Page 28 Flashcards
MCC of infectious aortitis
S. Aureus and Salmonella
Imaging findings of aortitis
Circumferential or cresentic inflammatory wall thickening (>3mm) on CTA w/ corresponding increased FDG uptake
MC aortic tumors
Aortic sarcoma
CT/MR showing irregular mass-like thickening along the aorta
Aortic Sarcoma
Increased pulmo vascularity, enlarged LA LV, small aorta
VSD
MCC of CYANOTIC CHD
TOF
MC involved sinus in Ruptures aneurysm of sinus of Valsalva
Right (anterior) aortic sinus - rupture is into the RVOT
Increased lulmo vascularity, enlarged LA LV, N/Large aorta
PDA
Increased pulmo vascularity, enlarged RA (RV), small aorta
ASD
Common pulmo vein communicates with R side of the heart
TAPVR
L-R shunt: defect involves either tricuspid valva annulus or just above RA
LV to RA shunt
L-R shunt: associated with ASD than being isolated
PAPVR
TAPVR: drains into RA via the vertical vein (persistent L SVC) and azygous v (R)
Type 1
TAPVR type: supradiaphragmatic
Type 1 and 2 (MC)
L-R shunt: failure of complete separation of primitive truncus arteriosus
Aorto-pulmonary window
TAPVR type: infradiaphragmatic
Type 3
TAPVR: drains into portal vein
Type 3
TAPVR type: active congestion
Type 1 and 2
TAPVR type: mixed
Type 4
Mimicker of figure 8 on CXR
Infant w/ VSD and enlarged thymus
PTA type: pulmo a arise from descending aorta via collateral vessels
Type 4 (Collett-Edwards)/Pseudotruncus Type1
TAPVR: drains into RA by coronary sinus
Type 2
Syndrome assoc w/ TAPVR1 wherein the vertical vein is compressed by pulmo a and
left bronchus
Pulmonary vise syndrome
TAPVR type: passive congestion (pulmo edema)
Type 3
Unilateral involvement of pulmonary vein will show one-sided interstitial edema
Pulmonary venous atresia
PTA type: associated with interrupted aortic arch
Type 4 (van Praagh)
Single vessel drains both ventricles and supplies the systemic, pulmonary, and coronary circulation
Persistent truncus arteriosus
PTA type: 1 PA arises from ascending aorta, the other from RV
Hemitruncus arteriosus (RPA abnormal)
PTA type: PDA supplies the pulmo arteries
Pseudotruncus type 2 (severe tetralogy)
All of PTA types have concave pulmonary artery on CXR, except
Type 1 - pulmo artery arises from trunk of truncus arteriosus
PTA type w/ no misdirection of venous blood into aorta, no cyanosis, and no assoc VSD
Hemitruncus arteriosus - one pulmo a arises from ascending aorta while the other is normal. Only 1 side has L-R shunt
TGA type: both great vessels receive blood from RV. PA arise from RV alone
Double outlet RV (Type 1)
Egg shape heart
TGA
TGA type: both great vessels receive blood from RV. Large PA arise from both ventricles overriding a high VSD
Double outlet RV (Type 2) -Taussig-Bing Anomaly
T or F. In TGA, the aorta always arises from RV.
TRUE
TGA type: reversed AP relation of great vessels, aorta remains in normal position from side to side
Complete/Simple TGA
TGA type: transposed great vessels and inverted great vessels and ventricles
Congenitally corrected TGA
TGA type: D transposition
Complete/simple TGA
TGA type: L transposition
Congenitally corrected TGA
TGA type: hemodynamically normal circulation, ACYANOTIC
Congenitally corrected TGA (blood in lungs to LA, to RV, to aorta; systemic blood to RA, to LV, to PA)
Decreased pulmo vascularity, concave PA, prominent Rsided aorta, RVH
TOF
Most important point to differentiate TOF from other CHD w/ diminished pulmo vascularity
TOF = RIGHTsided aorta
MCC cyanotic CHD beyond first 30days of life
TOF
One ventricle is large, the other is rudimentary
Single ventricle
MC form of single ventricle
Underdevelopment of RV
Critical component of TOF
pulmonary stenosis
Mild case of TOF w/ mild pulmonary stenosis
Pink TOF
MC side to have decreased pulmo vascularity in TOF
LEFT (LPA hypoplastic or absent)
TOF associated w/ pulmonary valve atresia
Pseudotruncus arteriosus type 2
Syndrome w/ small RV, large LA and LV, varying degrees of RA enlargement, and R-L shunting
Hypoplastic Right heart syndrome
Conditions in Hypoplastic Right heart syndrome
Tricuspid atresia and stenosis, pulmo atresia, and isolated hypoplasia of RV
MC condition in Hypoplastic Right heart syndrome
Tricuspid atresia
Pulmonary atresia type: more developed RV and patent tricuspid valve, marked RA enlargement
Type 2
Pulmonary atresia type: severe hypoplastic RV, atretic tricuspid v, no RA enlargement
Type 1
T or F. Type 2 pulmonary atresia may have similar heart configuration w/ Ebstein anomaly
TRUE
Tetralogy of Fallot components
PS, RVE, VSD, overriding aorta
Downward displacement of tricuspid valve (septal and posterior leaflet), RV is
incorporated to the RA (anatomically nad functionally)
Ebstein’s anomaly
Most frequest cause of death in Ebstein anomaly
Cardiac arrhythmia
Absent pulmo artery: isolated
Either RPA or LPA
Focal or complete absence of RV
Uhl’s disease
Trilogy of Fallot components
PS w/ intact ventricular septum, RAE, and R-L shunt (PFO/ASD)
Ebstein vs Uhl
Ebstein - only the atrialized portion of RV has thin wall; Uhl - RV is thin-walled (fibroelastic bag) dt absence of RV myocardium
Pentalogy components
Absent pulmo artery: TOF
LPA
Absent pulmo artery: PTA
either RPA or LPA
MC form of Supravalvular pulmonary stenosis
Multiple peripheral pulmo artery coarctations
T or F. Left-side obstruction shows normal pulmo vas pattern inspite of serious cardiac lesions.
