By Charles White, Joseph Chen
This easy-to-use, clinically orientated studying advisor offers one hundred fifteen distinct circumstances that conceal the scope of cardiac imaging, together with congenital, ischemic, myocardial, valvular, and pericardial middle sickness, in addition to postintervention problems. Given the normal structure of challenge and answer, each one case is dependent for powerful evaluation and studying for either the resident-in-training and the skilled clinician. instances are classified by way of part: the 1st features a short assessment of uncomplicated anatomy, and next sections are divided through affliction type. that includes over 440 pictures and observed by way of short but informative discussions, Cardiac Imaging Cases is the perfect source and reference consultant for an individual within the box of cardiovascular radiology. additionally to be had as an app for iPad at the Apple iTunes shop.
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Extra resources for Cardiac Imaging Cases
Semin Ultrasound CT MR. 2008;29(3):195–203. 24 Case 11 History ▶ A 1-month-old infant with clinical symptoms of congestive heart failure Figure 11-1 Image courtesy of Jacob Kirsch, MD (Cleveland Clinics, Ft. Lauderdale, Florida) Figure 11-2 Image courtesy of Jacob Kirsch, MD (Cleveland Clinics, Ft. Lauderdale, Florida) 25 Case 11 Bland-White-Garland Syndrome Findings ▶ An anomalous coronary artery, usually the LM segment of the LCA (arrow), arises from the PA (asterisk) and courses normally in the anterior interventricular groove Diﬀerential Diagnosis ▶ Other coronary artery anomalies ▶ Coronary artery fistula Teaching Points ▶ Also known as anomalous left coronary artery from the pulmonary artery (ALCAPA) ▶ Other coronary artery anomalies do not arise from the PA ▶ In coronary artery fistula, the LCA arises from the coronary ostium correctly, although abnormal branch vessels of the fistula may connect to the PA ▶ Most patients usually present as infants with heart failure; in rare cases, adults may present with angina, myocardial infarction, or heart failure ▶ Lower PA pressure results in the coronary steal phenomenon, which in turn results in ischemia Management ▶ In infants, reimplantation or intrapulmonary conduit of the anomalous coronary artery to the aorta can be performed ▶ In adults, the anomalous LCA can be ligated and CABG can be performed Further Readings Cowles RA et al.
Radiographics. 2006;26(2):317–333. 22 Case 10 History ▶ None 23 Case 10 Myocardial Bridging Findings ▶ A band of myocardial muscle (arrows) overlying a segment of coronary artery ▶ A segment of the coronary artery courses intramyocardially and resurfaces to the epicardial fat ▶ Most common in the middle segment of the LAD artery (as in this case), followed by LCx and RCA ▶ Electrocardiography (ECG)-gated reconstruction can be performed during the systolic and diastolic phases to assess maximal luminal narrowing and dilation, respectively Diﬀerential Diagnosis ▶ Coronary artery disease ▶ Cardiac tumor ▶ Hypertrophic cardiomyopathy Teaching Points ▶ Segment of the coronary artery proximal to the myocardial bridge is predisposed to atherosclerotic changes, while the tunneled area is relatively protected ▶ Cardiac tumor may invade epicardial fat and engulf the coronary arteries ▶ Hypertrophic cardiomyopathy may mimic myocardial bridging due to asymmetrical enlargement of the myocardium partially engulfing the coronary artery ▶ Presentation: Most cases are asymptomatic; symptoms include angina, myocardial infarction, life-threatening arrhythmias, and even sudden death ■ Due to marked systolic compression of an epicardial coronary arterial segment by the overlying myocardium Management ▶ None; usually asymptomatic ▶ Medical (ß-blocker or calcium channel blocker) or surgical (coronary revascularization or septal myomectomy) treatment in symptomatic patients Further Reading Konen E et al.
AJR Am J Roentgenol. 2007;188(2):W138–W146. Kim SY et al. Coronary artery anomalies: classification and ECG-gated multi-detector row CT findings with angiographic correlation. Radiographics. 2006;26(2):317–333. 16 Case 7 History ▶ None 17 Case 7 Benign Anomalous Left Coronary Artery Findings ▶ LM segment of the LCA arises from the right sinus of Valsalva or from the RCA, courses anteriorly to the RVOT (arrowheads), and becomes the origin of the LAD (minute and not seen in the above image) and LCx (arrow) coronary arteries ▶ Left sinus of Valsalva lacks a coronary ostium Diﬀerential Diagnosis ▶ ▶ ▶ ▶ Malignant, anomalous LCA Anomalous origin of the LAD artery Anomalous LCx artery Coronary artery fistula Teaching Points ▶ Malignant variant of an anomalous LCA courses between the PA and the aorta ▶ Both anomalous origin of the LAD and anomalous LCx arteries have an absent LM segment of the LCA but an intact coronary ostium in the left sinus of Valsalva ▶ In a coronary artery fistula, the involved coronary artery is dilated and tortuous and may mimic an anomalous LCA; there is an intact coronary ostium in the left sinus of Valsalva Management ▶ None; usually a benign congenital finding noted incidentally on catheter angiography or cardiac CTA (1%–2% of the general population) Further Readings Dodd JD et al.