Radiology Notes

My notes during radiology residency, fellowship, and beyond…

Archive for the ‘cardiac’ Category

Cardiomyopathies

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Hypertrophic

  • familial (AD)
  • sporadic

Dilated

  • infectious
  • metabolic
  • toxic: alcohol, Adriamycin
  • Collagen vascular disease

Restrictive

  • amyloid
  • sarcoid
  • Loeffer’s eosinophilic endocarditis
  • collagen vascular disease
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Written by lmwong

March 30, 2010 at 8:33 am

Posted in cardiac, chest, differential

Congenital Heart Disease Algorithm

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Written by lmwong

February 25, 2010 at 8:59 pm

Cardiac Perfusion

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Inferior = right coronary
Anteroseptal = LAD
Anteroapical = LAD (distal)
Anterolateral = Circumflex
Posterior = right coronary

Myocardial Perfusion

  • 201-Tl, 99m-Tc Sestamibi, NH3
  • prognostic value
  • protocols
    • 1 day: inject @ rest, image rest, exercise, inject, image stress
    • 2 day: exercise, inject, image stress // inject @ rest, image rest
    • dual isotope: inject Tl @ rest, image rest, exercise, inject sestamibi, image stress
  • Pharmacological Stress Agents
    • Persantine/Dipyridamole: increases serum adenosine by decreasing breakdown; reversed by Aminophylline
    • Adenosine: $$, <10s 1/2 life, side effects (heart block, bradycardia)
    • Dobutamine: adrenergic agonist increases myocardial oxygen demand, inducing ischemia; tritrate up to target HR; reversed by Esmolol drip
  • What to look for
    • reversible ischemia (mismatched defect on stress vs rest)
    • transient ischemic dilation: balanced 3 vessel ischemia; ischemic endocardium makes it look like ventricular dilation
    • LV aneurysm
    • RV prominence
    • Wall motion abnormality
    • LV EF
    • extracardiac activity (ie. tumors!)
  • Fixed defects can be:
    • infarct
    • hybernating myocardium
    • artifact
  • Pitfalls
    • liver can steal counts from myocardium; do delays
    • LBBB gives a false positive in atypical septal/inferior pattern; seen on only dobutamine and exercise; do adenosine

Viability Study

  • Viable Myocardium = “Flow + Metabolism Mismatch”; myocardial blood flow versus glucose utilization

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Written by lmwong

February 2, 2010 at 8:19 am

Right Aortic Arch

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Type 1 = Mirror Image
  • ~congenital heart abnormalities
  • arch descends on right
  • trachea

Type 2 = Aberrant Left Subclavian Artery

  • retroesophageal compression
  • dilateral subclavian artery = Kommerell diverticulum

Written by lmwong

January 24, 2010 at 3:57 pm

Pulmonary Sling

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  • anomalous origin of left pulmonary artery
  • left pulmonary artery comes off right pulmonary artery
  • passes between trachea and esophagus
  • compressed posterior trachea
  • compressed anterior esophagus
  • ~ congenital heart defects
  • causes upper airway compression

Written by lmwong

January 24, 2010 at 3:17 pm

Posted in cardiac, chest, pediatrics

Double Aortic Arch

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  • persistent right and left 4th aortic arches
  • anterior compression of trachea
  • posterior compression of esophagus
  • determine dominant arch for surgical planning

Written by lmwong

January 24, 2010 at 3:12 pm

Pericardial Cyst

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  • fluid filled cardiophrenic angle mass
  • R>L
  • attached to parietal pericardium; do not communicate with pericardial space

Written by lmwong

January 11, 2010 at 11:42 pm

Posted in cardiac, chest, cystic