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Radiology Boards > Cardiac > Flashcards

Cardiac Flashcards

1
Q

Three major branches off the aorta

A

Brachiocephalic (right common carotid, internal mamm, right vert, thyrocervical)
Left common carotid
Left subclavian (internal mamm, left vert, thyrocervical)

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2
Q

Bovine Arch Vessels off the Aorta

A

brachiocephalic/innominate (left common carotid*, right common carotid, right vert)
left subclavian (left vert)

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3
Q

Vessels in aberrant right subclavian

A

right common carotid
left common carotid
left subclavian (left vert)
right subclavian (right vert)

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4
Q

Define: diverticulum of Kommerel and dysphagia lusoria

A

Bulge at the origin of the aberrant subclavian artery

Indentation the posterior esophagus by the aberrant right subclavian with L arch

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5
Q

Aortic Dissection pathogenesis and risk factors

A

intimal disruption with high-pressure blood expanding the media

RF: atherosclerosis, Marfan/connective tissue dz, cocaine, bicuspid aortic valve, weight lifting, deceleration injury

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6
Q

Aortic Dissection Classification

A

Stanford A - ascending aorta - surgical management
Stanford B - descending aorta - medical management

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7
Q

Intramural hematoma pathogenesis

A

Rupture of vasa vasorum within the media (intima remains intact)
Check for this on non-con CT before the arterial phase in a dissection study
Treated based on Stanford classification

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8
Q

Penetrating atherosclerotic ulcer pathogenesis and RF

A

Plaque layers on and penetrates into the intima
Plaque ulcerates, allowing blood into the media

Continual blood pooling/pouring into the media can lead to aneurysm formation

RF: atherosclerosis instead of HTN

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9
Q

Thoracic aortic aneurysm size criteria and RF

A

Ascending >4cm – treat if > 6cm
Descending >3cm – treat if > 5.5cm

— or >1cm/y or 0.5cm/6m

threshold is 1cm less for CTD pt or bicuspid aortic valve

RF: Atherosclerosis, connective tissue dz (Marfan), bicuspid aortic valve, vasculitities (takayasu, giant cell, ank spond), infectious aortitis

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10
Q

Abdominal aortic aneurysm (AAA) criteria, screening, and follow-up

A

> 3cm

Screening US if >65 y/o

<4cm: 6m f/u and if not change, annual
4-4.5cm: 6m f/u
5-5.5cm: consider surg
>5.5cm: Surg recommended

OR

repair if >0,5cm growth in 1y; symptomatic

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11
Q

Endoleak definition and types

A

Persistent flow into an excluded aneurysm sac after endovascular repair with stent graft

1: Inadequate seal allows leakage from above or below graft into sac
2: Persistent collateral flow into the excluded aneurysm sac; often IMA or lumbars
3: Graft failure/break with leak through graft
4&5: diagnosis of exclusion; no endoleak can be see although sac increases
4. porous graft; transient and intraprocedural; usually resolves 1m post anticoag
5. endotension - leak too small to detect

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12
Q

Aortitis causes and complications

A

Causes: infection or inflammation (Takayasu, GCA, ank spond, rheumatoid)

Complications: acute mycotic aneurysm (infected aneurysm), chronic (segmental stenosis and/or aneurysm)

Findings: circumferential mural thickening and enhancement (>2mm)

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13
Q

Takayasu Arteritis: definition, imaging findings

A

idiopathic, inflammatory, large vessel vasculitis that involves the thoracic and abdominal aorta, subclavians, carotids, pulmonary artery, and the large mesenteric arteries

young to middle-aged women

Imaging: long, smooth stenosis, indistinguishable from GCA

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14
Q

Aortic cortication: Definition and imaging findings

A

Definition: Congenital, focal narrowing of the proximal, descending aorta
juxtaductal in adult for (at ductus arteriosis) -> UE HTN
preductal in ped: LVO obstruction and CHF

“3” sign on CXR

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15
Q

Coronary CTA retro and prospective gating

A

Retrospective gating: continuous scanning thru cardiac cycle; allows for cine recons for cardiac and valvular function; large rad exposure
Prospective gating: use ECG to time acquisition to decrease radiation

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16
Q

Uses of Phase Contrast Imaging sequence

A

Useful for velocity and volume
-regurg, shunts (L-R or R-L), HOCM velocity

measures flow coming toward or away from you by adjusting VENC (black or white)

-Nik has video on this

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17
Q

Cardiac Fibroma Appearance

A

Round, bulging well circumscribed intramural tumors within the ventricular myocardium that often contain central calcs

2nd most common pediatric tumor

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18
Q

Uses of T1 mapping

A

Creates a map of patient t1 values in the myocardium and compares them to normal values to detect abnormalities that aren’t seen as scars on traditional LGE phases; often useful in diffuse diseases like sarcoid

Disorders cause T1 prolongation except for Anderson-Fabry’s disease (short t1)

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19
Q

Uses of SSFP Sequence; “Bright blood”

A

Wall motion abnormalities, wall thickening; useful for “scouting” mass

T1 and T2 combo with bright fluid and fat

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20
Q

Cardiac Angiosarcoma Appearance

A

irregular vascular channels w/ associated hemorrhage and necrosis
Heterogenous enhancement on CT and MRI (on arterial and delay)
Most common malignant tumor

