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Wk 6, Case 1 - Review

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Report

Patient History
35-year-old male with a recent abnormal ECG and echocardiogram with evidence of right ventricular dilatation, persistent shortness of breath and chest pain. Request for CCTA for further risk stratification.

Findings
TECHNIQUE: Coronary CT Angiography

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

IVCM: 70mL Visipaque at 6 mL/s

Medication: Sublingual nitroglycerin 0.8 mg, 200mg oral metoprolol

Heart rate: 50 bpm

Rhythm: sinus rhythm

Artifacts: None

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 left 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 one diagonal branch and wraps around the apex. There is no plaque or stenosis in the LAD and its branches.

LEFT CIRCUMFLEX (LCX):

The LCX is a large dominant vessel which gives rise to two OM branches before terminating as a posterolateral branch and posterior descending artery. There is no plaque or stenosis in the LCX or its branches.

RIGHT CORONARY ARTERY (RCA):

The RCA is a small non-dominant vessel and gives rise to small marginal branches. There is no plaque or stenosis in the RCA.

NON-CORONARY CARDIAC FINDINGS:

Chambers: Normal left ventricular cavity size. Normal left atrial size. Dilated right ventricle and right atrium. There is a sinus venosus atrial septal defect measuring 16.4 mm x 27.8 mm in diameter. There is a persistent left sided superior vena cava that empties into the coronary sinus

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: Dilated at the main pulmonary artery. No central pulmonary embolism.

Pulmonary veins: There is partial anomalous pulmonary venous return to the left atrium with a right upper pulmonary vein emptying into the superior vena cava.

Impressions
1. Overall, there is no plaque or stenosis in the coronary arteries.
2. Sinus venosus atrial septal defect with partial anomalous pulmonary venous return of the right upper pulmonary vein.
3. Dilated right sided cardiac chambers with an enlarged pulmonary artery indicative of a significant right to left shunt.
4. Persistent left sided SVC.

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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