Medicine: Cardiac Radiology

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NMS Medicine
Chapter 4
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1
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whats wrong here

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nothing, normal CXR

2
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whats going on here

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nothing, normal CXR lateral

corresponding view

3

how is heart size msot commonly evaluated on a PA chest XR

cardiothoracic ratio

4

how big must the heart be on a PA chest to be considered enlarged

transverse cardiac diameter measuring more than half of the transverse thoracic diameter is enlarged

5
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is this AP or PA chest

AP

6
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is this AP or PA chest

PA

7

why is there less maginfication on a PA chest

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heart is closer to the XR sensor device

X ray source is 6 feet from the cassette

8
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inspiratory or expiratory

inspiratory

9
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inspiratory or expiratory

expiratory

10

what is a good way to see insp vs. exp

count ribs

11

what are some ways that the cardiothoracic ratio can fail

portable AP vs. non portabel PA fimls?

respiration depths on insp and exp

thoracic deformity (pectus excavatum) in elderly

pulmonary diseases that depress diaphragm (emphysema)

ab diseases that elevate diaphragm (hepatomeg, ascitis, pregnancy)

obseity

kids

12

how are upper lobe pulmonary arteries and veins positioned relative to one another

parallel with veins lateral in position

13

what makes up the lateral aspect of the upper portion of both hila in the lung

pulmonary veins

14

how are the lower lobe pulmonary arteries and veins positioned relative to one another

veins more horizonal, arteries more vertical

15

where can right descending pulmonary artery usually be identified

just inferior to right hilum

16

what is a phenomenon that happens in pulmonary venous hypertension

cephalization

17

what is cephliazation due to

increased L side pressure

18

what happens in cephalization

upper lobe vessels equal to or larger than the size of lower lobe vessels

19

where are kerley B lines and how big are they

1-2 cm long at lung bases

20

how are kerley B lines relative to pleural surface

horizontal and perpendicular

21

what are kerly B lines

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distended interlobular septa

22

what are kerley A lines

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distended CT near bronchoarterial bundle

23

where do kerley A lines run

obliquely near hilum

24

are kerly A or B lines longer

A

25

what is peribronchial cuffing from

interstital fluid accumulates around brnochi, causing thickening of bronchial walls

26
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what is being pointed out here

peribronchial ciffing

27
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what type of air space opacity is this

interstitial

28
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what type of air space opacity is this

alveolar

29
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where is this pleural fluid

in fissures

30
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where is this pleural fluid

pleural effusion

31

what are the places of pleural fluid accumulation

in fissures
in sac (effusion)

32

what are 4 reliable signs of CHF

kerley B lines
peribronchial cuffing
fluid in fissures
pleural effusion

33

are cardiomegaly and cephalization reliable signs of CHF

NO

34

what are common causes of CHF

CAD
HTN
CM
valvular lesions (AS, MS)
L to R shunt

35

what does valve stenosis produce with regard to overload and hypertrophy

pressure overload and myocardial hypertrophy without inital dilation

36

in valve stenosis, what is enlargement of the heart indicative of

chamber enlargemnt/heart failure

37

what does valve insufficiency produce with regard to overload and hypertrophy

volume overload and combinatino of dilation and hypertrophy

38

does a dilated heart mean cardiac decompensation in valve insufficiency

no

39
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what is going on here

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LA enlargement

40

where will LA enlargement show

bulge below pulmonary artery, can elevate left mainstem bronchus on PA

41
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what is shown here

prominent upper posterior border of the heart: LA enlargemnt

42

what does a CXR in someone with chronic MR show

enlargement of LA and LV

43
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what's this a CXR of

mitral insufficiency

44

are the pulmonary venous pressures elevated in mitral insuff

no

45
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what's this CXR showing

acute mitral insufficiency

46

what are the radiographic findings of acute mitral insufficiency

acute LV failure with pulmonary edema

normal sized or slightly increased heart size

47

what can cause acute mitral insufficiency

rupture of chorda
papillary muscle dysfunction
mitral leaflet perforation

48

what can cause aortic stenosis

degeneration of bicuspid aortic valve
degeneration of TC aortic valve (over 65)
rhematic heart diseases in TC valve