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21
Q

Second most common pediatric cardiac tumor and imaging findings

A

Fibroma

22
Q

Most common pediatric primary heart tumor & imaging findings

A

rhabdomyoma

23
Q

Most common adult primary cardiac tumor and imaging findings

A

Myxoma
treat w/ surg
t2 bright progressive enhancement

24
Q

Dumbbell shaped lesion in intraatrial septum sparring fossa ovalis

A

Lipomatus hypertrophy of the ibtraatrial septum

*shows up on PET cause contains brown fat

25
Q

Most common primary malignant adult cardiac tumor and imaging findings

A

angiosarcoma
poor prognosis

26
Q

Differential for mass on valve

A

Endocarditis

papillary fibroelastoma

27
Q

papillary fibroelastoma valve preference and amangement

A

Aortic valve - found on aortic side

Mitral valve - LA side

Should surgically resect if symptomatic (i.e. emboli)

28
Q

LAD gives off which two types of branches?

A

Diagonals and septal perforator

29
Q

The left circumflex and the RCA give off which type of vessels?

A

RCA: Acute marginals
LCX: Obtuse marginals

30
Q

SA nodal branch and conal branches come off the aorta in which direction? (ant or post)

A

Conal: anterior and down to the RVOT
SA Nodal: posterior and up

31
Q

Defining feature of malignant coronary artery course

A

Interarterial (between the aorta and PA)

can RCA from L or non-dominant cusp or LM/LAD/LCX from R or non-dominant cusp

32
Q

What do ALCAPA (Bland-White-Garland Syndrome) and ARCAPA stand for and what is their significance?

A

Anomalous left/right coronary artery arising from the pulmonary artery.

Always malignant

33
Q

Mid-myocardial delayed enhancement causes

A

Dilated cardiomyopathy: long differential (idiopathic, OH abuse, myocarditis, drugs); look for ventricular enlargement and decreased EF
Sarcoid: LV dysfunction, arythmia, restrictive CM
Chagas: T. cruzi; epi or mid myocardial
Hypertrophic cardiomyopathy (HCM): abnormal LV thickening; LGE often at junctions of IV septum and the RV free wall fibers

34
Q

Epicardial/subepicardial delayed gad enhancement

A

Myocarditis
Chagas
Sarcoid

35
Q

Circumferential, subendocardial late gad enhancement (LGE)

A

Amyloidosis: glycoprotein deposition throughout the extracellular spaces; biventricular myocardial thickening and enhancement with a dark blood pool

Cardiac transplant: thought to correlate with the presence of myocardial fibrosis

36
Q

CXR findings or LA enlargement and two primary causes

A

Causes: Mitral regurg (big LA and norm heart) and stenosis (big LA and big heart)

Double density sign (LA seen over the RH border)
Splaying of the carina
Upward shift of the L main bronchus on lat CXR

37
Q

False v true ventricular aneurysm

A

False: 2/2 occlusion of LCX or RCA; often rupture as only contained by pericardium; need surg treatment

True: 2/2 occlusion of LAD; contains all layers of the wall; within the left ventricle and often calcify; rarely rupture

38
Q

Valve locations on CXR

A
39
Q

Mitral annular calcification associations

A

Stroke, adverse cardiovascular events, atrial fibrillation, mitral regurg

NOT associated with mitral stenosis unlike mitral valve calcifcations

40
Q

Takotsubo (catecholamine induced) cardiomyopathy

A

self-limiting cardiomyopathy 2/2 emotional distress leading to ballooning often of the LV apex

No CAD or LGE on MR

41
Q

Arrhythmogenic cardiomyopathy (ARVD; arrhythmogenic RV dysplasia)

A

Fibrofatty replacement of the ventricular myocytes leading to contraction abnormalities and/or aneurysm

both ventricles in up to 3/4 or pts

prone to arrhythmia so need defibrillator

42
Q

Myocardial nonimpaction appearance and sequelae…

A

arrythmias, thrombus formation, stroke, cardiomyopathy

“heavily trabeculated LV”

43
Q

Restrictive cardiomyopathy imaging characteristics and causes

A

Imaging: small, stiff ventricles leading to dilated atria and backflow into IVC

Causes: Sarcoid, amyloid, hemochromatosis

44
Q

Name the associated valve:
Coronary sinus:
IVC:

A

Thebesian : Coronary sinus
Eustachian : IVC

45
Q

Name the structure denoted by the arrow

A

Crista Terminalis
In the posterior right atrium and separates the muscular and smooth portions of the RA

46
Q

Cardiac vascular supply picture

A
47
Q

Left SVC drains into the ______ and is the most common congenital thoracic venous anomaly.

A

Coronary sinus (near the LA)

48
Q

Middle and great coronary vein course

A

Middle CV cpurses through the posterior interventricular groove and drains into the coronary sinus

the great CV courses in the left AV groove and drains into the CS

49
Q

High

A
50
Q

The

A

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Savvy’s

Radiology Boards (1 decks)

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