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Incidental Cardiac Findings on CT

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So I'm going to show you a case to illustrate

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the importance of doing cardiac studies and,

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um, thinking about cardiac pathology and

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extracardiac situations, which is what this is.

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So this patient came in with symptoms.

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Let's see if you can guess.

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Here is the abdominal aorta.

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And this is the right common iliac artery.

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And look at the left.

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It's gone.

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So, occlusion of the left common

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iliac artery, although it came in with

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leg pain and diminished pulse.

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And then you'll also notice that the inferior

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mesenteric artery, which comes off here, goes.

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And the bowel,

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it's a little thickened, some haziness.

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Thanks.

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Sort of the bowel ischemia, and

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probably not that evident is that some

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of the SMA branches have gone as well.

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Any case, so you have multiple arterial occlusions,

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and in that situation, particularly

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in the young patient, notice the

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relative absence of atherosclerosis.

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It doesn't look like it's an atherosclerotic stuff.

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It's important to look at the heart.

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So, as you're looking at the

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heart, what are you looking for?

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You're looking for something in the left atrial

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appendage, such as thrombus, maybe a shunt

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that could have led to a paroxysmal embolus.

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This patient has this atrial appendage.

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Abnormality here in the proximal descending aorta,

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a bulge, which is from previous coarctation repair.

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Um, left occluded, although

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that might have been chronic.

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And very easy to miss

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is this abnormality here.

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Very easy to miss.

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It's globular.

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Doesn't look like a mixing

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artifact, looks like it has form.

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So it's a vegetation.

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It's a vegetation on the mitral valve.

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So this patient has endocarditis.

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Thanks.

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Thanks.

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With dislodgement of the vegetation, infected

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vegetation, into the lower extremities.

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Something that can easily be missed

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unless one diligently looks for them.

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Up to now, endocarditis has been the

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domain of echocardiogram and you don't

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get a CT scan to look for vegetations.

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But you often find it because the sort of pathology

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that people get, with endocarditis, the kind

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of diffuse, low-grade, nonspecific symptoms.

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People get CT scans for them, so they'll often be

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seen because of the nature of the presentation and

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the nature of the test ordering for the presentation.

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Thank you.

Report

Faculty

Saurabh Jha, MD

Co-Program Director, Cardiothoracic Imaging Fellowship, Associate Professor of Radiology

University of Pennsylvania

Tags

Vascular

Chest

Cardiac

CT

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