TRUE
Normal vascularity, LVH, normal/prominent aorta
Aortic stenosis
AS: cone shape LV from marked thickening of intraventricular septum and LV myocardium
Subvalvular AS
Aortic stenosis: infantile hypercalcemia (Williams) syndrome
Supravalvular stenosis
AS: associated with prominence of ascending aorta
Valvular AS
LVD (downward point of apex), prominent ascending aorta, prominent aortic knob
Aortic insufficiency
AS: small aortic knob
Supravalvular AS
AS: assoc w/ idiopathic hypertrophy of LV and interventricular septum
Subvalvular stenosis
COA: narrowing proximal to ductus arteriosus, long segment
Preductal/isthmic/infantile
COA: narrowing at/distal to L subclavian artery and ductus arteriosus; short and discrete
Adult type
Figure 3 sign (CXR); reverse figure 3 or figure E (barium esoph)
COA
MCC of CHF in the forst day or two fo life
Hypoplastic left heart syndrome
What happens in Hypoplastic L heart syndrome?
Impaired blood flow from Lside of heart, predispose to L-R shunt (ASD) and PDA; enlarged RA and RV
Marked LA and LV enlargement + passive congestion
Mitral insufficiency
Mitral insuffiency associated with Marfan syndrome
MVP
Extra chamber is present proximal to LA and separated by a perforated membrane
Cor triatriatum
Mitral insufficiency vs Cor triatriatum
Both have same abnormal hemodynamics w/ passive congestion. Cor triatriatum =No LAE
T or F. If CXR findings are normal in symptomatic patients, vascular ring is not likely.
TRUE
2 true vascular rings
1) double aortic arch, 2)R aortic arch w/ aberrant L subclavian a and encircling PDA/ligamentum arteriosum
T or F. Right arch will deviate the tracha and esophagus to the right.
TRUE
T or F. On expiratory film, trachea remains midline secondary to Right aortic arch
TRUE (with inspiration, normal trachea moves to the right)
MC vascular anomalies that produce no symptoms
Anomalous (aberrant) R subclavian artery
2nd MC vascular anomaly that produce no symptoms
R aortic arch, R desc a, mirror image branching
MC vascular anomalies that produce symptoms
The 2 true vascular rings
2nd MC vascular anomaly that produces symptoms
Vascular sling-aberrant LPA
MC vascular anomaly of all
Aberrant R subclavian artery
This vessel arises distal to the L subclavian artery (as the most distal br of aortic arch) crossing the midline posterior to tracha and esophagus
Aberrant R subclavian artery
MC CHD associated with R aortic arch w/ R descending aorta (mirror branching)
TOF
Variation of aberrant LPA associated w/ tracheal stenosis from complete cartilaginous rings
Ring-sling complex
Mirror image lesion of aberrant R subclavian artery w/ normal L aortic arch
Aberrant L subclavian artery w/ R aortic arch
Associated w/ “diverticulum of Kommerell”
Aberrant L subclavian artery
Reverse S shape indentation of the esophagus
Double aortic arch (large higher posterior arch, small lower anterior arch)
What constitute a “Congenital subclavian steal syndrome”?
Isolated left subclavian artery (atretic base) receives supply from aorta via retrogradeflow through ipsilateral vertebral artery
Vascular anomalies that produce isolated anterior tracheal compression
1) anomalous innominate artery, 2)anomalous L common carotid artery
Anomalous innominate artery
Arises from a point more distal along aortic arch (too near the left common carotid artery)
Anomalous L subclavian artery
Originates from a poit more proximal than normal (too near the innominate artery)
This vessel abnormally arises from the RPA then crosses the midline by encircling the trachea and passing b/w trachea and esophagus
Aberrant LPA or Vascular ring
Unusual high position of the aortic knob seen as paratracheal mass w/ leftward tracheal deviation
Cervical aortic arch (Circumflex aorta)
MC type of pericardial defect
Complete absence of pericardium LEFT)
Interrupted IVC usually has continuation w/ what vessel structure?
