 What's up YouTube today? We're going to do another vlog style video I haven't vlogged during the day those past vlogs have been over night shifts during my second and third year So I figured I might as well show you guys what a daily routine is like for me So let's get to it and good morning. It's about 5 30 a.m. And we are doing our morning work Sometimes and your honor will meet some scrambled eggs for me because she goes into work 30 minutes after me All right, so I just got to work And I don't know if you guys can tell but it is a beautiful day out Which is great because I don't think I've said this yet, but it's Monday And it was raining all weekend, which was miserable and I am on the cardiothoracic rotation Which basically we just read chest x-rays and chest CTs all day And it's pretty cool because my attending lets us out pretty early Because all of us have to study for boards Well the seniors do so usually take this way when it's really nice outside I take this long way in through the Loading dock and it's pretty disgusting because it's like all medical waste and stuff But I don't care Bio-waste Yeah, how are you? It's a little dark in here today All right, so I just finished reading the first couple studies and right when I got here this morning I had a positive Pulmonary embolism scan or a CTA chest with contrast and it was positive for PE And if you don't know what a PE is or pulmonary embolism I'll show you before I get into the CTA chest portion to see a pulmonary embolism I want to show you exactly where they come from So I'm gonna start by showing you the CT venogram Which is a it's essentially in a CT abdomen pelvis with the extension a little lower to the knees And you get a picture of the entire course of the veins all the way through IVC Iliac veins, femoral veins into the popliteal veins. You get a little bit of popliteal veins So we have a order here and we have IVC here So we're gonna follow the IVC down breaks off into the common Iliac vein Breaks off into the internal and external Iliac vein And down into the left femoral So if you look at the left common femoral vein, there's a little black dot in it or a filling defect in it But if you compare it to the right side, you notice the right side is nice and clean So this is actually what a non-inclusive thrombus looks like or a DVT looks like in the vein So you can see a nice filling defect within this left common femoral vein And it extends all the way up into the external Iliac vein here as well So what happens in a pulmonary embolism is this actually breaks off or portions of it this clot break off And they travel up north. So imagine a piece of this Breaks off and it goes up It'll go all the way into the IVC And keep going up here Past the renal veins, past the liver And up into the heart go into the right atrium, right ventricle And ultimately out the right ventricular outflow tract, which isn't imaged here So I'll show you what that looks like on a CTHS Before I go there, let me show you what it looks like on The coronal view. So I know it's hard to see here. So let me see if I can zoom in here So this is actually the entire clot Going all the way out the left common femoral vein I wish I could get in a better plane here, but that's all I got and it extends up into the external Iliac vein So again, as you can see This is the heart And this is the IVC which connects the heart to the every other vein in the body essentially So once you get on this main highway, the little clot breaks off from the leg Goes up this IVC and into the heart. Now you can see how it can go to the lungs. So this is a CTA chest This is your IVC right here. I know it's not opacified. That's because I windowed it a little bit and because in a CTA chest The pulmonary arteries and aorta are basically the only things that are opacified The timing is different with the contrast bolus. So I'm going to scroll up here You can see this IVC kind of sneaks in here. So this is the heart We have the right atrium Right ventricle up up up Now we're in the right ventricular outflow tract or the pulmonary artery So this is where the pulmonary artery breaks off. This is the main trunk right here And it breaks off into the left and right main pulmonary arteries And as you can see this filling defect right here is not supposed to be there Neither is this one So all this dark signal in this in the pulmonary artery here. This is all thrombus So as you can see in this thrombus, this is what we call a saddle pulmonary embolus or saddle pulmonary embolism And it kind of drapes over the heart rate this or the main pulmonary artery like this And can block out blood flow completely to the lungs As well, this is a large thrombus burden here So essentially no blood flow is getting to these lungs So you can imagine what happens to the lungs when you get no blood flow to them. They don't like it It's like a stroke to the lungs essentially So they can infarct they can the patient can actually die from a large thrombus like this, which is why Imaging these dvt's are so crucial and you need to catch them early to prevent this kind of thing So let me show you what it looks like on the coronal. So again, this is the heart right here This is the aorta and left ventricular outflow tract I'm going to follow up the this is from the right ventricle Coming up the right ventricular outflow tract coming through the right pulmonary artery left pulmonary artery branching And as you can see this large thrombus here Again, it looks very similar to what we saw in the leg The lower extremity, but now it is traveling all the way up into the heart and ultimately blocking out the left Pull it to the lung This clot extends all the way down on both