Chest& CVS Imaging Notes,Quizes&Polls

@mzebaradioquiz

Dedicated for SBAs Quizes&Polls about Chest,CVS&IR.

Chest& CVS Imaging Notes, Quizes&Polls (English)

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Chest& CVS Imaging Notes,Quizes&Polls

01 Oct, 03:20

CARDIAC PACEMAKER:
💓Components:
➖Power Source (Pulse Generator): Contains semiconductor chips and a sealed lithium battery with a lifespan of ~10 years.
➖Leads: Insulated wires conducting electrical pulses to electrodes placed on the cardiac muscle.

💓Lead Insertion:
Leads are introduced via the subclavian vein, and the generator is placed in a subcutaneous chest wall pocket.

💓Types of Pacemakers:
🕳Single Chamber Pacemaker:

1. Manages either atrial or ventricular dysrhythmias.
2. Atrial lead: Positioned in the right atrial appendage.
3. Ventricular lead: Positioned at the apex of the right ventricle. It only paces the ventricles and ignores atrial activity.
🕳Dual Chamber Pacemaker:
1. Two leads: One in the right atrium and one at the right ventricular apex.
2. Synchronizes atrial and ventricular activity for more physiological pacing.
🕳Biventricular Pacemaker:
1. Three leads: One in the right atrium, one in the right ventricle, and one in the coronary sinus to pace the left ventricle (used for biventricular pacing).

💓Implantable Cardioverter Defibrillators (ICDs):
1. Typically used for ventricular dysrhythmias.
2. Usually have a single lead, resembling a single chamber pacemaker on radiography.

(Source: CXR Survival Guide)

MZeba

1,083

Chest& CVS Imaging Notes,Quizes&Polls

30 Sep, 15:30

MITRAL REGURGITATION
🩻CXR Chronic Mitral Regurgitation
💜Left Atrial Enlargement.
💜Left Atrial Appendage convexity or straightening just below the main pulmonary artery.
💜Double Density Sign: Enlarged left atrium pushes into adjacent lung, creating a contour over the right heart.
💜Bronchial Elevation: Elevation of the left main bronchus and splaying of the carina.
💜Walking Man Sign: Visualized on lateral projections.
💜Upper Zone Venous Enlargement: Due to pulmonary venous hypertension.
💜Left Ventricular Enlargement: Eventually present due to volume overload.
💜Congestive Heart Failure Features: May also be present.

🩻CXR Acute Mitral Regurgitation
💜Pulmonary Edema: Often seen; can be unilateral (right upper lobe or rarely left upper lobe).
💜Left Atrial Enlargement: Typically absent on radiographs.

🩻Echocardiography
💜Severity Parameters:
➖Mild: Jet width <20% left atrial area; vena contracta <0.3 cm; regurgitant volume <30 mL/beat.
➖Moderate: Between mild and severe criteria.
➖Severe: Jet width >40%; vena contracta ≥0.7 cm; regurgitant volume ≥60 mL/beat; effective regurgitant orifice area ≥0.40 cm².

(Source: Radiopedia)
MZeba

866

Chest& CVS Imaging Notes,Quizes&Polls

30 Sep, 02:55

Dressler's Syndrome
🌀Triad of pleuritis, pericarditis, pneumonitis
🌀 10- 30 days post MI or Cardiac surgery.
🌀 Chest pain and high ESR
🌀 MRI:
➖Intense late post-gadolinium enhancement of entire pericardium.
➖Typically regional thinning and akinesis of the infarcted myocardium(a complication of transmural infarction)

(Source: Radiopedia, G&A Essentials)

MZeba

694

Chest& CVS Imaging Notes,Quizes&Polls

30 Sep, 01:20

TRUE VENTRICULAR ANEURYSM
💚 A large thin walled fibrous sac bulging from LV lumen and external surface of the heart.
💚 Normal cardiac silhouette is seen with or without diffuse left ventricular enlargement and with or without an obvious left ventricular focal bulge.
💚 Curvilinear calcifications can develop with the wall after several years.
💚 Aneurysm has a wide neck
💚 Non viable myocardium within the wall of a true aneurysm will show Gadolinium enhancement.

FALE VENTRICULAR ANEURYSM
💚 Result from a localized perforation of the ventricular myocardium following an infarct.
💚 Have tendency to rupture and should be excised.
💚 Generally have narrow necks.
💚 The false aneurysm has no myocardium within its wall therefore not demonstrate Gadolinium enhancement.
💚 The false aneurysm will fill and empty slowly with contrast medium.
💚 There is an abrupt change in wall thickness after with an abrupt angulation at the aneurysm mouth.

