Cardiovascular Imaging

Question 1

Associations/causes of aortic dissection

Answer 1

Hypertension
Marfan’s/connective tissue disorder
Bicuspid aortic valve
Coarctation of the aorta
Cocaine
Weight lifting
Sudden deceleration

Question 2

Characteristics of infarction on cardiac MR?

Significance of T2 bright?

Answer 2

Delayed enhancement with Gd
From subendocardium towards epicardium in a vascular distribution
Islands of dark tissue within area of delayed enhancement (microvascular obstruction)

Salvageable tissue

Question 3

Location of true ventricular aneurysm?

Location of false aneurysm?

Answer 3

Anterolateral wall

Posterolateral wall

Question 4

Structural appearance of heart with amyloid?

Specific findings for amyloid?

Cardiac MR findings?

Answer 4

All four chambers involved
Dilated atria
Concentric LV thickening

Interatrial septum and right atrial free wall thickening >6mm

Reduced systolic fx but this is a disorder of DIASTOLIC dysfunction
May be late enhancement of entire subendocardial surface

Question 5

Eosinophilic cardiomyopathy/Loeffler’s syndrome?

Answer 5

Biventricular or RV thrombus

Question 6

Abnormal thickness of pericardium?

Most common causes constrictive pericarditis?

CT/MR finding?

Answer 6

> 4mm

Viral/idiopathic, TB, post-CABG, post-radiation

Calcification, sigmoidization of septum, reduced RV size, diastolic bounce on CINE imaging, signs of heart failure

Question 6

Cardiac MR findings of myocarditis?

Answer 6

Midwall or epicardial enhancement, particularly involving the lateral free wall

Question 7

Subendocardial?

Midwall?

Epicardium?

Patchy midwall?

Answer 7

Vascular territory - infarct
Circumferential - amyloid

Myocarditis, sarcoid

Myocarditis, sarcoid

HOCM

Question 7

Differential for symmetric increased thickness of LV wall?

Answer 7

HOCM
Amyloid
Sarcoid
Fabry’s
Athlete’s heart
Adaptive

Question 8

HCM key measurement?

Differentiating factors from other causes of LV thickening?

Answer 8

Hypertrophy of muscle to >15mm

Hyperdynamic systolic function, patchy midwall delayed enhancement, abnormal EDV + EF

Question 9

Sarcoid on cardiac MR:
- site of involvement?
- MR findings?

Answer 9

Septum/LV - NOT RV
Increased T2 signal and Gd enhancement both early and late, midwall or epicardial, in a nodular or patchy pattern

Question 10

Prominent ventricular trabeculation?

Answer 10

Left ventricular non-compaction

Question 11

Most common metastasis to the heart?

Which cancer has the highest percentage of cardiac involvement?

Answer 11

Lung cancer

Melanoma

Question 12

Right atrial tumour?

Left atrial tumour?

LV tumour?

Right sided tumour + pericardium?

Tumour of the valve?

Answer 12

Angiosarcoma

Myxoma, undifferentiated sarcoma

Rhadomyoma

Primary cardiac lymphoma

Fibroelastoma

Question 13

Blunt cardiac injury:
1. Concussion?
2. Contusion?

Answer 13

1. Wall motion abnormalities but no anatomic or cellular injury
2. Anatomic injury with elevated enzymes and tissue damage

Question 14

Blunt cardiac injury:
1. What structures most likely to be injured?
2. Best screening modality in stable and unstable patients?

Answer 14

1. Right ventricle (most anterior) and left-sided valves (high pressure)
2. ECHO - unstable; CECT - stable