Radiology Notes

My notes during radiology residency, fellowship, and beyond…

Archive for the ‘heart’ Category

Absent Right Heart Border Differential

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Written by lmwong

January 19, 2010 at 11:45 pm

Coarctation of the Aorta

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  • congenital narrowing in the aorta, juxtaductal (proximal or distal to ductus arteriosis), with pressure gradient
    • proximal: blood shunts through PDA until it closes giving CHF and L to R shunt through VSD
    • distal: LVH, “3 figure” contour aortic knob, rib notching
  • associated with bicuspid aortic valve, VSD, PDA, Berry aneurysms, Turner’s syndrome
  • surgical placement of an aortic patch, ballooning for restenosis
  • MRI for followup
  • pseudocoarctation = kinking in aorta without pressure gradient

Written by lmwong

June 5, 2008 at 3:29 pm

Ebstein anomaly

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  • abnormal displacement of the septal and posterior leaflets of the tricuspid valve into the RV
  • tricuspid regurgitation occurs
  • associated with PFA or ASD secundum
  • Chest X-ray: elongated and enlarged RA with “box-shaped” contour
  • ECG: RBBB, prolonged PR intervals, WPW syndrome
  • in utero lithium exposure implicated

Written by lmwong

June 5, 2008 at 3:19 pm

Tricuspid Atresia

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  • newborn with cyanosis
  • chest X-ray: decreased pulmonary vascularity
  • MRI: muscular and fatty ridge in location of tricuspid valve, hypoplastic RV
  • associated VSD and ASD in all cases
  • 30% have transposition of great vessels
  • surgery is palliative, creating shunts from SVC (Glenn) or RA (Fontan)

Written by lmwong

June 5, 2008 at 3:11 pm

Congenital Heart Diseases

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  • Increased pulmonary vascularity
  • Enlarged heart; look at apex
    • Elevated = RV enlargement
    • Depressed = LV enlargement
  • Situs
    • apex opposite from gastric bubble, high association with CHD
    • Asplenia = right sidedness
      • Cyanotic CHD
      • malrotation, microgastria, midline GB or liver
    • Polyspenia = left sidedness
      • Acyanotic CHD
      • Azygous continuation of IVC, bilateral SVC, malrotation, lack of GB

Written by lmwong

June 5, 2008 at 2:56 pm

D-Transposition of great vessels

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  • Most common cause of cyanosis < 24 h
  • Transposition of aorta and pulmonary arteries
    • Aorta off RV
    • Pulmonary arteries off LV
    • 2 parallel circuits
  • Must have connection to survive: PFO, ASD, VSD, PDA
  • MC CXR finding: normal
  • Aorta is ANTERIORLY displaced
  • aorticopulmonary septum normally undergoes clockwise spiral to divide truncus arteriosus into aorta and pulmonary trunk, normal aortic position (situs solitus)
  • “D” = aortic valve to the right (dextro) of pulmonic valve.
  • surgery within 6-12 months to survive.

Written by lmwong

June 5, 2008 at 2:34 pm

Persistent truncus arteriosus

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  • Cyanosis + Cardiomegaly
  • One vessels pulmonary artery and aorta
  • Pulmonary and systemic circulation fail to divide during development
  • Always associated with VSD
  • Increased pulmonary flow and vascularity, early cyanosis
  • 1/3 have RS aortic arch
  • assess origin of coronary arteries on imaging for surgery planning
  • create new pulmnonary outflow tract from graft material

Collett and Edwards classification:

  • Type I: truncus -> one pulmonary artery -> two lateral pulmonary arteries (MC)
  • Type II: truncus -> two posterior/posterolateral pulmonary arteries
  • Type III: truncus -> two lateral pulmonary arteries

Written by lmwong

June 5, 2008 at 2:25 pm

Tetralogy of Fallot

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Cyanotic, low flow pulmonary vascularity, no cardiomegaly
MC cyanotic CHD

  1. Pulmonic stenosis
  2. Right ventricular outflow tract obstruction
  3. Over-riding aorta
  4. VSD

CXR findings

shunting of deoxygenated blood from RV to aorta
associated with RS aortic arch, mirror imaging branching
MRI used for planning surgery: note degree of pulmonary hypoplasia and collateral vessels
Surgery can be palliative (Blalock-Taussig) or complete repair (Lillehei procedure)

Written by lmwong

June 5, 2008 at 2:18 pm

Massive Cardiomegaly

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  • Ebstein anomaly
  • Pulmonary Atresia with intact septum


  • Rhabdomyoma
  • mediastinal masses
  • diaphragmatic hernia
  • AV fistulas

Written by lmwong

April 5, 2008 at 6:57 pm

Cyanotic Congenital Heart Disorders

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Low Flow

  • Tetralogy of Fallot
  • Ebstein Anomaly

Normal Flow:

  • Coarctation
  • AS
  • PS

Written by lmwong

April 5, 2008 at 6:55 pm