49

what are the radiographic findings in AS

rounded LV but normal heart size

post-stenotic dilation of ascending aorta

calcified valve

50

what are the most common early-calcifying heart valves

bc aortic and RHD valves

51
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what's funky about this ascending arota

post-stenotic dilation

52
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whats the diagnosis here

aortic insufficiency

53

if LV or aorta are enlarged, where will they show this on the frontal and lateral xrays

frontal: downward from left
lateral: postero-inferiorly

54

how far does the aortic knob measure when from the lateral border of adult trachea

less than 35 mm

55

what types of patients have multivalvular diseas

RHD
CM
CT disorders

56

what do the signs of regurge from prolapse of mitral or aortic valves result from

cystic medial degeneratino of valves

57

what is cystic medial degeneration of valves commonly associated with

Marfan's sydrome

58

what would really get a doctor to think about Marfan's from heart problems

dilated aorta or AA

59

how are MPA and RV enlargements seen on radiographs

tangent line to MPA over 15 mm

60

where will the enlarged RV be seen in lateral view

in front!

61

what is the easiest way to evaluate which ventricle is enlarged

examine corresponding outflow tract for each ventricle

62

can you assess enlargemnt of RV if LV is enlarged

no

63

will the RA ever be enlarged by itself

no

64

what are some pulmonary vasculature classification (flow)

normal
PV HTN
PA HTN
increased flow
decreased flow

65

what are the 3 parameters for pulmonary vascular classification

right descending pulmonary artery

distribution apex to base

distribution central to periphearl

66

how long is the RDPA before it branches

less than 17 mm

67

how is distribution of blood flow in pulmonary vasculature

greater in bases than apices, greater central than peripheral

68

how do the peripheral vessels appear in pulmonary arterial hypertension

too small for the central vessels they come from

69

what is the discrepancy in size between the central pulmonary fessels and peripheral pulmonary vasculature called

pruning

70
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whats goign on here

PV HTN

71
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whats going on here

r: PA HTN
l: increased flow

72

what does collateral flow involve in aortic coarctation

subclavian arteries and their branches, including 3-9 bilateral intercostals

73

was is a 3 sign indicative of

aortic coarctation

74

what does the 3 sign refer to

indentation of lateral margin of arta with post-stenotic dilation

75

what can a reverse 3 sign be seen on

barium esophagrams, same abnormality

76

what are the ConHDs that can be found on plain fils with increased pulmonary vascularity

ASD
VSD
PDA

77

what are the ConHDs that can be found in plain films with normal pulmonary vasculiarty

AS
coarctation

78

what are DCMs secondary to

coronary ischmia
toxins
previous infection

79

what can desribe the ventricles with global cardiomegaly

hypokinetic ventricles and decreased EF

80

what can cause HCM

familial or P overload

81

what is RCM due to

amyoidosis, sarcoidosis, endomyocardial fibrosis

82

does heart always enlarge in HCM

no, sometimes just shows wall thickening

83

what is the main dysfunction in RCM

diastolic dysfunction and pulmonary venous dysfunction

84

what is the shape of pericardial effusion

waterbottle shaped heart

85

what is the best diagnostic for pericardial effusion

US

86

can you get pericardial effusion diagnosis from CT

yes

87
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what is going on here

pericardial effusion

88

where does RCA course

right atrioventricular groove

89

what does RCA supply on heart

right ventricular free wall

90

what supplies the posterior descending coronary artery branch at crux of heart (AVN supply and posterior IV septum)

RCA

91

what are the RCA branches

marginal, posteiror descendin

92

what are the LCA branches

left Cx
LAD
marginal

93

what supplies the inferior heart with blood

RCA

94

what supplies the anteroseptal area of the heart with blood

LAD

95

what supplies the anteroapical area of the heart with blood

LAD

96

what supplies the anterolateral area of the heart with blood

circumflex

97

what supplies the posterior area of the heart with blood

RCA

98
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what type of test is this

nuclear medicine myocardial perfusion scan

99

what does radioisotope perfusion imaging use to track regional blood flow

Th-201 and Tc-99m sestamibi or myoview

100

what types of things does radioisotope perfusion imaging get used for

stress testing: ischemic changes
rest imaging

101

how could you see hibernating myocardium

thallium SPECT
PET

102

what are some applications of myocardial perfusion imaging

CAD detection

eval of extent and severity of coronary stenosis and prognosis

myocardial viability assessment

outcome of therapy assesment

103

is MPI or ECG better in negative prediction

MPI

104

how would you test someone with CAC (calcification of coronary arteries)

electron beam CT (EBCT) or spiral CT

105

how could EBCT or spiral CT be used

screen with risk factors

follow CAD progression

follow efficacy of intervention

106

how can LV aneurysms be seen

plain film

CT

venticulography

107

what is venticulogrphy

use labeled RBCs and measure LV function

108

what can cause constrictive pericarditis

lots of stuff

109

what can calcification of the pericardium do to cardiac pulsation and the RH

limit, RHF

110

how would you detect a mass in someone

...

