Heart and Peripheral vascular system

Pericardial cyst

Biomarkers of acute myocardial infarction

ST segment abnormalities on ECG Temporal raise in cardiac enzymes (troponin) Fixed perfusion defect at gated single-photon emission computed tomography Subendocardial/transmural late or delayed gadolinium enhancement at cardiac MR in coronary artery perfusion territory

Crawford classification of aortic dissection

Proximal Ascending and descending aorta Ascending aorta and arch only Distal Descending aorta only (distal to left subclavian artery)

DeBakey classification of aortic dissection

Type I: both ascending and descending aorta Type II: ascending aorta and arch only Type III IIIa: limited to thoracic aorta IIIb: extends to abdominal aorta

Stanford classification of aortic dissection

Type A Ascending aorta and arch Ascending aorta and descending aorta Type B Descending aorta only (distal to left subclavian artery)

Markers of myocardial viability

Preserved myocardial wall thickness at ECHO, cardiac MR Preserved tracer uptake at single-photon emission computed tomography Lack of enhancement/ or limited subendocardial enhancement at late or delayed gadolinium-enhanced CMR Flow/metabolism mismatch pattern at positron emission tomography Evidence of contractile reserve at dobutamine stress ECHO/CMR

Pulmonary venous hypertension

Left ventricular failure Mitral valve disease Left atrial myxoma Fibrosing mediastinitis Pulmonary veno-occlusive disease

Secondary cardiomyopathy

Infiltrative Storage Toxicity Endomyocardial Granulomatous inflammatory Endocrine Neuromuscular/neurological Nutritional deficiency Autoimmune/collagen Electrolyte imbalance Sequel of cancer therapy

Pericardial effusion

Normal fluid 15 – 35 ml > 50 ml is abnormal Cardiac failure, renal or hepatic insufficiency, bacterial, viral or fungal infection, neoplasia (lung, breast or lymphoma) Imaging Chest Xray Seen only when 200 ml of fluid present Symmetric enlargement of cardiac silhouette resulting in flask like configuration Cardiophrenic angles become acute Curvilinear lucency along…

Pericardial cyst

Rare congenital abnormality Most common benign pericardial mass Asymptomatic Incidental finding on chest radiography Thin, smooth walls, no internal septa, attached to pericardium directly or by a pedicle Imaging Round or oval in shape Frequently at cardiophrenic angles, mainly right Chest X-ray Sharply demarcated mass, well circumscribed, abnormal prominence of cardiac border in right cardiophrenic…

Cardiac rhabdomyoma

40% of benign neoplasms in infants and children Usually seen less than 1 year age Associated with tuberous sclerosis in 50% cases Arrhythmias usually presenting feature Inoperable – being deep seated, poorly demarcated and multiple Most regress spontaneously  Imaging Intramural, more common in ventricles Small and multiple Avg 3 to 4 cm in diameter ECHO:…

Cardiac lipoma

Slow growing neoplasm of mature adipose tissue Arise from epicardium, myocardium or endocardium, even interatrial septum Common in right atrium at level of interatrial septum Epicardial location, narrow attachment point and growth into pericardial space is typical Imaging CT Well circumscribed Homogeneous fat attenuation (-50 to -150 HU) Occasionally show internal soft tissue septa D/D:…

Cardiac myxoma

Most common benign tumor 25% of primary cardiac neoplasms Common in women Asymptomatic in some  Triad of findings Peripheral embolic phenomena Symptoms and signs of mitral valve obstruction Fever, anemia, raised ESR, clubbing Familial myxomas <10% of all myxomas Median age 20 years Multiple myxomas at atypical locations Spotty skin pigmentation and endocrine abnormalities in…

Pseudocoarctation of aorta

elongated aortic arch bulges posteriorly above the point it is fixed by the ligament produces 3 sign similar to true coarctation in a frontal radiograph no accompanying hemodynamic obstruction

Aortic atresia

associated with hypoplastic left heart syndrome ascending aorta smaller than brachiocephalic artery blood flows from heart to aorta via pulmonary trunk and persistent ductus. Arch fills retrograde normal origin of brachiocephalics coronaries arise from ascending aorta survival depends on PDA patency Norwood operation: converts morphological right ventricle into systemic ventricle, anastomosing pulmonary trunk to ascending…

Pericardial cyst

due to persistence of blind ending ventral parietal pericardial recesses cyst that communicates with pericardial space – pericardial diverticula imaging well defined oval or occasionally lobulated right cardiophrenic angle (70%) left cardiophrenic angle (20%) sometimes higher up in mediastinum clear fluid MR: low to intermediate on T1, high on T2 with no post Gado enhancement

Congenital absence of pericardium

rare and usually asymptomatic most common: complete absence of left pericardium associated anomalies: ASD, ToF, PDA, bronchogenic cysts, pulmonary sequestration imaging interposition of lung between aorta and main pulmonary artery in the aortopulmonary windows is the most reliable sign rotation of cardiac axis to the left side


two layers: parietal and visceral normal fluid < 50 ml left atrium partially covered by pericardium normal thickness < 2 mm pericardial sinuses show normally small amount of fluid oblique pericardial sinus behind left atrium (DD: bronchogenic cyst) transverse pericardial sinus behind ascending aorta (DD: aortic dissection, lymphadenopathy) superior pericardial recess lies posterior to ascending…


free air around mediastinal structures blunt or penetrating trauma, esophageal perforation, iatrogenic, pulmonary infections, gas forming organisms, cocaine inhalation, air extension from pneumothorax air per se is of no clinical significant in mediastinum, maybe mild substernal pain imaging ring around artery sign: air around usually right pulmonary artery sail sign: elevation of thymus air anterior…

Fibrosing mediastinitis

sclerosing mediastinitis or mediastinal fibrosis fibrous tissue and collagen in mediastinum sequel to infection from histoplasmosis or tuberculosis sarcoidosis, autoimmune diseases, retroperitoneal fibrosis, radiation, drugs (methysergide maleate) SVC obstruction, obstruction to central pulmonary artery or veins two types: focal or diffuse. Focal in tuberculous/ histoplasmosis. Diffuse in idiopathic form, associated with retroperitoneal fibrosis focal: calcified.…

Acute mediastinitis

rare but life threatening high morbidity and mortality most common causes: post op complications, esophageal perforation (Boerhaave syndrome) Esophageal perforation usually occurs just above gastro esophageal junction leakage from esophagus due to a necrotic neoplasm extension of infection from neck, retroperitoneum or intrathoracic structures ill, high fever, tachycardia, chest pain imaging Chest Xray widening, ill-defined…

Mediastinal masses

anterior mediastinum Morgagni hernia aortic aneurysm cystic hygroma diaphragmatic eventration thymic tumors retrosternal thyroid mass germ cell tumor lymph nodes (lymphoma) pericardial cyst pericardial fat pad sternal masses middle mediastinum hernia (hiatus/aortic) aortic aneurysm lymph nodes (sarcoid, TB, lymphoma, metastases) foregut duplication cysts neurenteric cyst mediastinal paragangliomas carcinoma bronchus fatty mediastinal tumors / mediastinal lipomatosis…

Abdominal aortic aneurysm

Incompetent calf vein perforator

Pericardial effusion

Deep vein thrombosis on ultrasound

Pulmonary arterial hypertension

40 year old lady was admitted and found to have severe pulmonary hypertension. A radiograph was taken on admission following which CT was requested to rule out acute or chronic pulmonary thromboembolism. The doppler study of both lower limbs did not reveal any deep venous thrombosis. Chest radiograph Findings cardiomegaly with elevated cardiac apex enlarged…