Radiology 101 for the Cardiovascular Team Member 101 CV Lecture.pdf · Radiology 101 for the Cardiovascular Team Member Saurabh Agarwal, MD Assistant Professor of Radiology . Division

Radiology 101 for the Cardiovascular Team Member Saurabh Agarwal, MD Assistant Professor of Radiology Division of Cardiac and Thoracic Radiology Medical Director, RIH/TMH 3D Imaging Laboratory Brown University, Alpert Medical School

Disclosures

• I have no relevant financial disclosures

Rhode Island Chapter of the ACC

Learning Objectives

• Recognize basic cardiovascular pathology on CXR • Understand common indications for cardiac CT and MRI • Discuss basic patterns of myocardial late gadolinium enhancement on

cardiac MRI


Introduction to CXR


42-year-old woman with chest pain and dyspnea


Pulmonary Edema

50-year-old man with chest pain


Pericardial Effusion


200 mL fluid to be visible

67-year-old man with worsening diastolic dysfunction


Calcific Pericarditis


34-year-old man presenting with cough



Right aortic arch with aberrant LSCA


Retroesophageal diverticulum “Kommerell”

• Vascular ring • Dysphagia

C/o Scott Collins, RT

57-year-old woman s/p MVC


Acute traumatic aortic injury with tamponade


62-year-old with Swan-Ganz catheter presenting with hemoptysis


Pulmonary artery pseudoaneurysm


• Contained rupture of pulmonary artery

• Trauma, iatrogenic, infection (TB)

• Cough and hemoptysis • Life-threatening

• High suspicion • Often missed (50%) • Look at enhancement

• Delayed images • Don’t biopsy!

62-year-old presenting for cough


Fractured pacemaker lead

37-year-old presenting with cough


Cardiac angiosarcoma


Common Indications for Coronary/Cardiac CT and MRI


Coronary CT • Coronary CT

• Low-intermediate risk for CAD • Coronary anomalies • Pre-surgical planning • CABG/stent patency • Problem solving

• Acute chest pain in the ED

• ROMICAT II, ACRIN-PA, SCOT-HEART


Gated Cardiac CT

• Cardiac CT • Cardiac masses

• Location and anatomic extent • Pericardial disease • Aorta • Pre-procedure planning

• TAVR • Pulmonary vein isolation • Redo sternotomy


Cardiac MRI

• Cardiac MRI • Cardiac function • CAD/viability* • Cardiomyopathies/Arrhythmias* • Cardiac masses* • Quantifying fibrosis* • Right ventricle/ARVD • Pericardium/constriction • Valvular disease • Congenital heart disease


*Currently requires gadolinium

Basic Patterns of Myocardial LGE


Midwall Subepicardial

Ischemic vs Nonischemic Cardiomyopathy

• Subendocardial: • Ischemic vs non-ischemic

cardiomyopathy

• Midwall and Subepicardial: • Nonischemic cardiomyopathy


0102030405060708090

ImprovedContractility (%)

Kim RJ et al. The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. NEJM 2000.

36-year-old man p/w chest pain


RCA Territory Infarct


65-year-old with diastolic dysfunction on recent echocardiogram


Cardiac Amyloidosis


14-year-old boy with chest pain and elevated troponins.


Myocarditis


57-year-old woman with labile HTN and chest pressure/pain with exertion and rest


Hypertrophic cardiomyopathy


Conclusions

• Many different cardiovascular processes are evident on CXR

• Several indications for cardiac CT and MRI • Distribution of LGE can help distinguish between

ischemic and nonischemic cardiomyopathy and guide differential diagnoses


Zelda Fitzgerald (1900 – 1948)

“Nobody has ever measured, not even poets, how much the heart can hold.”

Not until…

Questions: [email protected]

http://upload.wikimedia.org/wikipedia/commons/2/23/Zelda_Fitzgerald_portrait.jpg

Radiology 101 for the Cardiovascular Team Member 101 CV Lecture.pdf · Radiology 101 for the Cardiovascular Team Member Saurabh Agarwal, MD Assistant Professor of Radiology . Division

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