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Wk 7, Case 5 - Review

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Report

Patient History

43-year-old male with a history of 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: 70 mL Visipaque 320 injected at 6ml/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. The left pulmonary veins have separate ostia, while the right pulmonary veins have a shared ostium. No evidence of stenosis.

The esophagus courses along the middle of the posterior atrial wall without intersecting the pulmonary veins.

Left atrial appendage: Filling defect of the LAA apex on contrast images, with resolution of the defect on delayed images. Findings are consistent with slow cardiac emptying.

ADDITIONAL CARDIAC FINDINGS:

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

Chambers: Normal left and right ventricular chamber dimensions. Normal left and right atrial chamber dimensions.

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

Impressions
1. There are 2 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 along the middle of the posterior atrial wall not in proximity to the pulmonary veins.

3. Filling defect on LAA apex consistent with slow cardiac emptying.

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

Cardiac Chambers

Cardiac CT (SCCT Cat B1 Video Case)

Cardiac CT

Cardiac

Acquired/Developmental

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