History of Lung Diseases: Circulatory & Vascular

Disease Category & Link Progress, Diagnosis, Treatment, & Notable People
Pulmonary Embolism (PE) Progress: The concept of “embolia” (a plug) was first described by Rudolf Virchow in 1856. He established Virchow’s Triad (stasis, vessel injury, hypercoagulability), which is still the basis for understanding PE risk.

Diagnosis & Imaging:

  • Historic: EKG (McGinn & White‘s 1935 “S1Q3T3” sign) and chest X-ray (Westermark sign, Hampton’s hump) were nonspecific clues. The “gold standard” was the invasive pulmonary angiogram.
  • Modern: The development of helical CT in the 1990s led to the CT Pulmonary Angiogram (CTPA), which is now the definitive, non-invasive test. It allows direct visualization of the clot in the pulmonary arteries.

Treatment (Rx): Evolved from supportive care to anticoagulation (Heparin, then Warfarin). The use of thrombolytics (“clot-busters,” pioneered by Sol Sherry) for massive PE and surgical embolectomy provided life-saving interventions.

Pulmonary Hypertension (PH) Progress: First described by Ernst von Romberg (1891). It was largely a medical curiosity until an epidemic caused by the diet drug Aminorex in the 1960s proved it could be toxin-induced, sparking modern research.

Diagnosis & Imaging:

  • Gold Standard: The Right Heart Catheterization, pioneered by Cournand, Forssmann, & Richards, is the only way to definitively diagnose and measure the pressure.
  • Screening: The Echocardiogram is the primary non-invasive screening tool to estimate pulmonary pressures.
  • CT/X-ray: Show secondary signs like enlarged central pulmonary arteries and right-sided heart enlargement (cor pulmonale).

Treatment: Was untreatable. The 1990s-2000s saw a revolution with new drug classes, starting with IV Epoprostenol (prostacyclin) and followed by endothelin receptor antagonists and PDE5 inhibitors.

Aortic Dissection Progress: A catastrophic tear in the aorta’s wall. Early descriptions came from autopsies (e.g., King George II, 1760). The modern era was defined by surgeons Michael DeBakey and Denton Cooley (1950s), who created the first surgical repairs and classification systems (DeBakey and Stanford) still used today.

Diagnosis & Imaging:

  • Historic: X-ray might show a widened mediastinum. The gold standard was the invasive aortogram.
  • Modern: CT Angiography (CTA) is the test of choice. It is extremely fast and accurately shows the intimal flap (the tear) and the “true vs. false” lumens. Transesophageal echo (TEE) is also used, especially in the operating room.

Treatment: Stanford Type A (Ascending) is an immediate surgical emergency (graft repair). Stanford Type B (Descending) is managed with strict blood pressure control, unless complicated, and is now often treated with TEVAR (thoracic endovascular aortic repair).

Pulmonary Vasculitis (e.g., GPA) Progress: A group of autoimmune diseases that inflame and destroy blood vessels. Granulomatosis with Polyangiitis (GPA), formerly Wegener’s, was described by Friedrich Wegener (1930s). The discovery of the c-ANCA antibody (1980s) proved its autoimmune basis.

Diagnosis & Imaging:

  • Diagnosis: Relies on the c-ANCA blood test and biopsy.
  • Imaging (CT): Has classic findings:
    • Nodules: Often multiple and bilateral.
    • Cavitation: These nodules famously cavitate (hollow out), mimicking cancer or infection.
    • Hemorrhage: Can cause diffuse alveolar hemorrhage (bleeding), seen as bilateral ground-glass opacities.

Treatment: Formerly fatal. Revolutionized by Dr. Anthony Fauci (1970s), who developed the protocol of Corticosteroids + Cyclophosphamide, turning it into a treatable, chronic condition.

Traumatic Aortic Injury Progress: A “traumatic dissection” or transection, usually from high-speed car crashes (sudden deceleration). For decades, 90% of patients died at the scene.

Diagnosis & Imaging:

  • Historic: The widened mediastinum on a chest X-ray was the classic screening sign, prompting an invasive aortogram.
  • Modern: CT Angiography (CTA) has replaced this. It is the standard in all trauma bays (as part of the “pan-scan”) and can instantly identify the subtle tear, pseudoaneurysm, or active bleeding.

Treatment: Evolved from high-risk open-chest surgery (clamp-and-sew) to the modern standard of TEVAR (placing a stent-graft) in the 1990s, which is far less invasive and has dramatically improved survival.

1. Notables Who Advanced Diagnosis & Management of Vascular Lung Disease

Name & Wikipedia Link Comment on Contribution
Rudolf Virchow (1821–1902) A “father of modern pathology.” In the 1850s, he first described the mechanism of “embolia” and established Virchow’s Triad (stasis, hypercoagulability, vessel injury), which remains the foundational concept for understanding the cause of Pulmonary Embolism (PE).
Cournand, Forssmann, & Richards This team (see Infections) pioneered cardiac catheterization. This technique is the gold standard for diagnosing and quantifying Pulmonary Hypertension (PH) by directly measuring the pressure in the pulmonary artery.
Paul Dudley White (1886–1973) A preeminent 20th-century American cardiologist. He and his colleague McGinn described the “S1Q3T3” sign on the EKG (1935), which was one of the first non-invasive clues for diagnosing a massive Pulmonary Embolism.
Sol Sherry (1916–1993) An American physician who pioneered thrombolytic therapy (“clot-busting” drugs like streptokinase) in the 1950s. This treatment is still used today to dissolve massive, life-threatening Pulmonary Emboli.
Paul Wood (1907–1962) A British cardiologist whose 1950s work, using right heart catheterization, established the first modern hemodynamic classification of Pulmonary Hypertension (PH), separating primary (idiopathic) PH from secondary causes.

2. Notables Who Suffered From Vascular and Circulatory Diseases of the Lung

G

Name & Wikipedia Link Comment on Disease
Serena Williams (b. 1981) The tennis champion has a history of Pulmonary Embolism. She suffered a life-threatening PE in 2011, and again had to advocate for herself against a dismissive medical team after giving birth in 2017, when she recognized the symptoms and demanded a CT scan that confirmed clots.
David Bloom (1963–2003) An NBC journalist who died from a massive Pulmonary Embolism while embedded with U.S. troops during the invasion of Iraq. His death was caused by a Deep Vein Thrombosis (DVT) from spending long, cramped hours riding in an armored vehicle, bringing global attention to the risk of DVT/PE.
Hillary Clinton (b. 1947) The former Secretary of State has a well-documented history of recurrent Deep Vein Thrombosis (DVT), the precursor to PE. She suffered clots in 1998, 2009, and 2012 (a cerebral sinus thrombosis), and as a result, remains on long-term anticoagulation (“blood thinners”) to prevent a future PE.
Alex Trebek (1940–2020) The long-time host of Jeopardy! was hospitalized in 2017 for blood clots in his lungs (PEs), which were a complication of a fall he had sustained earlier, requiring surgery.
Dick Cheney (b. 1941) The former Vice President, who has a long and complex cardiac history, was diagnosed with Deep Vein Thrombosis (DVT) in his leg in 2007, requiring anticoagulation therapy to prevent a Pulmonary Embolism.