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Wk 4, Case 5 - Review

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Patient History
32 years old male with a recent abnormal ECG and echocardiogram with evidence of right ventricular dilatation, and an atrial level shunt. Request for coronary CT angiogram for evaluation of coronary anatomy and atrial level defect evaluation as part of perioperative evaluation.

Findings
TECHNIQUE: Coronary CT Angiography

Prospective ECG gating Cardiac; data acquisition between 65-80 % of the R-R interval

Cardiac CT: dual source CT scanner with a 0.25 s rotation time

IVCM: 90 mL Administered @ 6 mL/s

Medication: Sublingual nitroglycerin 0.8 mg, 200mg oral metoprolol

Heart rate: 50 bpm

Rhythm: sinus rhythm

Artifacts: Mild misregistration artifact.

The technical quality of the scan: good.

CORONARY FINDINGS:

The left and right coronary ostia are in a normal anatomic position. 


The coronary anatomy is right dominant. 



LEFT MAIN:


The left main coronary artery is a short, large caliber vessel that trifurcates into the LAD, RI and LCX. There is no plaque or stenosis in the left main.



LEFT ANTERIOR DESCENDING (LAD): 


The LAD is a large caliber vessel and gives rise to three small diagonal branches and wraps around the apex. There is no plaque or stenosis in the LAD and its branches.

LEFT CIRCUMFLEX (LCX):


The LCX is a non-dominant vessel which gives rise to one OM branch before terminating as a small vessel in the AV groove. There is no plaque or stenosis of the LCX or the OM branch. There is a short superficial myocardial bridge in the first OM branch.

RIGHT CORONARY ARTERY (RCA):


The RCA is a dominant vessel and gives rise to a PDA and the PLB branches. There is no plaque or stenosis in the RCA or its branches.

NON-CORONARY CARDIAC FINDINGS:


Chambers: Normal left ventricular cavity size. Normal left atrial size. Dilated right ventricle and right atrium. There is an atrial secundum defect measuring 15.8 x 25.7 mm in diameter with insufficient aortic, posterior superior and posterior inferior rims for percutaneous closure.

Myocardium: Normal wall thickness.

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

Pericardium: No pericardial effusion, calcification, or thickening.

Aorta: No aortic rupture, aneurysm, dissection, intramural hematoma.

Pulmonary arteries: No enlargement. No central pulmonary embolism.

Pulmonary veins: There is normal pulmonary venous return to the left atrium.

Impressions
1. Overall, there is no plaque or stenosis in the coronary arteries.
2. Atrial secundum defect with insufficient rims for percutaneous closure.
3. Dilated right sided cardiac chambers.

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

Congenital

Cardiac Chambers

Cardiac CT (SCCT Cat B1 Video Case)

Cardiac CT

Cardiac

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