Persistence of levoatrial cardinal vein with an interatrial courseA 39-year-old woman presented with a history of chest pain, palpitations, and syncope. A coronary CT angiography revealed normal coronary arteries with a normal left atrial outflow. The only finding on the CT angiography was a persistent levoatrial cardinal vein with an interatrial course [Fig. 1]. The clinical and rest of other laboratory evaluations were unremarkable. The patient remained asymptomatic during an observation period and was discharged without treatment. During the follow-up visit, the patient remained asymptomatic.
Proving the innocence of a “malignant” coronary artery: Calling dobutamine stress CT for the defence!A 49-year-old lawyer underwent an exercise test for an insurance physical. In recovery, he had frequent premature ventricular complexes and asymptomatic runs of monomorphic non-sustained ventricular tachycardia (NSVT) not preceded by ST segment shift or chest pain, suspicious for non-ischemic, anterior fascicular VT.
Cardiopulmonary manifestations of isolated pulmonary valve infective endocarditis demonstrated with cardiac CTRight-sided infective endocarditis involving the pulmonary valve is rare. This pictorial essay discusses the use and findings of cardiac CT combined with delayed chest CT and noncontrast chest CT of pulmonary valve endocarditis. Cardiac CT is able to show the full spectrum of right-sided endocarditis cardiopulmonary features including manifestations that cannot be demonstrated by echocardiography.
Coronary CT angiography for chest pain in pseudoxanthoma elasticum and cardiac intervention managementWe describe the case of a rare cause of severe coronary artery disease in a young woman without cardiovascular risk factors. Cardiac CT played an important role in diagnosis and cardiac management including coronary intervention.
Circumferential type A aortic dissection with intimal intussusceptionA 62-year-old man was admitted to our hospital with sudden chest pain. CT examination showed the presence of an intimal flap in the aortic root and in the descending aorta, with no intimal flap in the ascending aorta and curvilinear filling defects in the aortic arch, and extension into the left subclavian artery. Surgical treatment consisted of ascending aorta replacement. During the operation, the intimal tear was found to be circumferential with intussusception of the intimal layer. The patient died at surgery.
Expanding pseudoaneurysm compressing the coronary arteries and causing cardiogenic shockA 37-year-old man who recently underwent aortic valve replacement after endocarditis presented with cardiogenic shock. A large expansile pseudoaneurysm was subsequently discovered using multiple imaging modalities. Although transesophageal echocardiography is important in diagnosing valve endocarditis, coronary CT angiography of prosthetic valves is feasible and image quality is good. In this case, coronary CT angiography allowed for better understanding of transesophageal echocardiography images and earlier diagnosis of coronary involvement as cause for left ventricular dysfunction.
Multimodality imaging of multivalvular endocarditis after transcatheter aortic valve replacementTranscatheter aortic valve replacement (TAVR) has emerged as an alternative to surgery for severe aortic stenosis in non-operable and high surgical risk patients. While endocarditis following TAVR is rare, the significant co-morbidities commonly found in this patient population can complicate evaluation and management. A case of TAVR endocarditis initially diagnosed by cardiac computed tomography angiography and confirmed with transesophageal echocardiogram is presented. In addition to demonstrating the appearance of vegetations and perivalvular involvement in endocarditis complicating TAVR, this case illustrates the utility of cardiac CT techniques in imaging suspected TAVR endocarditis.
Case of double-outlet right ventricle after repair with pulmonary arteriovenous malformations using cardiac CTWe present a case where cardiac CT clearly defines the complex anatomy of a 22 year old man with double outlet right ventricle who is status bilateral bidirectional Glenn and Fontan conduit. This case also shows the association of pulmonary arteriovenous malformations with Fontan and Glenn procedures.
