Post-transplant deep vein thrombosis (DVT) is common after lung transplantation and may contribute to pulmonary embolism and other complications. Whether DVT adversely affects contemporary outcomes and how venovenous ECMO (VV-ECMO) bridging influences early DVT patterns remain unclear. We performed a retrospective single-center study of adult lung transplant recipients (2018-2025). DVT and clinical outcomes were ascertained. Primary analyses compared outcomes and overall survival between recipients with and without DVT in the overall cohort. Secondary analyses assessed DVT-free survival and early anatomic distribution among recipients bridged with preoperative VV-ECMO. Comparisons used Fisher's exact/Mann-Whitney U tests; survival used Kaplan-Meier/log-rank tests. Among 502 recipients, 240 developed DVT. Compared with those without DVT, recipients with DVT had higher rates of pulmonary embolism (22.5% vs. 5.0%, p < 0.0001), acute kidney injury (52.9% vs. 41.2%, p = 0.009), PGD grade 3 (18.3% vs. 10.7%, p = 0.016), longer hospitalization (21 vs. 14 days, p < 0.001), and worse overall survival (HR 2.19, 95% CI 1.49-3.23; log-rank p < 0.001). Of 240 DVT cases, 31 (12.9%) were bridged with VV-ECMO. Within 14 days, upper-extremity DVT was more frequent with VV-ECMO (53.3% vs. 23.5%, p = 0.03), whereas lower-extremity and neck distributions were similar. In multivariable models, operative time was independently associated with DVT (OR 1.18 per hour, 95% CI 1.07-1.31, p < 0.001). Post-transplant DVT is frequent and portends worse outcomes. VV-ECMO bridging is associated with an upper-extremity-predominant DVT pattern but is not an independent DVT predictor after adjustment. Vigilant surveillance is warranted in this high-risk population.

Introduction: Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, first emerged in Wuhan, China, in late 2019. Besides respiratory involvement, COVID-19 may cause coagulation abnormalities, leading to thromboembolic events. Mild forms of acute pancreatitis have also been reported in patients with COVID-19 pneumonia. The aim of this case report is to highlight rare extrapulmonary manifestations of SARS-CoV-2 infection, with emphasis on pancreatic involvement. Case Report: A male patient was admitted with sore throat, dry cough, and fever up to 38.0°C. He had received the first dose of the Sinopharm COVID-19 vaccine three weeks prior and was obese (BMI 44.7 kg/m²). On admission, he developed pulmonary thromboembolism. Color Doppler ultrasonography of the lower extremities showed no signs of superficial or deep vein thrombosis. On the eleventh day of treatment, laboratory tests revealed elevated serum amylase, lipase, and leukocyte count. Abdominal ultrasonography demonstrated a hyperechoic, non-enlarged pancreas, consistent with mild acute pancreatitis. Given the widespread presence of endothelial cells, SARS-CoV-2 infection may affect multiple extrapulmonary organs, including the CNS, cardiovascular system, kidneys, pancreas, liver, and gastrointestinal tract. Conclusion: SARS-CoV-2 infection may lead not only to pneumonia but also to thromboembolic complications and mild acute pancreatitis. Awareness of such rare extrapulmonary manifestations is important for timely diagnosis and management.

Computed tomography pulmonary angiography (CTPA) is the gold standard for pulmonary embolism (PE) diagnosis, but patients with iodinated contrast allergies or renal insufficiency are often ineligible. CT-derived perfusion (CTP) is a novel, non-contrast method to quantify pulmonary perfusion from an inhale/exhale CT image pair (4DCT). The resulting CT-P information can be used to identify hypo-perfused regions associated with PE. This pilot study introduces a thresholding approach that estimates the number of lung lobes with perfusion deficits according to optimally selected CTP thresholds. The number of lobes indicated as low-functioning provides a score to categorize patients as PE-positive, negative, or inconclusive. We trained and validated the model on a retrospective dataset of 123 suspected PE patients, achieving 72% accuracy, 75% sensitivity, and 69% specificity, with 17% of cases inconclusive. To our knowledge, this is the first PE diagnostic model from non-contrast 4DCT, showing the feasibility of non-contrast PE diagnosis strategies.

Rheumatic heart disease (RHD) remains a leading cause of mitral stenosis (MS), particularly in developing countries like India, China or countries within Africa. Characterized by a long latent phase after acute rheumatic fever, rheumatic MS often leads to significant morbidity and mortality. This paper explores its epidemiology, natural history, and clinical consequences, including associations with atrial fibrillation, pulmonary hypertension, heart failure, systemic embolism, and infective endocarditis. We review diagnostic tools, particularly echocardiography, and management strategies such as balloon mitral commissurotomy and surgical interventions. Emerging therapies, including lithotripsy-facilitated procedures and trans-catheter valve replacement, offer promise for high-risk patients. Early detection and comprehensive care are essential to reduce the global burden of rheumatic MS.

Laparoscopic surgeries have revolutionised surgical practice due to their advantages, including minimal invasiveness, fewer postoperative complications, quicker recovery and reduced hospital stay. Carbon dioxide (CO2) is used for abdominal insufflation because of its inert nature, colorlessness, low cost, high solubility, low combustibility and wide availability. Despite these advantages, laparoscopy is not without complications-it can cause hypotension, arrhythmia, pulmonary barotrauma and, rarely, carbon dioxide embolism (CO2E) and cardiac arrest. CO2E is commonly associated with cardiac arrest and has rarely been linked to acute respiratory distress syndrome (ARDS). Cases of CO2E complicated by ARDS have shown improvement with conventional invasive lung-protective ventilation. However, CO2E complicated by severe ARDS with hypoxia refractory to standard therapy has not been reported. We report a case of CO2E complicated by severe ARDS with refractory hypoxia requiring extracorporeal membrane oxygenation (ECMO) therapy, which resulted in a favourable outcome.