abnormal clusters and knots of vessels form. People with this condition often have small blood vessel malformations that cause red or purple spots on the lips or tongue. These are telangiectasia, sometimes known as birthmarks, and are commonly seen in other conditions.

The walls of the abnormal vessels are thin, weak, and fragile, and easily bleed after minor trauma. Internal blood-pressure may make them blow up like a small balloon called an aneurysm.

Millions of fine capillaries in normal lungs act to filter out any blood clots that may arise in the body. In OWR abnormal connections can also occur between arteries and veins that allow blood to shunt from one to the other. In this way, blood clots normally filtered in the lungs may cross over into the arterial system. Blood-flow then sweeps them along to lodge elsewhere in the body, including the brain where they block an artery causing a stroke.

The chest X-ray in this image comes from a person with this condition. I have retained quite a lot of the original X-ray in the picture and the complex blood vessels remain visible. People may carry the gene for the condition and never express it, and so it is impossible to know who carries this. I have therefore included several people in a crowd to represent the random nature of genetic conditions generally, and in the background complex pipework in a factory with valves and dials represent the arteries and veins of the body.

 

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Chest 156; Pseudo-Aneurysm

25 Jan

chest-156-pseudo-aneurysm

When damage occurs to the wall of a normal blood vessel and bleeds into body tissues, clotting blood generally causes the hemorrhage  to stop. Leaked blood disperses and is slowly re-absorbed. However if damage occurs to the inner layer of the vessel whilst the soft, thin outer coating is unbroken, the pressure of blood into the area  may cause the thin tissue layer to blow up like a balloon and form a cavity. Pressure does not allow the space to collapse, blood swirls around keeping it open and, indeed, increasing its size. This is known as a pseudo-aneurysm.

The Chest X-ray in this image is from a 40-year-old driver one month after a major accident. He complained of a swelling above the right collarbone (clavicle) and was unable to move his right arm. An X-ray study of the artery – an angiogram – showed a large pseudo-aneurysm.

In my image, I have overlaid the man’s chest X-ray with the angiogram study of the arteries of his right arm. The artery and the aneurysm are depicted in multiple layers and I have used the colour scheme to indicate the dangerous nature of this condition.

Chest 153; Atherosclerosis

21 Dec
turtle-rock

Chest 155; Atherosclerosis – alternative title Turtle Rock

 

The series of images that build up this picture were taken on an excursion to Turtle Rock; an ancient cave close to where I live with Aboriginal paintings on walls and roof. During the walk I was much taken by the patterns of dried and flaking bark clinging to the stems and branches of white eucalyptus trees that we call Ghost Gums. It reminded me of the angiographer’s nightmare, unstable fatty deposits on internal walls of arteries – arterial fibro-fatty plaque –  and the dangers of advancing a catheter through a plaque ridden vessel. The plaque cap, like the eucalyptus bark, is often weak and prone to rupture. A catheter-tip may dislodge small pieces of the fragile cap causing it to  embolise to the periphery of the artery being investigated. Loss of the fibrous cap also exposes thrombogens that may cause thrombosis within the vessel itself. The thrombi may occlude the vessel, or could detach, move into the circulation, and themselves embolise further downstream. Angiographic techniques and catheters have been devised to minimise these risks.

The index chest X-ray was from an elderly man with calcified plaque lining the aortic arch.

Lux – Light; pel-lucidem

7 Nov
Lux pel-lucidum J

Lux – Light; Pellucidum

The middle of the human brain contains a membrane structure that separates the two halves of the cerebrum. This membrane, a septum, so fine that it allows light to pass through it, it is almost translucent; pel-lucid, named in Latin; the septum pel lucidum, i.e. the dividing wall that is translucent.

Absence of the septum pellucidum occurs in certain congenital conditions and because the septum is involved with formation of the tracts concerning vision, it is often associated with blindness, and incidentally many other neurological problems.

I have included the X-ray of a newborn baby with congenital absence of this structure as well as absence of other brain structures. The Chest X-ray itself was normal.

The image consists of two base images; a red flower, colour inverted, and a layer of rusty iron is subtracted. Light (lux in Latin) is provided by a picture of a candle overlaid to give focus to the image.

 

Chest 117; Silicosis

7 Nov
Chest 117 MPF 2C

Chest 117; Silicosis

After a good friend married to a mining engineer asked me to consider make a picture relating to mining diseases, I chose an X-ray of a person with severe emphysema and Progressive Massive Fibrosis of the lung due to silicosis. The name silica comes from the Latin word silex – a flint.