4D-Cine CT imaging of a bicuspid pulmonary valveA 71-year-old woman underwent diagnostic workup for progressive shortness of breath. Transthoracic echocardiography showed a dilated main pulmonary artery (MPA) and an anomalous configuration of the pulmonary valve. CT revealed a bicuspid pulmonary valve (BPV) and confirmed MPA dilation. Further congenital abnormalities were excluded. An isolated finding of BPV is rather rare. To our knowledge we present the first 4-dimensional CT images of a BPV. As in this case, 4-dimensional cine cardiac CT may be helpful to reveal the underlying cause of MPA dilation.
Dual connection of single pulmonary vein in partial anomalous pulmonary venous returnWe present the case of a 6-month-old infant born premature at 29 weeks with perinatal stroke and postnatal hypoxia. Echocardiogram was suspicious for partial anomalous pulmonary venous return (PAPVR). Cardiac CT showed an unusual variant of PAPVR, with a vertical vein having a dual connection superiorly to the left innominate vein and inferiorly to the morphologic left atrium. This unusual variant has the potential for right-to-left flow with a possibility of systemic hypoxia and paradoxical embolism.
A rare case of ventricular septal defect associated with patent ductus arteriosus and coarctation of aorta: A multimodality approachThis case report describes a unique form of a complex congenital anomaly; ventricular septal defect associated with patent ductus arterious and coarctation of aorta in a 21-year-old patient with a multimodality approach.
Incidental finding of migrated pacing lead fragment into pulmonary artery detected with CTThis case shows a rare complication of a migrated atrial lead into the pulmonary artery incidentally detected during a comprehensive evaluation of coronary CT angiography.
Congenital absence of the pericardium and its mimicsCongenital absence of the pericardium is a rare entity, with less than 400 cases reported in the literature. Pericardial absence is typically left sided, which results in herniation of the great vessels or portions of the heart. Patients may be asymptomatic, typical for complete defects, or can present with various degrees of chest pain in the setting of partial absence and strangulation. The finding may be isolated or associated with complex heart disease. We present a number of cases of pericardial absence that show isolated right- and left-sided defects, as well as entities in the differential diagnosis.
A low-dose comprehensive cardiac CT protocol assessing anatomy, function, perfusion, and viabilityRadiation exposure in cardiac imaging is a major healthcare concern and low-dose cardiac imaging has important implications for patients. We describe the application of a low-dose comprehensive cardiac computed tomography protocol that assesses anatomy, function, perfusion and viability with correlations to invasive coronary angiography and magnetic resonance imaging.
Multimodality imaging of an adult with Shone complexShone complex is a rare combination of valvular or supravalvular aortic stenosis, supra-valvular mitral membrane, parachute mitral valve, and coarctation of the aorta. This article presents an unusual case of a 40-year-old woman who presented with a history of progressive dyspnea. We describe the main imaging features and protocol used for visualizing this syndrome using various imaging modalities.
Accessory mitral valve tissue: Appearance on cardiac computed tomographyAccessory mitral valve tissue is an uncommon congenital malformation and a rare cause of left ventricular outflow tract obstruction. Although echocardiography provides a "gold standard" for evaluation of valves, the high temporal and spatial resolutions of computed tomography technology makes it useful in the assessment of valvular structure and function.
Imaging of infective endocarditis with cardiac CT angiographyInfective endocarditis (IE) is a disease characterized by high rates of morbidity and mortality that can present with a spectrum of clinical and imaging findings. Cardiac-gated computed tomographic angiography (CTA) has been shown to be highly accurate in evaluation of both coronary artery disease and structural heart disease and is now considered an appropriate preoperative imaging modality in patients undergoing noncoronary cardiac surgery. This review discusses the use of cardiac-gated CTA in preoperative evaluation of patients with IE, with emphasis on imaging findings of valvular and perivalvular complications.