sides into the segmental and subsegmental branches of of the pulmonary arteries Which can be pretty devastating to the lungs Okay So that concludes this session on pulmonary embolism and dvt's as it pertains to CT imaging I hope you guys learned something If you have any questions about these studies leave a comment below and I'll try to answer it Otherwise, let's get back to the video So I hope you enjoyed that video on pulmonary emboli and how to find them on chest CT Or what they look like for that matter It's time for me to get back to reading some studies. Also, I lifted arms this morning And holding up this phone with my arm is like making me shake off of the place workout problems So it is now 11 45 and I'm going to get something to eat I've pretty much just been reading studies answering phone calls Like this one Jess Michael Good sorry for the way my computer shut down on me. So yeah, they are calling this little P in the lower lung here. Yeah I I agree it is real. I mean it's subsegmental. So it's one of the distal branches, but it's still real. That's good enough for you All right then Thanks. Bye Now I'm going to get something to eat and go to our noon conference, which we have every day I'll show you what that's like, too. Also, even though I work out this morning I'm still gotta take the stairs Because yes, they fit only take the elevator if you're injured or can't walk So I usually go with a grilled chicken sandwich But what I do is I take off the bun and just eat the grilled chicken We're just going pure protein today And now we're going to conference. Let's go Why are you seeing our roasting artifacts? Direction because the motion you see this the artifacts on the Again, this direction. All right, so it is now about 130. I checked in with my attending And he doesn't need me the rest of the day. So he's doing to give me the rest of the day off to study Which is not normal but Right now we're studying for boards and we gotta take off pretty much any time off we can get we take So we are grateful for that And yeah time to go home and study the rest of the day Which I'd probably rather be working to be honest with you And just so you guys know, this is not a common thing to get out this early Usually we get out around five ish or six ish But like you guys know now I'm on my chest rotation and it's really not that busy It's busy in the morning right now. Some days are busier than others depending on what clinic there is if there's The chest then like where they just do a whole bunch of follow-up malignancy chest cancer scans then Yeah, it can be pretty busy, but Today wasn't that bad. So read like, I don't know 10 or 15 cts this morning caught up the list My attending helped me out along the way So by time I went to conference the list was all caught up and I came back And he was basically reading the whole time I was in conference And he said I can get out of here and go study. So that's exactly what I'm gonna do And before anybody asks Yes, I am an interventional radiology resident But like I said before you have to do three years of diagnostic radiology before you can do full-time IR work And I completely agree with that because You can't be a good interventional radiologist without having a good diagnostic background If you don't know imaging you can't perform Image-guided procedures That's pretty much it So yes, you have to do an internship in three years of diagnostic radiology Before you do full-time interventional radiology. So I am a PGY4 or a third-year radiology resident I will do starting in july, which is will be my PGY5 year I will be doing almost like 75 iR and then a few diagnostic rotations of Mamo and nuclear medicine But for the most part I'll be doing all IR then my senior year after that Which is what I'm interviewing fellowship wise or my PGY6 year I will be doing Mostly IR and by mostly I mean Like 99% What better way to start my study afternoon than a nice Cup of iced coffee Literally can't survive without it. Now it's time to be productive for a good four-hour session of studying Which is what I do every single day We're like multiple months now It's pretty sweet, right? All right, I take that back. I'm going to do a little Quick grocery shopping because as you can see I don't Drink any creamer in my coffee But under Yana does And being the good husband I will go get her some creamer because we're out And maybe pick up a few more supplies while we're at it So off to the store and then study But now We're going to study All right, so I just got home set down opened my book and I will be sitting here for the next few hours But it's really tough because it is like so sunny outside And it's like 75 degrees Super sunny no cloud in the sky and the pool is right down there And all I want to do is go lay out I have a job to do and that's part of the sacrifice of being in medicine Sometimes you have to study when you don't want to sometimes you have to go into work when you don't want to But it's the way it goes. So I'll be studying for the next few hours I'll probably just study up until the wife he gets home around like 8 p.m. Or so and Hang out with her the rest of the night, but this is where I'll be And that's about it. All right guys, so that concludes my Monday. I hope you guys enjoyed this daytime vlog I'll probably do many more of these in the future, especially when I started doing full-time interventional radiology I think you guys will really enjoy that as always make sure you smash that like and subscribe button If you have any questions, leave a comment below If I like it I'll respond to it if I don't I won't make sure you guys follow me on instagram And otherwise I will see you guys on the next video