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Wk 2, Case 1 - Review

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Report

Patient History

53-year-old male with a history of mitral valve regurgitation with repair and paroxysmal atrial fibrillation. Request for Cardiac CT to assess pulmonary vein anatomy prior to planned pulmonary vein isolation.

Report
PROCEDURE:

1. Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology (including 3D image postprocessing, assessment of cardiac function, and evaluation of venous structures, if performed) (CPT code: 75572)

TECHNIQUE:

Gating: Prospective; data acquisition between 70-75%

Medications: 100 mg oral metoprolol tartrate.

Contrast: 85mL Visipaque 320 injected at 7ml/sec.

QC (signal/noise): increased image noise.

Artifacts: None that are significant

Complications: None

Heart rate: 52 bpm.

Findings:
PULMONARY VEINS:

There are 3 right and 2 left pulmonary veins. The left pulmonary veins have separate ostia, while the right pulmonary veins have a shared ostium. No evidence of stenosis.

The esophagus courses posterior to the left upper and left lower pulmonary veins.

Left atrial appendage: Filling defect of the LAA apex on contrast images, with a residual filling defect on delayed images. Findings are consistent with a thrombus.

ADDITIONAL CARDIAC FINDINGS:

Coronary arteries: Right dominant circulation with normal coronary artery origins. Study not optimized for assessment of stenosis.

Chambers: Normal left ventricular cavity size. Severely dilated left atrium. Dilated right ventricular cavity size with a dilated right atrium.

Myocardium: Normal thickness. No outpouching or masses.

Valves: Trileaflet aortic valve with normal leaflet thickening. Moderately thickened mitral valve with mild calcifications. Well seated annuloplasty ring.

Pericardium: Normal thickness. Small posterior pericardial effusion.

Aorta: There is no aortic rupture, aneurysm, dissection, intramural hematoma.

Pulmonary arteries: Normal in size without proximal filling defect. Not fully opacified.

Impressions
1. There are 3 left and 2 right pulmonary veins. The left pulmonary veins have separate ostia, while the right pulmonary veins have a shared ostium.

2. Esophagus courses posterior to the left upper and lower pulmonary veins.

3. Filling defect on LAA apex consistent with a thrombus.

4. Severely dilated left atrium.

Case Discussion

Faculty

Giovanni E. Lorenz, DO

Cardiothoracic Radiologist

San Antonio Military Health System (SAMHS)

Emilio Fentanes, MD

Director of Cardiac Imaging, Department of Cardiology

Brooke Army Medical Center

Tags

Vascular

Pulmonary Vessels

Idiopathic

Coronary arteries

Cardiac Chambers

Cardiac CT (SCCT Cat B1 Video Case)

Cardiac CT

Cardiac

Acquired/Developmental

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