Cardiothoracic Flashcards
What’s Ritalin lung?
Ritalin lung (a.k.a. methylphenidate lung) describes pulmonary changes induced by the illicit injection of talc-containing methylphenidate. CT: panlobular emphysematous change mainly in Lower lobes.
Which cardiac mass shows Delayed enhancement?
Fibroma.
What defines a high origin of a coronary artery?
defined as >1 cm above the sinotubular junction of the ascending aorta. there is a reported increased incidence of high origin of the right coronary artery in patients with bicuspid aortic valves.
The most common coronary anomaly associated with TOF?
the right coronary artery arising from the left anterior descending artery (LAD).
What might cause constitutional symptoms in atrial myxoma
Release of IL-6
Water lily sign
Complete detachment of the membranes inside a hydatid cyst results in free floating membranes within the cyst cavity.
What’s fallen lung sign?
the appearance of collapsed lung away from the mediastinum encountered with tracheobronchial injury (in particular those >2 cm away from the carina). It is helpful to look for this rare but specific sign, in cases of unexplained persistent pneumothorax. It can be seen on both plain radiographs and CT.
What’s Eloesser flap?
s a single-stage procedure for the treatment of severe pleural empyema, and involves a U-shaped incision and the resection of a number of subjacent posterolateral ribs. The U-shaped flap is then folded into the pleural space creating a permanent communication.
What’s the enhancement pattern in Post-partum cardiomyopathy?
Sub-Epicardial in non-vascular territory.
What’s Carney Complex?
- Cardiac myxoma.
- Skin pigmentation.
- Enodcrine tumors.
All sternochondral joints are synovial except
1st joint which is a 1ry cartilaginous
What’s the most common cause of displaced azygoesophageal recess?
Hiatal hernia.
Where the thoracic duct drains?
Into the junction of the left IJ and left subclavian vein.(where left brachiocephalic vein forms)
Cystic lung mets ddx
- Colorectal
- Transitional cell ca.
- Osteosarcoma mets.
MC location for cardiac angiomyosarcoma?
RA
Fibrous tumor of the pleura extra-pulmonary features?
- Hypoglycemia
- hypertrophic osteoarthropathy.
What’s the MC benign tumor of the trachea?
Laryngeal papillomatosis (HPV-6) is , 1/3 can have invasive SCC transformation.
What separates the subclavian artery from the vein?
Scalenus anterior muscle ( the vein being anteriorly).
A key feature differentiating NSIP from IPF
is the presence of ground glass in NSIP.
If there’s gas within the empyema
there should be a bronchopleural fistula!!! Empyema should not contain air even if it’s caused by gas-forming organism.
What separates the muscular wall from the smooth wall of the atrium?
Crista terminalis is on the lateral wall of the RA
Posterior descending artery run in
the posterior AV groove.
First branch of the RCA
is the conus branch.
What’s the most common primary malignant neoplasm of the chest wall?
Chondrosarcoma
What’s the difference between diaphragmatic eventration ana paralysis?
In eventration, the anterior 1/2 or 2/3 of the hemidiaphragm is typically affected. When a hemidiaphragm is paralyzed, the entirety of the hemidiaphragm is elevated, including the posterior portion
Positive remodeling with LOW attenuation plaques
VERY high risk of plaque rupture and acute MI
Loeffler endocarditis
- hypereosinophilic syndrome.
- subendocardial enhancement on BOTH VENRTICLES.
- bi-ventricular thrombi.
Endocarditis prophylaxis is necessary for both muscular and membranous VSDs.
Endocarditis prophylaxis is necessary for both muscular and membranous VSDs.
Mitral valve clefts seen with what anomalies?
- Primum ASD.
- Associated with Down’s.
The most common variant of pulmonary venous anatomy
single left pulmonary ostium
What’s the 2nd MC primary cardiac mass after a myxoma?
Papillary fibroelastoma.
When you see LGE with dark blood?
Consider amyloid.
Gad gets extracted by tissues faster in amyloid patients
What’s the reason for LGE in amyloid?
The LGE signal corresponds to interstitial amyloid deposition and the subendocardial fibrosis consequent to ischemia, which is itself due to capillary obstruction by amyloid deposits
The most 2 important sequences to evaluate for amyloid?
LGE and T1-mapping.
When is mirror-image pattern seen in amyloid?
When the inversion time inappropriately shorter than it’s supposed to be.
What supplies the anterolateral papillary muscle?
- LAD
- LCx.
What supplies the posteromedial papillary muscle?
RCA.
More prone to rupture following RCA MI given single blood supply, leading to MR and acute RUL pulmonary edema.
Where’s the aortic root?
Between arotic annulus and STJ.
Which cardiomyopathy is relative contraindication for heart transplant?
Amyloid, especially if there’s marked systemic involvement.
LA appendage thrombus is best evaluated with?
TEE
Sinus of Valsalva aneurysm mostly involve which cusp?
RIGHT (70%)
What’s the MC interstitial pattern in RA?
UIP.
When do you see MAPCA? Major aortopulmonary collateral arteries
- pulmonary atresia with ventricular septal defect
- tetralogy of Fallot with severe pulmonary stenosis
- Pulmonary capillary hemangiomatosis.
- Pulmonary veno-occlusive disease.
- Shared continuum of path-physiology.
- Young patients with Pulmonary HTN.
- Pulmonary vasodilators might cause SEVERE pulmonary edema; and death.
Multifocal Multinodular Pneumocyte Hyperplasia (MMPH)
- Hamartoma of type II pneumocytes.
- Seen in TS.
- Random distribution.
Thea heart sits in which mediastinal compartment?
ANTERIOR!
The separation between anterior and middle mediastinum is a line drawn behind the heart and anterior to the trahea.
Where does the posterior mediastinum start?
Line 1 cm behind the anterior vertebral edge to the posterior ribs.
Microvascular thrombosis?
Implies transmural infarct. Seen best in first pass phase.
What’s the artery?
SA nodal branch. Runs posteriorly and inferiorly
What’s the first branch of RCA?
Infundibular brach (aka Conus).
Runs superiorly and around the
Which types of endoleak need immediate treatment?
Type I and III
Dome-like aortic valve seen in?
Bicusbid valve.
High blood eosinophil count is seen in which phase oh eosinophilic pneumonia?
Chronic.
High eosinophils in BAL seen in ACUTE.
Cardiac osteosarcoma almost always occurs in
LA
What’s the significance of this finding?
Mitral annular calcification. It’s a marker for:
- Coronary artery calcification
- Heart block
- MILD mitral Regurgitation.
What’s the other technique to obtained nulled myocardial sequence without using T1 scout?
Phase Sensitive Inversion Recovery (PSIR) can be used which does not require a TI scout.
What’s the orientation of the VENC plane when acquiring cine?
It has to be perpendicular to the path of the flowing blood.
What’s a single dose of Gadolinium in cardiac imaging?
0.1 mmol/kg, which is 0.2 cc/kg (0.1 for mmol).
A double dose is twice that: 0.2 mmol/kg or 0.4 cc/kg.
How can ECG gating be done if the gating through the leads is unsuccessful?
pulse triggering can be employed using a pulse oximeter with the systolic upstroke as the trigger for the pulse sequence.
In which phase Atrial Diameter is measured?
End systole.
Ventricular diameter and spetal thickness are measured during in diastole.
Lack of pericardial slippage on tagged images seen in?
Constrictive pericarditis
Soft tissue mass in the anterior mediastinum that drops out in OP sequence?
Normal thymus gland.
