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Wk 3, Case 3 - Review

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Patient History

65-year-old female with a history of diabetes, hypertension, 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: 85 mL 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 2 right and 2 left pulmonary veins with separate ostia. There is evidence of anomalous pulmonary venous return of a third right upper pulmonary vein into the SVC.

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

Left atrial appendage: No evidence of a filling defect on contrast images.

ADDITIONAL CARDIAC FINDINGS:

Coronary arteries: Right dominant circulation with normal coronary artery origins. Study not optimized for assessment of stenosis. Medium amount of calcified, and partially calcified plaque in the coronary arteries in a multivessel distribution.

Chambers: The right ventricle is at the upper limits of normal in mid diastole. Normal left ventricular cavity size.

Myocardium: Normal thickness. No outpouching or masses.

Valves: Trileaflet aortic valve with normal leaflet thickening and mild calcifications. Normal mitral valve leaflet thickening.

Pericardium: Normal thickness with no significant effusion or calcium present.

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

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

Impressions
1. Overall, there is a medium amount of calcified, and partially calcified plaque in the coronary arteries in a multivessel distribution.

2. Partial anomalous pulmonary venous return of a right upper pulmonary vein into the SVC. The right ventricle is at the upper limits of normal, but the pulmonary artery is dilated suggestive of a significant shunt.

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

Recommend further evaluation with a cardiac MRI to better evaluate right sided chamber dimensions and shunt severity.

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

Congenital

Cardiac Chambers

Cardiac CT (SCCT Cat B1 Video Case)

Cardiac CT

Cardiac

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