MZeba (Source: G&A Essentials)

673

Chest& CVS Imaging Notes,Quizes&Polls

29 Sep, 04:01

Kawasaki Disease
💜A small to medium vessel vasculitis primarily affecting young children, especially the coronary vessels.
💜Diagnostic Criteria:
➖Fever for at least 5 days and at least 4 of the following:
1️⃣Mucosal Changes: Cracked lips, strawberry tongue, or erythema of oral mucosa.
2️⃣Conjunctival Injection:
3️⃣Rash
4️⃣Hand/Foot Changes: Erythema and edema.
5️⃣Cervical Lymphadenopathy: Unilateral, ≥1.5 cm.
💜Imaging:
➖CXR: May show calcified coronary aneurysms years later. Aunt Minnie
➖Angiography: Detects coronary ectasias, aneurysms, and stenosis; most sensitive for vascular assessment. Small: <5 mm, Medium: 5-8 mm, Large: >8 mm
➖Echo
1️⃣Coronary Artery Dilation: Aneurysmal if >2.5 standard deviations above the mean.
2️⃣Left Ventricular Dysfunction.
3️⃣Mitral Regurgitation.
4️⃣Pericardial Effusion.
MZeba

(Source: Radiopedia)

648

Chest& CVS Imaging Notes,Quizes&Polls

29 Sep, 02:59

Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)
💜A cardiomyopathy linked to sudden cardiac death in young patients.
💜Male predominance (2.7:1).
💜CMRI:
➖Regional RV Dysfunction: Akinesia, dyskinesia, or dyssynchronous contraction.
➖RV End-Diastolic Volume: ≥ 110 mL/m²
➖RV Ejection Fraction: ≤ 40%
➖Fatty Infiltration: In the triangle of dysplasia: Inflow tract/outflow tract/apex
➖Accordion Sign: Corrugated appearance of RV wall.
➖Focal LV Dyskinesia: Possible with fatty infiltration.
➖Myocardial Fibrosis/Scarring: Evaluated using MRI.

(Source: Radiopedia)

MZeba

565

Chest& CVS Imaging Notes,Quizes&Polls

29 Sep, 02:27

Anderson-Fabry Disease:

💜Lysosomal storage disorder can lead to cardiac involvement with hypertrophy.
💜Usually presents with additional systemic symptoms like pain crises, skin lesions, and other organ involvement.
💜Echo:
➖LV Hypertrophy, Concentric or eccentric.
➖RV Hypertrophy: Variable.
➖Papillary Muscle Thickening.
➖Binary Sign: Hyperechoic region in myocardium.
➖Thinning of Left Basal Inferolateral Wall.
➖Diastolic Dysfunction.
➖Reduced Ejection Fraction.
➖Valvular Thickening
💜CMR:
➖Cine SSFP: LV hypertrophy.
➖Increased LV and Papillary Mass.
➖Late Gadolinium Enhancement (LGE): often in basal inferolateral region.
➖T1 Mapping: Decreased in remote areas, Increased in inflamed/fibrotic areas.
➖T2 Mapping: Normal in remote areas, Increased in chronic inflammation
(Source: Radiopedia)

MZeba

532

Chest& CVS Imaging Notes,Quizes&Polls

29 Sep, 02:07

Hypertrophic Cardiomyopathy (HCM)
💜Unexplained left ventricular hypertrophy (LVH).
💜Symptoms and Signs: Congestive Heart Failure, Ejection Systolic Murmur: Increased with Valsalva maneuver due to LVOT obstruction.
💜CXR:
➖Cardiomegaly
➖Pulmonary Congestion.
💜Echo:
➖Septal Thickness Ratio: > 1.3.
➖Mitral Valve Displacement: Anterior leaflet moves toward the septum.
➖Systolic Anterior Motion (SAM): Possible contact with septum.
➖Wall Thickness: Any segment > 15 mm unexplained.
➖Additional Features: LV systolic dysfunction, LVH, possible right ventricular hypertrophy.
💜Cardiac MRI:
➖LV systolic dysfunction
➖LV hypertrophy: Predilection for basal interventricular septum
➖RV hypertrophy (may or may not be present)
➖Systolic anterior motion (SAM) of the mitral valve +/- Mitral regurgitation
➖LV apical aneurysms
➖Differentiation from Masses: HCM shows preserved contractility, iso-intense signals on T1/T2, and patchy delayed enhancement.
MZeba (Source: Radiopedia)

511

Chest& CVS Imaging Notes,Quizes&Polls

28 Sep, 23:14

Why fainting spells in cardiac myxoma?
💎 Primary Cause:
Obstruction of blood flow. Tumor located in the left atrium, can block the mitral valve, leading to reduced cardiac output and poor perfusion of the brain.
💎 Secondary cause: myxomas can cause emboli, tumor break off and embolize to the 🧠, resulting in transient ischemic attacks.

Reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9048271/

532

Chest& CVS Imaging Notes,Quizes&Polls

28 Sep, 01:20

Myocarditis:

💜Often viral infections.

💜Acute myocarditis can lead to sudden cardiac death.

💜Most patients recover spontaneously; 5-10% may develop dilated cardiomyopathy.

💜Symptoms: Can mimic acute myocardial infarction (chest pain).

💜Diagnosis:

1. Abnormal lab findings and ECG changes may indicate acute coronary syndrome.

2. MRI: Key for differentiation; late enhancement is subepicardial/midmyocardial, unlike subendocardial in myocardial infarction. Non vascular distribution. Sarcoidosis: usually septum.

