IgG4-related disease: Coronary arteritis masquerading as coronary “masses”A 64-year-old man with a history of psoriasis and latent tuberculosis presented to the emergency department with cough and dyspnea. Transthoracic echocardiogram (TTE) showed a large pericardial effusion with early echocardiographic signs of tamponade and a well circumscribed right atrioventricular groove mass extending into the pericardial space, moving with the cardiac cycle without independent mobility (Fig. 1). Pericardiocentesis drained 1 L of sanguinous fluid with a lymphocytic predominance and negative infectious and cytologic work-up.
Live integration of comprehensive cardiac CT with electroanatomical mapping in patients with refractory ventricular tachycardiaAim of the present study was to verify the feasibility and accuracy of live integration of myocardial fibrosis evaluated at CCT with EAM (electro-anatomical mapping).
Left ventricular assist device pseudo-thrombosis due to use of metal artifact reduction algorithm on cardiac CTProjection-based metal artifact reduction (p-MAR) is a CT technique in which projection data corrupted by metallic artifact is replaced by ‘estimated’ corrected values. This technique has shown promise with its ability to improve image quality in patients with metallic hardware or implants. p-MAR is becoming increasingly popular, as it can be used after image acquisition and does not lead to increase in the radiation dose to the patient.1 While the advantage of p-MAR for metal artifact reduction is well established, it may induce artifact in high-attenuation cardiovascular structures with attenuation characteristics similar to metal.
Never too late for amplatzer endocarditis: Key role of cardiac CT imagingTwenty-year-old New Zealand Maori man with previous percutaneous closure of right coronary artery to right ventricular fistula with an 8mm Amplatzer septal occluder at the age of eight presented with fevers, generalized body aches and diarrhea. He was hypotensive on admission requiring vasopressor support. Six blood cultures grew methicillin-sensitive Staphylococcus aureus. Transthoracic echocardiogram (TTE) revealed new moderate right ventricular dilation and dysfunction, and tricuspid regurgitation but no evidence of endocarditis.
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.
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.
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.
Recurrent subaortic membrane causing subvalvular aortic stenosis 13 years after primary surgical resectionThis case demonstrates the use of cardiac CT angiography as part of the preoperative evaluation of a recurrent subaortic memebrane in a 23-year-old women. A subaortic membrane is a rare finding on coronary CT angiography and typically consists of a thin fibrous membrane in the left ventricular outflow tract (LVOT). The resulting turbulent flow may lead to LVOT obstruction and aortic insufficiency.
Prosthetic mitral valve thrombosis: Cardiac CT, 3-dimensional transesophageal echocardiogram, and pathology correlationImages in cardiovascular computed tomography display prosthetic mitral valve thrombosis with cardiac CT, 3-dimensional transesophageal echocardiography, and pathology correlation.
Cardiac inflammatory myofibroblastic tumor: Evaluation with dual-source CTWe present a case of inflammatory myofibroblastic tumor that was evaluated with retrospectively gated dual-source cardiac CT. Imaging features included a broad-based attachment, lobulated contour, and patchy areas of contrast medium enhancement that persisted on delayed imaging. Inflammatory myofibroblastic tumor is an extremely rare slow-growing but locally invasive neoplasm. Cardiac CT has an emerging role in the evaluation of cardiac masses, permitting detailed assessment of lesion extent and relationships.
Left atrial myxomaA 56-year-old woman presented with sudden onset right arm weakness and was diagnosed with a small left internal capsule stroke. Transesophageal echocardiogram showed a 3.5 cm × 3.0cm pedunculated, lobulated mass of heterogeneous echogenicity in the left atrium (Fig. 1A and B) with Doppler flow acceleration along the edge of the mass suggestive of dynamic mitral valve obstruction (Fig. 1C and D). The presumptive diagnosis was of an atrial myxoma. A 64-slice electrocardiography-gated multidetector CT coronary angiogram was performed (Fig.