111

what are the cardiac masses

thrombus
myxoma
lipoma
angiosarcoma
mets

112

where are thormbi most common

LV or atrial appendage

113

what are thrombi in the heart usually secondary to

MS
a fib
CMyopathy

114

where are myxomas of heart usually

near atrial septum

115

how many myxomas of heart are on the R side

10%

116

how many of the benign tumors of the heart do myxomas make up

50%

117

how many of benign tumors of the heart do lipomas make up

10%

118

how many of malignant tumors do angiosarcomas make up

1/3

119

what is the most common malignant tumor in the heart

metastases

120

what is the most commonly used imaging for AD or AA

CT

121

what is the gold standard of AA or AD imaging

angiography

122

what part of the aorta does debakey type 1 dissection involve

Ascending A, Aarch, Descending A

123

what part of the aorta is involved in debakey 2 or stanford A

AA

124

what part of the arota is involved in stanford B or debakey III

DA

125

where is the tear in type I AD

ascending

126

where is the tear in type II AD

ascending

127

where is the tear in type III AD

descending

128

where is the tear in type IV AD

one in ascending, one in descending

129

what teras in aortic dissection

intimal tear

130
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what is this here

aortic aneurysm

131

what usually causes ascending aorta aneurysms

cystic medial sclerosis

132

what suually causes aortic arch aneurysms

cystic medial sclerosis
atherosclerosis
infection

133

what usually causes descending aorta aneurysms

atherosclerosis

134
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where is the blood here

card image
135
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what else is interesting here

calcified wall

136

where do most aortic aneurysms occur

infrarenal segment

137

what is a AAA

localized dilation of artery by at least 50% as compared with the expected normal diameter of vessel

138

what do almost all AAAs involve

infrarenal abdominal aorta

139

what is the risk zone for aneursym aorta size

4-5 cm

140

what might the aortic angiogram show in acute traumatic aortic injury

subtle intimal tears
complete transection
traumatic aneursym, dissection, coarctation

141

where does injury in trauma cases usually happen in aorta

suspended points:

aortic isthmus distal to left subclavian orgin (95%)

aortic arch, descending aorta superior to aortic valve, aortic hiatus along diaphragm

142

when are V/Q lung scans used to check PE

renal functoin abnormal or patient allergic to contrast

143

what are the classifications of V/Q lung scans

normal
low prob
IM/indeterminate prob
high prob

144

what V/Q result rules out PE

normal

145

what types of abnormalities show up in low probability V/Q scans

nonsegmental

146

if you get an IM V/Q scan, how can it be compromised

single defect
extensive pulmonary consolidation
COPD

147

what will a high probablility V/Q scan show

multiple unmatched segmental perfusion defects with no other likely etiology

148

what are the plain film indications

Congestive Heart Failure
Valvular Heart Disease—chamber enlargement
Congenital Heart Disease—pulmonary vascularity
Some Aortic Aneurysms
Pulmonary Emboli

149

what are the CT indications

Coronary artery calcification—screening test for coronary artery disease particularly with Electron Beam CT
Congenital Heart Disease
Cardiac Masses
Pericardial disease
Pulmonary Emboli
Aortic aneurysms or dissections
.

150

what are the MRI indications

Multiplanar imaging of cardiac anatomy and pathology
Aneurysms and dissections
Intracardiac thrombi and tumors
Coronary artery disease
Congenital heart disease

151

what are the nuclear cardiography indications

Myocardial Perfusion Imaging—certain molecules are taken up by myocardial cells in proportion to regional flood flow.
Ventriculography—radioisotope labeled RBCs provide assessment of cardiac size and function
PET scanning—evaluation of cardiac perfusion and metabolism


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