Year : 2013  |  Volume : 16  |  Issue : 4  |  Page : 302-

Authors' reply

Rajinder Singh Rawat, Yatin Mehta, Naresh Trehan 
 Medanta Institute of Critical Care and Anesthesiology, Medanta The Medicity, Gurgaon, Haryana, India

Correspondence Address:
Yatin Mehta
Medanta Institute of Critical Care and Anesthesiology, Medanta The Medicity, Sector 38, Gurgaon - 122 001, Haryana

How to cite this article:
Rawat RS, Mehta Y, Trehan N. Authors' reply.Ann Card Anaesth 2013;16:302-302

How to cite this URL:
Rawat RS, Mehta Y, Trehan N. Authors' reply. Ann Card Anaesth [serial online] 2013 [cited 2021 Dec 2 ];16:302-302
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Full Text

The Editor,

We appreciate Dr. Narendra Bodhey's remarks about our article. [1] We wish to make following points:

We agree that the chest X-ray shown in the article is a rotated film. It is important to note that in practical scenario, it is often difficult to take a true frontal radiographical view of a patient who is on ventilatory support and has chest tubes, electrocardiography electrodes, pulmonary artery catheter, Foley's catheter and endotracheal tube in place; therefore, some degree of rotation is a possibility in taking anterior-posterior view of such patients.

There are several causes of tracheo-bronchial calcification and include advanced age, congenital, [2] hypercalcaemia and hyperphosphatemia, [3] chondrodysplasia punctata, adrenogenital syndrome and diastrophic dysplasia. [4] It has also been reported following cardiac surgery [5] and in patients who have been on long-term warfarin therapy. [4] The mechanism by which warfarin causes tracheal calcification is not known, but it is suggested that it may inhibit the normal formation of a vitamin K dependent protein that prevents calcification of cartilage and connective tissue. [6]

We completely agree that reading a chest radiograph is not easy. It requires expertise to make a final conclusion.


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4Moncada RM, Venta LA, Venta ER, Fareed J, Walenga JM, Messmore HL. Tracheal and bronchial cartilaginous rings: Warfarin sodium-induced calcification. Radiology 1992;184:437-9.
5Rifkin MD, Pritzker HA. Tracheobronchial cartilage calcification in children. Case reports and review of the literature. Br J Radiol 1984;57:293-6.
6Price PA, Faus SA, Williamson MK. Warfarin causes rapid calcification of the elastic lamellae in rat arteries and heart valves. Arterioscler Thromb Vasc Biol 1998;18:1400-7.