My upbringing from the late 1940s through to the 1970s was in a small copper-mining town, part of a series of mines known as the Copperbelt in Zambia. Almost the entire population was dependent one way or another on Copper Mine for a living, as was my father who worked underground. Underground workers spent their days breathing silica dust released during blasting. The Miners Phthisis Board figured prominently in all our lives and had the power to dictate the difference between being allowed to work or not.

Miner’s phthisis (or Potter’s Rot) is a debilitating occupational disease due to deposition of fine grains of crystalline silica dust in the lung, and the body’s immunological reaction to it. It causes fibrous scarring of the lung that restricts the ability of the tissue to absorb oxygen in exchange for carbon dioxide. It leads to emphysema with chronic shortness of breath, cough, and cyanosis (blueness of the skin). Sometimes the immune response is overwhelming and causes large lumps of fibrous tissue known as Progressive Massive Fibrosis (PMF) to form. It predisposes to infections, especially TB, and the tissue can break down causing lung cavities.

A major concern in mining and other industries, silicosis has caused such devastation that it is an important economic issue which governments cannot ignore, therefore focus was very much on the financial interests of mining. Other risks of silica were not appreciated till relatively recently. Since the 1990s there’s been re-evaluation of its role in triggering auto-immune diseases such as rheumatoid arthritis and sarcoidosis.

The ubiquity of silicosis throughout the world has given rise to an entire culture, particularly within coal-mining communities. Many ballads, poems, and works of art relate to this disease. The paradox is that the men must work to live, whilst knowing they work to die.

The opening stanza of Gabriel Gadfly’s Poem http://gabrielgadfly.com Briar Patch gives a taste of this;

Press your ear close.

Sometimes you can hear the breath
rattling in my chest like a bone shrugged
its moorings and ought to be tied back down…..

A 1940s lino-print The Cough by Noel Counihan 1947 is particularly moving and reminds me of heart-wrenching encounters with men, struggling for breath, dying of emphysema due to dust inhalation, smoking, and recurrent infections, whilst I was working in a chest hospital in a coal mining area of England.

The cough

The Cough, Noel Coulihan 1947

My picture, based around a severe case of PMF with collapse, fibrosis, and cavitation in the upper zones of the lung, includes photos of a mining rock-face and a shaft headgear such as those that were central to our life in Zambia, and which will be familiar to many mining communities. On the right side of the image a faintly perceived ghost-like figure can be seen.

Chest 155, Parklands

7 Nov

 

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Chest 155, Parkland

The pictures that comprise this image were taken in parkland, in Queensland, in a wet, humid area. These conditions are ideal for the growth of environmental fungi. Fungal organisms are indispensable in the natural ecosystem and to life on this planet. They benefit humans, plants and animals, but they also interact in pathological ways. Of the many thousands of identified fungi only a dozen or so are “life-threatening” to humans, indeed many benefit humans such as penicillin. There are very few “primary” human fungal pathogens, e.g. coccidiomycosis and histoplasmosis.

Fungi can however cause devastating disease in plants and animals, though very few can do both. Cryptococcus gattii is one that infects both humans and animals but is non-pathogenic in plants. Humans are largely resistant to fungal disease, possibly due to the high basal temperature of mammals which fungi do not like.

The incidence of fungal disease in humans is however increasing, most likely due to the growing population of immuno-compromised people e.g. people who have received organ transplants, people on long term steroid treatment, and of course HIV/AIDS, and once established these diseases are difficult to treat.

The X-ray, which is hardly visible in this image, is from a woman who contracted Cryptococcus gattii in South-East Asia. This causes a deadly infection of both lung and brain. It was initially a disease of tropical and sub-tropical regions of Asia and Australia but is recognized as an emerging disease in Canada.

 

Chest 154; Purple headed mountain

26 Aug
Chest 154; purple headed mountain

Chest 154; Purple headed mountain

Using Photoshop I drew the background hills and vegetation in a soft water-colour type of picture, then backed it with colour and texture. Finally with a chest X-ray of a man with severe emphysema. Just the sort of person whose respiratory reserve is so small that a small chest infection sends them into respiratory failure and the skin goes blue-purple with with severe cyanosis.

 

 

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