B4.030 Thoracic Vascular Imaging

Question 1

what should you use if you’re trying to decide which imagine study to get?

Answer 1

ACR Appropriateness Criteria

Question 2

good studies for suspected aortic dissection

Answer 2

CXR - 9
CTA chest w contrast- 9
MRA- 8
TEE- 8

Question 3

what CXR finding might be present in the case of an aortic dissection?

Answer 3

widened mediastinum due to leaking fluid

Question 4

how should the aorta appear on a CTA chest?

Answer 4

contrast flowing through the structure should be completely homogenous

Question 5

what are some CTA findings in the case of an aortic dissection

Answer 5

intimal flap dissecting involving ascending and descending thoracic aorta
opacification of the lumens
pericardial effusions

Question 6

Stanford classification of aortic dissection

Answer 6

type A: involves ascending aorta

type B: involved descending aorta (originating after takeoff of briachiocephalic artery)

Question 7

aortic dissection etiology

Answer 7

peak age 50-65
male > female
signs:
-tearing/ripping chest pain
-back pain
-aortic insufficiency
-BP difference between arms

Question 8

steps for evaluation of aortic dissection imaging

Answer 8

1. evaluate intimal flap
2. classify type of dissection
3. evaluate extent of dissection
4. distinguish true and false lumens
5. evaluate for complications (tamponade, carotid involvement, coronary involvement)

Question 9

management of type A dissection

Answer 9

surgical

Question 10

management of type B dissection

Answer 10

usually medical

consider surgery if organ hypoperfusion or shock

Question 11

physical finding consistent with DVT

Answer 11

unilateral leg swelling

Question 12

imaging studies for suspected PE with high pretest probability

Answer 12

CXR- 9

CTA chest- 9

Question 13

imaging studies for suspected PE with low pretest probability

Answer 13

CXR- 9

CTA chest- 5

Question 14

what is right heart strain?

Answer 14

sign of hemodynamically significant PE

estimate 50-75% occlusion of PA vasculature

Question 15

what should be done if right heart strain is seen?

Answer 15

emergent catheter directed thrombolytic therapy/embolectomy if systemic signs of right heart failure

Question 16

what is an IVC filter?

Answer 16

metallic basket places in the IVC to catch emboli from lower body veins

Question 17

what types of patients might get an IVC?

Answer 17

people with DVT to prevent PE

PE with or without DVT

Question 18

absolute indications for IVC in patients with DVT/PE

Answer 18

contraindication for anticoagulation
recurrent PE in spite of anticoagulation
anticoagulation related complication

Question 19

relative indications for IVC

Answer 19

free floating thrombus
PE and limited cardiac reserve
prophylaxis in pts with severe trauma, spinal cord injury, or paraplegia
prophylaxis before surgery
poor compliance with anticoagulation
protection during DVT thrombolysis

Question 20

where should an IVC be placed?

Answer 20

below renal veins because the kidneys do not have collateral flow

Question 21

what happens if an IVC becomes occluded when it is placed correctly?

Answer 21

patient may experience edema or be asymptomatic

Question 22

when are IVC filters removed?

Answer 22

when they are no longer needed

• hemorrhage has resolved and anticoagulation can be prescribed
• surgery/rehab complete
• resolution of extensive acute clot/ clot has become chronic

Question 23

IVC filter complications

Answer 23

migration
limb fracture
IVC rupture
pierce adjacent viscera/aorta

Question 24

diagnostic criteria for DVT

Answer 24

Wells Score

Question 25

why is D-dimer an important test?

Answer 25

high NPV

Question 26

contraindications for contrast?

Answer 26

kidney failure

shellfish allergy

Question 27

what is an alternative study for PE if a patient can’t have contrast?

Answer 27

VQ scan

nuclear medicine study