Cardiac/Vascular Flashcards
Most common primary malignant cardiac tumour in adults and features?
Angiosarcoma
**Right atrium **and involve more than one chamber
Broad based attachment
Can encase the Coronary
Present - septic emboli or invasion into pericardium = effusion/tamponade
Heterogeneously high signal on T1 and T2-weighted images with heterogeneous enhancement
Undifferentiated sarcoma mostly arises in the left atrium, although they can also involve the cardiac valve
DDx
Lymphoma
- Primary cardiac lymphomas
- Right atrium, with frequent involvement of more than one chamber and
invasion of the pericardium
-isointense on T1-weighted images and heterogeneously hyperintense on T2-weighted images
Most common benign cardiac tumour in adults?
Atrial Myxoma
LA and stalk attached to interatrial septum.
Prolapse through MV
Enhance with Gd (thrombus will not)
Associated with
Carneys syndrome (myxoma, facial/buccal blue neavi, sertoli tumours testes)
Most common fetal cardiac tumour?
Rhabdomyoma
LV. Associated with TS
Most common aortic arch anomaly
Left arch aberrant right subclavian artery
Posterior indentation of oesophagus.
If symptomatic = Dysphagia lusoria
Indentation both oesophagus ‘reverse S’
Posterior indention and anterior indentation of the trachea?
Double aortic arch
Most common vascular ring
What is pulmonary artery sling
Aberrant left pulmonary artery
Anomalies origin of the left pulmonary artery from the right pulmonary artery.
passes above the right main bronchus and in between the trachea and oesophagus
anterior indentation of the oesophagus and posterior trachea
Only vascular ring to between the oesophagus and trachea
Follow up for AAA ?
3 - 4.4 cm (small) = 12 month US
4.5 - 5.4 cm (medium) = 3 month US
> 5.5cm (large) = Vascular ref and CT if Sx candidate
Hydronephrosis, retroperitoneal fibrosis, anuerymsal abdominal aneurysm, soft tissue thickening of wall?
Inflammatory aortic aneurysm
More fusiform shape.
Extend to distal aorta and iliacs
assoicated with other ig4-related diseases
Rapidly growing lobulated saccular aneurysm arising eccentrically from abdominal aortic wall. Adjacent periaortic soft tissues sweeling and gas locules?
Mycotic aneurysm
Bacterial. Look for adjacent Psoas abscess or vertebral infection.
DDx Syphilitic aortitis shows curvilinear calcifications
Smoker, young, arterial occlusion with corkscrew collaterals in hands and feet ?
Buerger
Soft tissue swelling in lower limb, varicose veins, port wine stain ?
Kippel - trenaunay - weber
Classic triad
Bone and soft tissue hypertrophy
Cutaneous capillary malformation (port-wine stain)
Congenital lymphatic and venous malformations (slow flow)
Soft tissues of the right leg diffusely enlarged . Soft tissue enlargement is secondary to multiple low-flow vascular malformations and fat hypertrophy.
A phlebolith is present within 1 of the venous malformations.
May-thurner?
obstruction of the left common iliac vein by compression right common iliac artery
Describe Cystic advential degeneration
Mucus cysts on wall of popliteal artery.
High T2 and T1 (depending on mucin present)
Popliteal artery entrapment syndrome
Anomalous insertion of the medial gastrocnemius
claudication in young fit people
Types of endoleaks ?
Type 1 = proximal or distal graft attachment site
Type 2 = Retrograde filling of sac from persistent collateral
Type 3 = mechanical problem with endograft (fabric tear/graft disruption)
Type 4 = Porous graft material
Type 5 = Endotension
What type of vascuilitis is Takasayau and what does MRI/CT show?
Large vessel vasculitis
Young, female
**High STIR signal in wall = oedema
CT mural thickening, mural enhancement and aneurysmal dilatation, pseudoaneurysm +/- large vessel occlusion
what type of vasculitis is PAN and what condition strongly assoiciated with?
Medium vessel vasculitis
Branches of aorta
Associated with Hep B
Multiple 1-5 mm peripheral aneurysms , Occlusions , Irregular stenoses
Diffuse wall thickening of medium-sized arteries
Kidneys (70-80%)
GI tract, peripheral nerves, and skin (50%)
Skeletal muscles and mesentry (30%)
What condition in children assoaicted with Coronary artery aneurysm?
Kawaski
Lung features in Granulomatosis With Polyangiitis (Wegener)
**Multiple lung nodules or masses ± cavitation
GGO ( pulmonary hemorrhage)
Severe chronic rhinosinusitis septal cartilaginous and osseous destruction
Tracheal wall thickening Circumferential (involvement of posterior membranous trachea)
** Spared in relapsing polychondritis
C- ANCA
Transient, peripheral consolidation in patient with asthma and positive p-ANCA
Eosinophilic Granulomatosis With Polyangiitis (churg struss)
Peripheral, transient consolidations
Mimics eosinophilic pneumonia
Microscopic polyangitis
Consider MPA in patients with alveolar hemorrhage (i.e., ground-glass opacities &/or consolidation) and concomitant renal disease (i.e., glomerulonephritis)
also P-ANCA
Angio vessels affected are too small unlike PAN etc
Bechets
Consider multiple pulmonary artery aneurysms, particularly young men of Mediterranean, Middle Eastern, or Asian ethnicity
Oral and genital mucosal ulcers, uveitis
Involves distal ileum and closely mimics Crohn disease or malignancy
Hodgkins vs NHL
Hodgkins
-spread is contiguous
-anterior mediastinal nodes
- Thorax predominantly
- abdo involvement ~ 4 %
NHL
-spread is non-contiguous
- Abdomen predominantly
- posterior mediastinal nodes
- thorax involvement in ~50%
Classification of aortic dissection?
see picture
