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Pediatric Imaging > Heart Disease > Flashcards

Heart Disease Flashcards

1
Q

Type of congestion where there is increased pulmonary vascularity due to increased flow of blood through the lungs

A

Active congestion

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2
Q

Type of congestion wherein there is increased pulmonary vascularity due to elevated pulmonary venous pressure

A

Passive congestion

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3
Q

4 types of pulmonary vascularity

A

Active, passive, decreased due to obstruction through the PA and normal vascularity

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4
Q

Most commonly encountered type of congestion that appears when a systemic to pulmonary, left to right shunt is occurring that is large enough to detect on a chest xray

A

Active congestion

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5
Q

Rule of thumb in increased pulmonary vascularity

A

Right descending PA is as large as the trachea diameter and other vessels are increased in diameter

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6
Q

Occurs when there is elevation of the pulmonary venous pressure, from LV abnormalities, mitral valve, RA (cor triatriatum), or obstruction of pulmonary venous return (TAPVR or pulmonary vein stenosis)

A

Passive congestion

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7
Q

Pulmonary veins enlarge and become ill-defined in passive congestion due to

A

Fluid leaking into the interstitial tissues of the lungs

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8
Q

Causes of decreased pulmonary vascularity

A

Obstruction of the right ventricular outflow at the infundibulum, pulmonary valve or main PA

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9
Q

Heart disease with normal blood flow and therefore normal vascularity

A

Coarctation of the aorta, early cardiomyopathy

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10
Q

CHD that presents with asymmetric pulmonary blood flow

A

TOF, truncus arteriosus, pulmonic stenosis and postoperative patients

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11
Q

Asymmetric blood flow can be due to

A

Focal pulmonary arterial stenosis (William syndrome) or underlying lung abnormality (prematurity, congenital diaphragmatic hernia)

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12
Q

A right aortic arch can be seen in what conditions

A

TOF, truncus arteriosus, double aortic arch and right aortic arch with an aberrant left subclavian artery

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13
Q

Most commonly encountered contour abnormality of the aorta is from what condition

A

Coarctation of the aorta

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14
Q

Main PA can be concave along with decreased vascularity in what condition

A

TOF

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15
Q

Main PA can be large due to what conditions

A

Left to right shunt, poststenotic dilation from pulmonary valvar stenosis, pulmonary valvular insufficiency or pulmonary hypertension

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16
Q

What creates the figure 3 sign of coarctation of aorta

A

Prestenotic and postenotic dilatation of aorta

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17
Q

How many anterior ribs should be present above the diaphragmatic shadow to say you have a normally aerated chest

A

6

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18
Q

On lateral radiograph, cardiomegaly can be assessed by tracing a line down the anterior trachea, if the posterior aspect of the heart doesnt extend beyond this line, then what does it say

A

Normal. No cardiomegaly

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19
Q

If a left to right shunt is large enough, the pulmonary pressures will eventually increase and the shunt will reverse because of pulmonary hypertension, a phenomenon called

A

Eisenmenger physiology

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20
Q

Most common congenital heart anomaly and can be isolated or associated with more complex CHD

A

VSD

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21
Q

Most common form of VSD that is most commonly symptomatic

A

Perimembranous defects

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22
Q

Type of VSD where the membranous and muscular septum fuse

A

Perimembranous

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23
Q

Type of VSD that are often small, multiple, less hemodynamically significant and tend to close over time

A

Muscular

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24
Q

Type of VSD that is least common and occur due to an abnormal development of the conus portion of the truncus during cardiac development

A

Conal VSD

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25
Q

What type of VSD is usually seen in TOF and truncus arteriosus

A

Conal VSD

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26
Q

A VSD is usually not evident either clinically or radiographically due to

A

High pulmonary vascular resistance at birth

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27
Q

Radiographic features of VSD

A

Prominent LV, main PA segment enlargement and LA enlargement, increases vascularity

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28
Q

Cardiac defect most commonly missed in infancy because it is a low-pressure left to right shunt that increases as the pulmonary resistance decreases after birth

A

ASD

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29
Q

Radiographic features of ASD

A

Enlarged or prominent right heart border due to RA enlargement, extension of RV into the retrosternal space and increased pulmonary vascularity

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30
Q

Why does LA enlargement do not occur in ASD?