3. Most lesions found in the lateral free wall.

4. Wall Motion abnormalities may or may not be present.

MZeba

552

Chest& CVS Imaging Notes,Quizes&Polls

23 Sep, 16:52

Constrictive Pericarditis:
🧤Causes:
➖Developed Countries: Post CABG, Idiopathic presumed viral.
➖Developing Nations: Tuberculosis (TB).
Imaging Features:
🧤CT Findings:
➖Pericardial thickness > 0.4 cm is indicative of constrictive pericarditis.
➖Calcification of the pericardium is diagnostic, typically found over the atrioventricular (AV) groove.
🧤MRI Findings:
➖Sigmoidization: Observed on SSFP cine imaging.
➖Characterized by the ventricular septum moving toward the left ventricle in a wavy pattern during early diastole, referred to as "diastolic bounce."
➖This "bounce" is most pronounced during inspiration.
MZeba

652

Chest& CVS Imaging Notes,Quizes&Polls

23 Sep, 16:16

Cardiac Thrombus:
🧤Most common intra-cardiac “mass.”
🧤Common Locations:
➖Left Atrial Appendage: Frequently associated with atrial fibrillation .
➖Left Ventricular Apex: Often seen post MI.
🧤Imaging Characteristics:
➖Enhancement: Thrombus typically does not enhance on imaging (e.g., MRI).
➖Tumors, in contrast, will show enhancement.
MZeba

606

Chest& CVS Imaging Notes,Quizes&Polls

23 Sep, 16:01

Fibroelastoma 🫀:
🧤Second most common primary cardiac tumor in adults.
🧤Typically occurs in adults aged 50-60.
🧤Presentation:
➖Incidental.
➖If symptomatic: symptoms arise from emboli, leading to stroke or TIA.
🧤Location:
➖Primarily involves cardiac valves, with the aortic valve being the most common site.
➖Usually located on the aortic side of the aortic cusp.
🧤Size: Typically less than 1 cm in diameter.
🧤Distinguishing Features:
➖Unlike vegetations (e.g., from infective endocarditis), fibroelastomas are more centrally located on the valve surface.
MZeba

556

Chest& CVS Imaging Notes,Quizes&Polls

23 Sep, 15:53

Atrial Myxoma:
🧤Most common primary cardiac tumor in adults (ages 30-60).
🧤Symptoms:
➖Presents with fainting spells.
➖Associated with distal emboli.
🧤Location: Arises from the intra-atrial septum, typically growing into the left atrium.
🧤Younger patients may have syndromic associations: MEN syndromes, and Blue Nevi (Carney Complex).
🧤Imaging:
➖Appears as a "ball with a stalk" attached to the interatrial septum.
➖Dynamic imaging shows mobility and prolapse of the "ball."
➖Enhances with Gadolinium.
➖About 25% of myxomas may show calcification.
MZeba

684

Chest& CVS Imaging Notes,Quizes&Polls

23 Sep, 14:04

Dilated Cardiomyopathy:
🫀Characterized by dilatation with end-diastolic diameter > 55 mm and decreased ejection fraction (EF).
🫀Causes:
Idiopathic: Unknown origin.
Ischemic: Related to coronary artery disease.
Other Causes: Alcohol, Doxorubicin, Cyclosporine, Chagas disease
🫀Imaging Patterns:
Ischemic: May show subendocardial enhancement.
Idiopathic: Typically shows no enhancement or linear mid-myocardial enhancement.
🫀Associated Conditions: Often linked with mitral regurgitation due to dilation of the mitral ring.
🫀Peripartum Cardiomyopathy: A form of dilated cardiomyopathy occurring in the last month of pregnancy to 5 months postpartum.

MZeba

588

Chest& CVS Imaging Notes,Quizes&Polls

23 Sep, 13:04

Sarcoidosis: 🫀
🩵Cardiac involvement in 5% of cases; increases mortality risk.
🩵 Increased signal on T2 and early/late Gd imaging.
🩵Late Gd patterns may appear middle and epicardial, non-coronary distribution.
🩵 Focal wall thickening mimicking hypertrophic cardiomyopathy.
🩵Often affects the septum; right ventricle and papillary muscles are rarely involved.

MZeba

548

Chest& CVS Imaging Notes,Quizes&Polls

15 Sep, 17:59

Channel name was changed to «Chest& CVS Imaging Notes,Quizes&Polls»

Chest& CVS Imaging Notes,Quizes&Polls

15 Sep, 17:57

Radiation-Induced Pulmonary Fibrosis:
🌀Timing & Symptoms:
🔸Onset: 6-12 months post-radiotherapy, may progress up to 2 years.
🫁Radiographic Features:
🌀Plain Radiograph:
🔸Volume loss
🔸Architectural distortion
🔸Mediastinal shift
🌀CT Scan:
🔸Linear scarring
🔸Volume loss
🔸Chronic consolidation with air bronchograms
🔸Non-anatomical, geographic distribution; may cross fissures
🌀MRI:
🔸Differentiates fibrosis from tumors, though granulation tissue and necrosis can mimic malignancy.
🌀PET-CT:
🔸Effective for distinguishing fibrosis (non-avid) from malignancy after inflammation subsides (9-15 months).

(Radiopedia)

MZeba

737