Aunt Minnies Flashcards
Thoracic Aortic Dissection (type A)
- widened, lobulated mediastinal contour
Dissection With Aortic Arch Involvement
-) MR images demonstrate the intimomedial dissection flap (arrows) with delineation of the true (T) and false (L) lumens. The true lumen (T) is smaller and demonstrates acute angles with the dissection flap, while the larger false lumen (F) demonstrates obtuse angles at interface with the flap. Note also the small pericardial and left pleural effusions, most evident in A. Sagittal reformat (C) shows the dissection extending into the arch but not involving the ascending aorta.
Sinus of Valsalva Aneurysm.
-Coronal oblique CTA in a patient with chest pain and no significant past medical history shows a large aneurysm arising from the left sinus of Valsalva (A, arrow) . Still image from a coronary angiography shows that the large sinus of Valsalva aneurysm stretches and narrows the left anterior descending coronary artery (B, arrow)
Pseudocoarctation.
PA chest radiograph (A) demonstrates a rounded density (white arrow) superior to the aortic arch (black arrow) . On sagittal CT (B), the aortic arch and proximal descending thoracic aorta are elongated and folded on themselves (white arrow), producing focal kinking (white arrow) but without significant narrowing
Type B Interrupted Aortic Arch
-3D VR shows a type B interrupted aorta arch with the ascending aorta (dashed yellow arrow) giving rise to the right brachiocephalic artery (yellow arrowhead) and left common carotid artery (LCCA, white arrowhead). The aortic arch is absent, or interrupted, after the origin of the LCCA (white arrow). The left subclavian artery (dashed white arrow) arises from the descending thoracic aorta which received flow through a large patent ductus arteriosus (yellow arrow)
Cervical Arch With Aberrant Left Subclavian Artery.
-Coronal oblique MIP CT image shows the ascending aorta extending high into the right supraclavicular region (red arrows) with a rightsided cervical arch (yellow arrow). Similar to other right arches with an aberrant subclavian artery, the first vessel of the aorta is the left common carotid artery (yellow arrowheads) followed by the right common carotid artery (white arrow) and right subclavian artery (not visualized). The last branch off the aorta is the aberrant left subclavian artery (black arrow)
Double Aortic Arch
-Axial MIP image in a 1-month-old baby with severe stridor and vomiting (A) shows a double aortic arch creating a vascular ring and causing compression of the trachea (black arrow). Additionally, lateral view from an esophagram (B) shows marked compression of the posterior wall of the esophagus (black arrow).
Double Aortic Arch
-PA chest radiograph in an adult (A) with mild dysphagia demonstrates two bilateral indentations on the lower trachea (*), a slightly larger and more superior right indentation (red arrow) and slightly smaller and more inferior left indentation (white arrow). Coronal CT image (B) shows that the indentations represent a larger and more superior right aortic arch (red arrow) and smaller and more inferior left aortic arch (white arrow). Axial MIP image (C) shows the double aortic arch. The right arch is larger than the left arch, which is common.
Four-Vessel Arch
-Oblique sagittal MIP CT demonstrates separate origin of the left vertebral artery (3) between the left common carotid artery (2) and left subclavian artery (4) . The brachiocephalic artery (1) is the first branch off the arch.
Two-Vessel Arch (BovineArch)
-3D volume-rendered image of the aortic arch shows common origin (*) of the brachiocephalic artery and left common carotid artery.
ductus diverticulum” or “ductus bump”
Subclavian Steal
-Coronal MIP CT demonstrates NARROWING of the proximal left subclavian artery secondary to large noncalcified atherosclerotic plaque (arrow). Normal origins of the vertebral arteries (*) from the ipsilateral subclavian arteries. Patient presented with diminished left upper extremity pulses.
Quadricuspid Aortic Valve
Unicuspid Aortic Valve
-CT image transverse to the aortic valve demonstrates a single, eccentric opening/commissure (arrow, A), indicating an unicuspid valve
Ulcerated Plaque
-Parasagittal (A) and axial (B) CT images of the aorta show extensive layering, mixed but predominantly noncalcified plaque throughout the thoracic aorta (white arrows). In certain areas, contrast can be seen extending into the plaque (yellow arrows) but does not extend beyond the intima, which is demarcated by a thin calcification along the aortic wall (white arrowheads).
Penetrating Atherosclerotic Ulcer (PAU
-contrast outpouching in the mid-descending thoracic aorta (white arrow) which extends beyond the calcified intima (yellow arrow), consistent with a PAU. Noncontrast CT image (B) just inferior to this level shows subtle high attenuation in the aortic wall (white arrow) due to adjacent hematoma.
Proximal Descending Aorta Pseudoaneurysm.
-large saccular pseudoaneurysm (P) along the inferior aspect of the aortic arch and descending thoracic aorta. A relatively narrow neck (yellow arrows) connects the aorta to the pseudoaneurysm. This represents a contained aortic rupture.
pericardial cyst
-PA (A) and lateral (B) radiographs in a 59-year-old woman with a cough shows a smooth, ovoid mass in the right cardiophrenic sulcus (white a
Ddx: pericardial diverticula (with connection to fluid in pericardial space)
Pericardial Effusion
- The cardiac silhouette is markedly enlarged and has a rounded, globular appearance
Ventricular Septal Defect (VSD)
-Cardiac enlargement that is predominantly left sided with increased pulmonary vascularity are.
- Lateral view demonstrates left atrial enlargement (arrows).
Atrial Septal Defect (ASD)
- Cardiomegaly, mild right atrial enlargement, and increased pulmonary vascularity
- Lateral view shows a normal LA and fullness in the retrosternal region (arrow) caused by right ventricular enlargement
Patent Ductus Arteriosus (PDA)
-The heart is enlarged, with left-sided prominence with increased pulmonary vascularity AND prominent aorta (arrow).
Transposition of the Great Vessels (TGV)
-oval heart shape with a prominent apex and variable cardiomegaly and a narrow upper mediastinum
- “EGG ON A STRING”
Total Anomalous Pulmonary Venous Return
“SNOWMAN” Appearance
Cor Triatriatum
- Sagittal MR image reveals the membrane (arrow) within the left atrium into which the common pulmonary vein enters, resulting in pulmonary venous obstruction.
Persistent Truncus Arteriosus
-Oval cardiomegaly, INCREASED pulmonary vascularity, a concave pulmonary artery segment (arrow), and a RIGHT AORTIC ARCH.
Tetralogy of Fallot
“Boot-shaped” heart
ASD
*hypervascular, right-sided cardiomegaly, unenlarged LA
TAPVR type 1
*Snowman sign
*type 1; supracardiac; (most common type)
Ebstein Anomaly
*water bottle sign
TGV (transposition of the great vessel)
*egg-on-a-string appearance
Mitral Valve Prosthetic
*Aortic valve prosthetic (more superior and medial ring)
*sternotomy wires
Pulmonary Stenosis with Post-Stenotic Dilation
VSD
*hypervascular; left-sided cardiomegaly
Aortic Stenosis
-tortuous ascending aorta, mild LV enlargement
Mitral Valve Stenosis
-DOUBLE DENSITY sign: enlarged LA
Ebstein Anomaly
*Atrialization of the right ventricle