Youssef

And I'm not going to delve deeply into these until we get more information from Maddy in the next Aliquot.

So Maddy, can't wait to hear more.

I'm right there with you, Noah.

So no left-sided heart disease.

We're in the capillary.

And now the big question, do we have chronic embolic disease or are we going to delve into the other etiologies?

And so what are these other etiologies that we're talking about?

So in general, you want to think about inflammatory causes and non-inflammatory causes.

So inflammatory causes include the, we talk about the eye-made pneumonic infections, such as like HIV, schistoma, syphus, if the patient's from the endemic region, malignancy, like Mark said, so either microthrombi or...

macrothrombi, and in this case, I mean tumor thrombus, and it can cause a TMA as well in the pulmonary vessels.

Autoimmune disease, so lupus, scleroderma, mixed connective tissue disease, even sarcoid can cause it as well.

And then drug, we don't hear about any drugs here, but thinking about amphetamines, for example, or some chemotherapeutic agents.

And then in terms of non-inflammatory causes, I think of shunt.

So if you have like a big shunt physiology, that can be one cause.

Thyroid disease is another.

And then vitamin deficiencies such as

vitamin C deficiency, which is Mark's favorite disease.

And then there are rare etiologies like pulmonary veno-obstructive disease and hereditary hemorrhagic telangiectasias.

And then there's a genetic component as well, usually presents in younger patients who have the step one question, which is the bumper to gene mutation.

And that causes like pulmonary arterial hypertension, but this patient is older.