A

It acts as a passive conduit for the blood shunted from LA to RA

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31
Q

During fetal life, the right ventricular blood flow is shunted away from the developing lungs via the ______ and into the aorta

A

Ductus arteriosus

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32
Q

Consequence of PDA

A

Left side of the heart dilates

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33
Q

Cardiac anomalies that are ductal dependent for systemic blood flow

A

Hypoplastic left heart, interrupted aortic arch

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34
Q

Rare condition that develops when there is incomplete division of the primitive truncus arteriosus and there is absence of a wall between the aorta and PA immediately above the valves

A

Aortopulmonary window

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35
Q

Rare cause of left to right shunt that can shunt blood from the aorta to the right cardiac chambers, coronary sinus or PA

A

Coronary artery fistula

36
Q

Classic and most common CHD resulting in the cyanosis

A

Transposition of great vessels (D-transposition)

37
Q

In this condition, systemic veins, pulmonary venous flow and atrioventricular connections are normally connected, but the origin of the PA and aorta are reversed, resulting in ventriculoarterial discordance

A

Transposition of great vessels

38
Q

In TOGV, aorta arises from ____ and PA arises from _____

A

Aorta from RV, PA arises from LV

39
Q

Presents as oval heart shape with a prominent apex and variable cardiomegaly and a narrow upper mediastinum due to superimposition of the aorta and main pulmonary artery in the AP plane, thymic atrophy

A

TOGV

40
Q

Surgical intervention for TOGV to allow free mixing of oxygenated and deoxygenated blood until the definitive repair can be performed

A

Catheterization and balloon atrial septostomy (Rashkind procedure)

41
Q

In this condition, the ventricles are also inverted such that the morphologic LV is attached to the RA and the morphologic RV is attached to the left atrium.

A

Corrected transposition (L-transposition)

42
Q

Usual coexisiting cardiac defect in corrected transposition that allows systemic to pulmonary shunting

A

VSD

43
Q

Characteristic finding on chest xray that suggest corrected transposition in the absence of increased pulmonary vascularity

A

Border forming ascending aorta on the left side of the heart due to aorta arising from the leftward and posterior RV

44
Q

Condition in which both arteries arise from the RV and the outlet from the LV is a VSD

A

Double-outlet right ventricle

45
Q

Absence of pulmonary stenosis un double outlet RV results in

A

Large main PA segment, increased vascularity, moderate cardiomegaly

46
Q

Severe pulmonic stenosis in double-outlet RV results in

A

Concave PA segment, decreased vascularity with mild cardiomegaly

47
Q

Present when all the blood returning from the lungs returns to the right side of the heart

A

TAPVR

48
Q

Most common type of Anomalous venous site in TAPVR

A

Supracardiac

49
Q

Imaging features of TAPVR

A

Right heart and PA are enlarged, increased blood flow to the lungs

50
Q

Appearance of obstructive TAPVR

A

Normal heart size with severe interstitial or alveolar pulmonary edema

51
Q

Snowman sign in TAPVR only occur when

A

The vertical vein empties into the brachiocephalic vein

52
Q

Rare anomaly that presents in early infancy with pulmonary venous obstruction. The pulmonary veins empty into a common confluence separated from the LA by a partial membrane causing obstruction to return of the pulmonary venous flow to the left heart

A

Cor triatriatum

53
Q

Name was derived from the appearance of an extra “atrium” posterior to the LA

A

Cor triatriatum

54
Q

Defect where there is failure of the primitive truncus to divide correctly into the aorta and PA

A

Truncus arteriosus

55
Q

Chest xray presentation of truncus arteriosus

A

Cardiomegaly and active pulmonary congestion, right arch, concave MPA

56
Q

Decreased pulmonary vascularity happens when

A

There is obstruction on the right side of the heart and an intracardiac right to left shunt

57
Q

Most common cyanotic CHD

A

TOF

58
Q

4 components of TOF

A

Right ventricular hypertrophy, pulmonic stenosis, perimembranous VSD, aorta that overrides the VSD)