Azygos
Clue to pa partial left paracardial defect
Herniation of LA appendage
Persistent L SVC is commonly associated with?
Polysplenia syndrome
MC involved in congenital cardiac aneurysm
Ventricles
MCC of myocarditis in children
Viral infection
CXR findings of myocarditis in children
Generalized cardiimegaly and passive congestion of lungs
MCC of endocarditis in children
Bacterial infection
MC affected structure in Idiopathic cardiomyopathy
LV
Transient hypertrophy of the interventricular septum in the subaortic region of the LV
Diabetic cardiomyopathy of the neonate
Aggravating factore in Hypoxic (ischemic) cardiomyopathy of neonate
Papillary muscle necrosis
T or F. Both hyperthyroidism and hypothyroidism can lead to cardiomegaly
TRUE
MC AV fistula in neonates
Vein of Galen aneurysm
MC of fluid overload in older children (in the past)
Acute glomerulonephritis
Cause of Myocardial infarction in neonates
Coronary artery embolism resulting from paradoxical thrombi originating from ductus venosus
MC cardiac tumors in neonate
Rhabdomyoma
Condition associated with fibroma of the heart
Basal cell nevoid or Gorlin’s syndrome
Condition associated with Rhabdomyoma
Tuberous sclerosis
Common causes of pericardial calcifications
Infection, hemorrhage, or trauma
MCC of pericarditis
Viral etiology
MCC of hemopericardium
Chest trauma (accidental or iatrogenic)
MC pericardial tumor in childhood (especially in infancy)
Pericardial teratoma
MC location of pericardial cysts
Right side in the cardiophrenic angle
Predisposing factors to thrombosis (arterial or venous)
Dehydration and/or sepsis, indwelling catheters, infants of diabetic mothers
Main contributing factor todevelopment of renal artery thrombosis
Indwelling catheter
Characteristic oval or bullet-shaped calcification in ghe vessels involved
Calcified venous thrombosis
MCC of arterial aneurysm in the pediatric age group
Mycotic aneurysm secondary to infection from umbilical artery catheterization
MC location of venous aneurysms in children
SVC and Jugular veins
T or F. Systemic vein stenosis are usually asymptomatic, while arterial stenosis are symptomaotic.
TRUE
Pulseless disease
Takayasu’s arteritis
Storage disease associated with calcification of the aorta
Singleton-Merten syndrome
T or F. Arterial calcification are more common than venous calcifications.
FALSE
MCC ofvenous calcifications
Calcified venous thrombi
Collagen vascular disease involving neonates and young infants
Periarteritis nodosa
Collagen vascular disease involving older children
SLE
Microcardia is a temporary phenomenon resulting from severe dehydration or massive blood loss
TRUE
Chamber enlargement characteristically absent in ASD
LA - bec blood is shunted into the RA right away
Chamber enlargement characteristically absent in VSD
RA (in all types of VSD)
Type of VSD seen w/ PTA and TOF
Bulbar defect - high in the membranous portion of IV septum (defective formation of flap derived from conus portion of TA)
Right lung hypoplasia + curvilinar shadow at the base of RLL (anomalous vein)
Scimitar syndrome (PAPVR draining to IVC)
Advanced form of ASD/VSD/PDA wherein L-R shunt is decreased/reversed resulting to RVH and pulmo HPN
Eisenmenger physiology
Most valuable roentgenographic view in assessing the cardiac chambers?
frontal projection
(What makes up the upper third of the anterior cardiac border?)
RV outflow tract and root of the PA
In pulmonary valve stenosis, which pulmonary artery does the flow of blood preferentially enter through a stenotic valve?
left PA (but expected findings are difficult to detect on plain films)
In what region of the aorta can one best detect its smallness?
aortic knob
Most difficult chamber to asses radiographically?
RA
Which ventricular enlargement produces clockwise rotation of the heart?
RV
Which ventricular enlargement produces counterclockwise rotation of the heart?
LV
What is the only specific ancillary finding in the evaluation of CHD?
bilateral rib notching
What is the only condition in which one sees a truly concave pulmonary artery in the face of generally increased pulmonary vascularity?
PTA
Which type of aortic stenosis should you consider if there is poststenotic dilatation?
valvular
Which pulmonary artery is most often the abnormal one in hemitruncus arteriosus?
right PA
Which intercostal arteries are usually involved in the formation of collaterals in COA?
T4-T8 (therefore same lang sa rib notching tapos POSTERIOR ribs; pero kay Brant 3rd to 8th ribs siya haha)
What are the only vascular abnormalities that produce isolated anterior tracheal compression?
anomalous INNOMINATE artery and anomalous LEFT COMMON CAROTID artery
ing modalities Ductus arteriosus closure
functional - 1st 24 hours; anatomic - by 10 days
Normal cardiothoracic ratio
0.5 - PA; 0.6 - AP
