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.