59
Q

What dominates the physiology of TOF

A

Right ventricular outflow tract obstruction and a large perimembranous VSD

60
Q

How many percent of patients with TOF has right sided aorta

A

25%

61
Q

Imaging findings in TOF

A

Upwardly displaced cardiac apex caused by right ventricular hypertrophy and concave pulmonary artery shadow

62
Q

Treatment approach in TOF

A

Complete surgical repair

63
Q

Condition where there is complete atresia of the tricuspid valve, allowing no communication of blood from RA to RV, therefore an atrial-level shunt is required, and in 80% of the cases this is a patent foramen ovale. To keep the flow to PA, it is dependent on a ductus arteriosus

A

Tricuspid atresia without TGA

64
Q

To keep the ductus to keep the ductus arteriosus open in tricuspid atresia, this procedure is done

A

Blalock-Taussig shunt or superior cavopulmonary anastomosis (bidirectional Glenn) and eventually a total cavopulmonary anastomosis (Fontan)

65
Q

Rare condition wherein there is redundant tricuspid valve that balloons into the RV and is adherent to the RV myocardium

A

Ebstein anomaly

66
Q

Third most common CHD after VSD and ASD. It is often asymptomatic and the disease is first suspected when a systolic heart murmur is noted

A

Pulmonic valvar stenosis

67
Q

Most common cause of pulmonic valvar stenosis

A

Commissural fusion (90%)

68
Q

Most common congenital abnormality of the heart because of bicuspid aortic valves

A

Aortic valvar stenosis

69
Q

Chest xray features of aortic valvar stenosis

A

Prominent ascending aortic shadow along the right mediastinum just above the heart, and with age and elongation of the aorta, the transverse segment becomes conspicuous

70
Q

One of the congenital heart lesions that can present later in life with signs first recognized from a chest xray or a renal ultrasound performed to evaluate hypertension

A

Coarctation of the aorta

71
Q

Rib notching in coarctation of the aorta happens when

A

There are well-developed collaterals, usually not until age 8

72
Q

Condition wherein there is bounding upper extremity pulses or have upper-extremity hypertension relative to the lower extremities

A

Coarctation of the aorta

73
Q

Presence of tardus parvus in the aorta suggests what condition

A

Coarctation of the aorta

74
Q

Type of COA that is associated with VSD, ASD and mitral valve abnormalities in many cases

A

Diffuse type “infantile”

75
Q

Type of COA with localized narrowing at or just distal to the ductus arteriosus

A

Juxtaductal

76
Q

Type of single ventricle heart disease that occurs as a spectrum of underdevelopment of left-sided heart structures (aorta, aortic valve, LV, mitral valve and left atrium)

A

Hypoplastic left heart syndrome

77
Q

In this condition, the clinical presentation is severe and out of proportion to the chest xray, which appears relatively normal

A

Hypoplastic left heart syndrome

78
Q

Palliative Surgical procedure for hypoplastic left heart syndrome

A

Norwood procedure

79
Q

Relationship between the thoracic and abdominal viscera is described in terms of

A

Situs

80
Q

Normal configuration of the thoracoabdominal viscera with the cardiac apex

A

Situs solitus

81
Q

It is a complete mirror image of the thoracoabdominal viscera

A

Situs inversus totalis

82
Q

It is when the apex and the bulk of the heart are to the left

A

Levocardia

83
Q

It is when the apex of the heart is to the right and the bulk of the heart in on the right

A

Dextrocardia

84
Q

Should be used when the heart is in the center and the laterality of the bulk of the heart is indeterminate

A

Mesocardia

85
Q

If there are bilateral eparterial bronchi, bilateral trilobed lungs, bilateral right atria, absence of spleen and a liver that spans the abdomen, what heterotaxy is present

A

Right atrial isomerism and asplenia

86
Q

This syndrome typically have hyparterial bronchi, bilateral bilobed lungs, with an asymmetric liver with its bulk on the left or right or in midline, bilateral pulmonary/left atria

A

Polysplenia syndromes

Pediatric Imaging (5 decks)

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