Chest& CVS Imaging Notes,Quizes&Polls

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TAPVR Supra 🫀Type 🫀Most common 🫀CXR: snowman 🫀Large PFO/ASD needed to survive. 🫀50% asplenia patients have congenital 💙disease, 100%include TAPVR. MZeba

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Metastatic pulmonary calcification (MPC) It is characterized by the deposition of calcium salts in the 🫁, often due to systemic disorders like chronic renal failure, hypercalcemia, or hyperparathyroidism. 🗝️ Points: 🪅Appearance: Bilateral, diffuse, fine, nodular, or reticular calcifications. 🪅Location: Primarily in the upper lung zones. 🪅CT Findings: Patchy, perivascular, or interstitial calcifications. 🪅Associated Conditions: Chronic renal failure, hypercalcemia, hyperparathyroidism. 🪅Key Feature: Symmetric distribution, without significant inflammation. 🪅Differentiation: Distinct from infections like tuberculosis due to symmetric and diffuse pattern. MZeba

CARDIAC PACEMAKER: 💓Components: ➖Power Source (Pulse Generator): Contains semiconductor chips and a sealed lithium battery with a lifespan of ~10 years. ➖Leads: Insulated wires conducting electrical pulses to electrodes placed on the cardiac muscle. 💓Lead Insertion: Leads are introduced via the subclavian vein, and the generator is placed in a subcutaneous chest wall pocket. 💓Types of Pacemakers: 🕳Single Chamber Pacemaker: 1. Manages either atrial or ventricular dysrhythmias. 2. Atrial lead: Positioned in the right atrial appendage. 3. Ventricular lead: Positioned at the apex of the right ventricle. It only paces the ventricles and ignores atrial activity. 🕳Dual Chamber Pacemaker: 1. Two leads: One in the right atrium and one at the right ventricular apex. 2. Synchronizes atrial and ventricular activity for more physiological pacing. 🕳Biventricular Pacemaker: 1. Three leads: One in the right atrium, one in the right ventricle, and one in the coronary sinus to pace the left ventricle (used for biventricular pacing). 💓Implantable Cardioverter Defibrillators (ICDs): 1. Typically used for ventricular dysrhythmias. 2. Usually have a single lead, resembling a single chamber pacemaker on radiography. (Source: CXR Survival Guide) MZeba

MITRAL REGURGITATION 🩻CXR Chronic Mitral Regurgitation 💜Left Atrial Enlargement. 💜Left Atrial Appendage convexity or straightening just below the main pulmonary artery. 💜Double Density Sign: Enlarged left atrium pushes into adjacent lung, creating a contour over the right heart. 💜Bronchial Elevation: Elevation of the left main bronchus and splaying of the carina. 💜Walking Man Sign: Visualized on lateral projections. 💜Upper Zone Venous Enlargement: Due to pulmonary venous hypertension. 💜Left Ventricular Enlargement: Eventually present due to volume overload. 💜Congestive Heart Failure Features: May also be present. 🩻CXR Acute Mitral Regurgitation 💜Pulmonary Edema: Often seen; can be unilateral (right upper lobe or rarely left upper lobe). 💜Left Atrial Enlargement: Typically absent on radiographs. 🩻Echocardiography 💜Severity Parameters: ➖Mild: Jet width <20% left atrial area; vena contracta <0.3 cm; regurgitant volume <30 mL/beat. ➖Moderate: Between mild and severe criteria. ➖Severe: Jet width >40%; vena contracta ≥0.7 cm; regurgitant volume ≥60 mL/beat; effective regurgitant orifice area ≥0.40 cm². (Source: Radiopedia) MZeba

Dressler's Syndrome 🌀Triad of pleuritis, pericarditis, pneumonitis 🌀 10- 30 days post MI or Cardiac surgery. 🌀 Chest pain and high ESR 🌀 MRI: ➖Intense late post-gadolinium enhancement of entire pericardium. ➖Typically regional thinning and akinesis of the infarcted myocardium(a complication of transmural infarction) (Source: Radiopedia, G&A Essentials) MZeba

TRUE VENTRICULAR ANEURYSM 💚 A large thin walled fibrous sac bulging from LV lumen and external surface of the heart. 💚 Normal cardiac silhouette is seen with or without diffuse left ventricular enlargement and with or without an obvious left ventricular focal bulge. 💚 Curvilinear calcifications can develop with the wall after several years. 💚 Aneurysm has a wide neck 💚 Non viable myocardium within the wall of a true aneurysm will show Gadolinium enhancement. FALE VENTRICULAR ANEURYSM 💚 Result from a localized perforation of the ventricular myocardium following an infarct. 💚 Have tendency to rupture and should be excised. 💚 Generally have narrow necks. 💚 The false aneurysm has no myocardium within its wall therefore not demonstrate Gadolinium enhancement. 💚 The false aneurysm will fill and empty slowly with contrast medium. 💚 There is an abrupt change in wall thickness after with an abrupt angulation at the aneurysm mouth. MZeba (Source: G&A Essentials)

Kawasaki Disease 💜A small to medium vessel vasculitis primarily affecting young children, especially the coronary vessels. 💜Diagnostic Criteria: ➖Fever for at least 5 days and at least 4 of the following: 1️⃣Mucosal Changes: Cracked lips, strawberry tongue, or erythema of oral mucosa. 2️⃣Conjunctival Injection: 3️⃣Rash 4️⃣Hand/Foot Changes: Erythema and edema. 5️⃣Cervical Lymphadenopathy: Unilateral, ≥1.5 cm. 💜Imaging: ➖CXR: May show calcified coronary aneurysms years later. Aunt Minnie ➖Angiography: Detects coronary ectasias, aneurysms, and stenosis; most sensitive for vascular assessment. Small: <5 mm, Medium: 5-8 mm, Large: >8 mm ➖Echo 1️⃣Coronary Artery Dilation: Aneurysmal if >2.5 standard deviations above the mean. 2️⃣Left Ventricular Dysfunction. 3️⃣Mitral Regurgitation. 4️⃣Pericardial Effusion. MZeba (Source: Radiopedia)

Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) 💜A cardiomyopathy linked to sudden cardiac death in young patients. 💜Male predominance (2.7:1). 💜CMRI: ➖Regional RV Dysfunction: Akinesia, dyskinesia, or dyssynchronous contraction. ➖RV End-Diastolic Volume: ≥ 110 mL/m² ➖RV Ejection Fraction: ≤ 40% ➖Fatty Infiltration: In the triangle of dysplasia: Inflow tract/outflow tract/apex ➖Accordion Sign: Corrugated appearance of RV wall. ➖Focal LV Dyskinesia: Possible with fatty infiltration. ➖Myocardial Fibrosis/Scarring: Evaluated using MRI. (Source: Radiopedia) MZeba

Anderson-Fabry Disease: 💜Lysosomal storage disorder can lead to cardiac involvement with hypertrophy. 💜Usually presents with additional systemic symptoms like pain crises, skin lesions, and other organ involvement. 💜Echo: ➖LV Hypertrophy, Concentric or eccentric. ➖RV Hypertrophy: Variable. ➖Papillary Muscle Thickening. ➖Binary Sign: Hyperechoic region in myocardium. ➖Thinning of Left Basal Inferolateral Wall. ➖Diastolic Dysfunction. ➖Reduced Ejection Fraction. ➖Valvular Thickening 💜CMR: ➖Cine SSFP: LV hypertrophy. ➖Increased LV and Papillary Mass. ➖Late Gadolinium Enhancement (LGE): often in basal inferolateral region. ➖T1 Mapping: Decreased in remote areas, Increased in inflamed/fibrotic areas. ➖T2 Mapping: Normal in remote areas, Increased in chronic inflammation (Source: Radiopedia) MZeba

Hypertrophic Cardiomyopathy (HCM) 💜Unexplained left ventricular hypertrophy (LVH). 💜Symptoms and Signs: Congestive Heart Failure, Ejection Systolic Murmur: Increased with Valsalva maneuver due to LVOT obstruction. 💜CXR: ➖Cardiomegaly ➖Pulmonary Congestion. 💜Echo: ➖Septal Thickness Ratio: > 1.3. ➖Mitral Valve Displacement: Anterior leaflet moves toward the septum. ➖Systolic Anterior Motion (SAM): Possible contact with septum. ➖Wall Thickness: Any segment > 15 mm unexplained. ➖Additional Features: LV systolic dysfunction, LVH, possible right ventricular hypertrophy. 💜Cardiac MRI: ➖LV systolic dysfunction ➖LV hypertrophy: Predilection for basal interventricular septum ➖RV hypertrophy (may or may not be present) ➖Systolic anterior motion (SAM) of the mitral valve +/- Mitral regurgitation ➖LV apical aneurysms ➖Differentiation from Masses: HCM shows preserved contractility, iso-intense signals on T1/T2, and patchy delayed enhancement. MZeba (Source: Radiopedia)

Why fainting spells in cardiac myxoma? 💎 Primary Cause: Obstruction of blood flow. Tumor located in the left atrium, can block the mitral valve, leading to reduced cardiac output and poor perfusion of the brain.  💎 Secondary cause: myxomas can cause emboli, tumor break off and embolize to the 🧠, resulting in transient ischemic attacks. Reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9048271/

Myocarditis: 💜Often viral infections. 💜Acute myocarditis can lead to sudden cardiac death. 💜Most patients recover spontaneously; 5-10% may develop dilated cardiomyopathy. 💜Symptoms: Can mimic acute myocardial infarction (chest pain). 💜Diagnosis: 1. Abnormal lab findings and ECG changes may indicate acute coronary syndrome. 2. MRI: Key for differentiation; late enhancement is subepicardial/midmyocardial, unlike subendocardial in myocardial infarction. Non vascular distribution. Sarcoidosis: usually septum. 3. Most lesions found in the lateral free wall. 4. Wall Motion abnormalities may or may not be present. MZeba

Constrictive Pericarditis: 🧤Causes: ➖Developed Countries: Post CABG, Idiopathic presumed viral. ➖Developing Nations: Tuberculosis (TB). Imaging Features: 🧤CT Findings: ➖Pericardial thickness > 0.4 cm is indicative of constrictive pericarditis. ➖Calcification of the pericardium is diagnostic, typically found over the atrioventricular (AV) groove. 🧤MRI Findings: ➖Sigmoidization: Observed on SSFP cine imaging. ➖Characterized by the ventricular septum moving toward the left ventricle in a wavy pattern during early diastole, referred to as "diastolic bounce." ➖This "bounce" is most pronounced during inspiration. MZeba

Cardiac Thrombus: 🧤Most common intra-cardiac “mass.” 🧤Common Locations: ➖Left Atrial Appendage: Frequently associated with atrial fibrillation . ➖Left Ventricular Apex: Often seen post MI. 🧤Imaging Characteristics: ➖Enhancement: Thrombus typically does not enhance on imaging (e.g., MRI). ➖Tumors, in contrast, will show enhancement. MZeba

Rhabdomyoma 🫀 🧤Most common primary cardiac tumor in infants. 🧤Association: Often seen in infants with tuberous sclerosis. 🧤Location: ➖Typically favors the ventricular myocardium. ➖Can be multiple in number. 🧤Imaging Characteristics: ➖T2-weighted MRI: Rhabdomyoma appears T2 bright. ➖Discriminator from Fibroma, which is T2 dark. MZeba