Gerbode-type left ventricular outflow tract to right atrial fistula complicating prosthetic aortic valve replacement identified by cardiac computed tomographic angiographyAcquired left ventricular-right atrial communication ( Gerbode-type defect) is a rare complication of infective endocarditis. Although transesophageal echocardiography remains the technique of choice for the evaluation of complications of endocarditis this case highlights the usefulness of cardiac computed tomography in this scenario, particularly in cases where assessment of coronary anatomy is required before surgery.
Primary cardiac lymphoma diagnosed by multiphase-gated cardiac CT and CT-guided percutaneous trans-sternal biopsyWe present a case of a primary cardiac B-cell lymphoma where a multiphase-gated cardiac CT exam helped to successfully guide trans-sternal needle biopsy to establish a tissue diagnosis.
Apical-sparing variant of stress cardiomyopathy: Integrative analysis with multidetector row cardiac computed tomography in dual-energy modeStress cardiomyopathy is a unique reversible cardiac syndrome that is frequently precipitated by a physical or emotionally stressful event and has a clinical presentation that is indistinguishable from a myocardial infarction. We describe the case of a patient with apical sparing variant of stress cardiomyopathy in whom dual energy cardiac CT identified characteristic regional wall motion abnormality without concomitant coronary artery disease and myocardial perfusion defects.
Coronary CTA assessment of coronary anomaliesCoronary anomalies occur in <1% of the general population and can range from a benign incidental finding to the cause of sudden cardiac death. The coronary anomalies are classified here according to the traditional grouping into those of origin and course, intrinsic arterial anatomy, and termination. Classic coronary anomalies of origin and course include those in which a coronary artery originates from the contralateral aortic sinus or the pulmonary artery with anomalous course. Single coronary artery anomalies, in which single coronary artery branches to supply the entire coronary tree, are also included in this category.
Computed tomography evaluation for transcatheter aortic valve implantation (TAVI): Imaging of the aortic root and iliac arteriesFor patients with severe aortic stenosis, open-heart surgical valve replacement remains the current clinical standard with documented, excellent long-term outcome. Over the past few years, transcatheter aortic valve implantation (TAVI) has developed into a treatment alternative for high-risk patients with severe aortic stenosis. Because transcatheter valvular procedures are characterized by lack of exposure of the operative field, image guidance is critical. This Pictorial Essay describes the role of 3-dimensional imaging with multidetector row computed tomography for detailed reconstructions of the aortic valve, aortic root, and iliac arteries in the context of TAVI.
Right ventricular outflow tract pseudoaneurysm: Two casesRight ventricular pseudoaneurysm is a rare complication following repair of Tetralogy of Fallot. Presented are two patients, both with history of Tetralogy of Fallot, successful repair and pseudoaneurysms discovered on symptomatic follow up. Because surgical intervention is often required, the location and characteristics of the pseudoaneurysm are critical determinants of successful outcomes. Cardiac gated CT provides physicians with an invaluable tool in evaluating pseudoaneurysms.
Pseudoaneurysm of the mitral-aortic intervalvular fibrosa: A delayed complication of aortic root replacementA 41-year-old male with prior history of aortic root replacement for infectious endocarditis was found to have a pseudoaneurysm in the fibrous continuity between the aortic and mitral valves: the so called “mitral-aortic intervalvular fibrosa.” Preoperative cardiac-gated computed tomographic angiography and intraoperative transesophageal echocardiography imaging findings used to guide surgical repair are presented.
Evaluation of cardiac morphology, function, and perfusion at low radiation dose before mitral valve surgeryA low-dose cardiac CT examination for preoperative assessment of coronary artery disease and mitral valve annulus dimensions in 79-year-old female with mitral valve regurgitation, consisting of a prospectively ECG-triggered high-pitch first-pass perfusion scan under adenosine stress and a sequential scan at rest enabled the diagnosis of occlusion of the right coronary artery and high-grade stenosis of the left circumflex artery, reversible perfusion defects of the inferoseptal and inferolateral walls and a persistent inferior wall perfusion defect associated with inferior wall thinning and akinesia.