Dr R. 'Behoshiwala', MBBS, MD

Proud 🇮🇳 , #Anaesthesiologist , Bengun Chop enthusiast , #COVIDWarrior, #Oncology, #Perioperative #Cardiology, #EchoFirst #CriticalCare; One of the 🥭 People.

[Dr R. 'Behoshiwala', MBBS, MD @BehoshiWalax]

But what is a dream branch?

Did you note more than half of the new gen #MedTwitter wanted to pursue radiology?
Is it that amazing a branch?

What if you joined in and hated it?

The real questions to ask yourself are:
Do you see your work ethic fitting in that branch?
Contd...

[Dr. Praveen Tripathi @drpraveenpsy]

@Dr_Vidhihihi https://t.co/us1NuwehWC

[WithAScalpel - Fumiya Yoneyama, MD, PhD @WithAScalpel]

Birth Day, Surgical Timing, and Brain Injury in Critical CHD —⚠️Wednesday Effect🗓️

👉In neonates with critical CHD, birth day influenced surgical timing, with Wednesday-born infants waiting the longest.
👉This delay was linked to more postoperative white matter injury, reaching 81.5% in Wednesday-born infants.
👉The study highlights delivery planning and timely surgical access as system-level strategies to reduce neurologic risk.

#JTCVS Open: https://t.co/yClIjIGrth

[Alexander Mladenow MD @alex1708ander]

Interesting #echofirst finding here 👉 2 sinus BAV (antero-posterior) phenotype, a rare morphological variant 👉 with both coronaries coming from the anterior sinus @AguilarMolina_ 🌟

[Ritika Tuli @RitikaTuliMD]

#CardioNuggets™

The Pickelhaube sign is a sharp, spiked high-velocity systolic tissue Doppler signal of the lateral mitral annulus seen in arrhythmic mitral valve prolapse.

It’s named after the old German “Pickelhaube” helmet because the Doppler waveform resembles the helmet’s pointed spike.

Why it happens:
Prolapsing mitral leaflets cause abrupt systolic tugging of the papillary muscles/mitral annulus → creating a tall systolic velocity spike on TDI.

Why it matters:
Suggests arrhythmic MVP
Associated with ventricular arrhythmias/SCD risk
Often seen with bileaflet MVP and mitral annular disjunction (MAD)

Image from @drahmedmohsen85

#CardioNuggets #MedEd #EchoFirst

[WINFOCUS WORLD @WINFOCUS]

The lung does not always show us anatomy.
Sometimes, it shows us artefacts.
And in lung ultrasound, artefacts can be powerful clues.
Today’s clue: B-lines.
They appear as bright vertical lines arising from the pleura, moving with lung sliding, extending to the bottom of the screen
But spotting them is only step one.

The real question is:

What story are they telling?
💧Diffuse bilateral B-lines may suggest pulmonary congestion.
💧Focal B-lines may point towards local pathology.

So don’t just count lines.

Swipe through for tips on how to spot B-lines. 🫁

#LungUltrasound #POCUS #BLines #CriticalCare #WINFOCUSAcademy

[Alexander Mladenow MD @alex1708ander]

A functionally normal bicuspid pulmonary valve is not necessarily a concern and may be safely left in situ, as is also done in the arterial switch operation (ASO), where after surgery it becomes the neo-aortic valve #echofirst

[Alexander Mladenow MD @alex1708ander]

Origin of the coronary arteries in d-TGA in TTE & TEE🫀 #echofirst

https://t.co/641td7pApM

[Suchitha Kuntla @DocPeriop]

@miryalasrikanth Alanti time lone Propofol 10mg IV bolus ivvali, ledante Dexmed infusion rate penchaali. Drug marchaali, scene kaadhu ☺️ What say? @neurons

[Dr R. 'Behoshiwala', MBBS, MD @BehoshiWalax]

@swatigar The country literally made the sport well 👌👌

[Mohan Sai Gudela, DM @drmohansai]

Six ways I truly learned Critical Care Medicine during my DM superspeciality journey

Check the instagram post 👇🔗

https://t.co/LGd5SRACuk

[drpurpleready @epicnephrin_e]

Managed 6 MIs in a day🙏🏻

[Anesthesia&Analgesia @IARS_Journals]

Can in-plane #ultrasound guidance improve success and reduce complications during subclavian central line placement? 💉📊
#POCUS #CriticalCare #PatientSafety #PerioperativeMedicine #Anesthesiology
https://t.co/br4DkCi5uY

[Dr. FEVI🫀🩺 @javier20ch]

🔱Documento de consenso ESC @escardio 2026 sobre las Complicaciones Mecánicas del IAM. 🫀💥
🟥Rotura de pared libre ventricular, pseudoaneurisma ventricular y rotura del músculo papilar. Aunque hoy ocurren en <1% de los IAM gracias a la reperfusión temprana, siguen siendo complicaciones devastadoras, con mortalidad intrahospitalaria de 30–40%. ⚠️📈☠️
🔺️Rotura de pared libre ventricular (RPLV): suele aparecer entre las primeras 24–48 h, aunque clásicamente se describía a los 5–7 días post-IAM. Puede manifestarse con dolor torácico, disnea, choque cardiogénico, taponamiento o paro cardíaco. Factores de riesgo: presentación tardía, IAM extenso, sexo femenino, edad avanzada e hipertensión.
🔺️Pseudoaneurisma ventricular
Es una ruptura contenida por pericardio o trombo, con alto riesgo de ruptura franca. Su incidencia actual es 0.1–0.3%. Suele localizarse en pared inferior o posterolateral y puede debutar semanas o meses después del IAM. El riesgo de ruptura espontánea puede alcanzar 30–45%. Datos clásicos: cuello estrecho (relación cuello/fondo <0.5) y flujo turbulento Doppler. El riesgo de ruptura espontánea puede alcanzar 30–45%.

📜🆓️⤵️
https://t.co/rMc1LU3xqn
https://t.co/jU8OGv1XW0

[Daniel Lorenzatti, MD. @danilorenzatti]

One loop, one Dx 🔎 .. no need for differentials in this case 😉

*tissue characterization is 🔑 for the management of these patients, tough

[Irina Akhmedova @Irina67790690]

🫀 PLAX view in an adult patient with an uncorrected subaortic VSD — a teaching example of its late natural history.

✅️Echo findings: prolapse of the right coronary cusp, aneurysm of the right sinus of Valsalva ruptured into the RV (windsock deformity + continuous systolo-diastolic flow on CWD), aortic regurgitation, and LV dilation.

✅️Pathophysiologic cascade: VSD → loss of RCC support + Venturi effect → Laubry–Pezzi syndrome → formation and rupture of the sinus of Valsalva aneurysm → LV volume overload.

A rare "textbook" case of unrepaired ACHD in adulthood.

#echofirst #ACHD

[Doctor Dilwala ❤️‍🩹 @healthefyheart]

Middle-aged male with NYHA Class III DOE
Echo below 👇
What's happening and best management?
@nihar_nayak2 @DrRajeshG1 @ecgrhythms @Drakhil_cardio #CardioX #Echocardiogram

[Oung Savly MD FACC FASE FESC FAAP FEACVI 🇰🇭 @OungSavly]

8-month-old, boy.
📌DCRV without VSD supports the concept that DCRV is fundamentally a congenital RV muscular bundles.
📌 Obstruction may be progressive
@AEPCcongenital @iamritu @alexsfelixecho @CASivaram1 @echoleolopez @WithAScalpel @alex1708ander @SIwa23288585 @sujithsp

[Oung Savly MD FACC FASE FESC FAAP FEACVI 🇰🇭 @OungSavly]

11M, 7.6kg,DC juxta-arterial VSD
📌AR tends to be progressive rather than static
📌Cusp prolapse or even trivial AR👉🏻early closure to preserve the aortic valve @iamritu @CASivaram1 @alex1708ander @ASE360 @SIwa23288585 @echoleolopez @loomba_rohit @swatigar @argulian @WithAScalpel

[Dr R. 'Behoshiwala', MBBS, MD @BehoshiWalax]

No raphe seen! Unicuspid indeed

[CardiovascularCorner @TrackYourHeart]

How many cusps does this aortic valve have?
1️⃣ Unicuspid
2️⃣ Bicuspid
3️⃣ Quadricuspid

[CardiovascularCorner @TrackYourHeart]

The apical four-chamber view in this patient with Fabry disease

[Dr R. 'Behoshiwala', MBBS, MD @BehoshiWalax]

@drahmedmohsen85 Perhaps SAM with MR