Heart and Peripheral vascular system

Pericardial cyst

Biomarkers of acute myocardial infarction

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

Crawford classification of aortic dissection

ProximalAscending and descending aortaAscending aorta and arch onlyDistalDescending aorta only (distal to left subclavian artery)

DeBakey classification of aortic dissection

Type I: both ascending and descending aortaType II: ascending aorta and arch onlyType IIIIIIa: limited to thoracic aortaIIIb: extends to abdominal aorta

Stanford classification of aortic dissection

Type AAscending aorta and archAscending aorta and descending aortaType BDescending aorta only (distal to left subclavian artery)

Markers of myocardial viability

Preserved myocardial wall thickness at ECHO, cardiac MRPreserved tracer uptake at single-photon emission computed tomographyLack of enhancement/ or limited subendocardial enhancement at late or delayed gadolinium-enhanced CMRFlow/metabolism mismatch pattern at positron emission tomographyEvidence of contractile reserve at dobutamine stress ECHO/CMR

Pulmonary venous hypertension

Left ventricular failureMitral valve diseaseLeft atrial myxomaFibrosing mediastinitisPulmonary veno-occlusive disease

Secondary cardiomyopathy

InfiltrativeStorageToxicityEndomyocardialGranulomatous inflammatoryEndocrineNeuromuscular/neurologicalNutritional deficiencyAutoimmune/collagenElectrolyte imbalanceSequel of cancer therapy

Pericardial effusion

Normal fluid 15 – 35 ml> 50 ml is abnormalCardiac failure, renal or hepatic insufficiency, bacterial, viral or fungal infection, neoplasia (lung, breast or lymphoma) Imaging Chest XraySeen only when 200 ml of fluid presentSymmetric enlargement of cardiac silhouette resulting in flask like configurationCardiophrenic angles become acuteCurvilinear lucency along left hear borderLateral view: loss of…

Pericardial cyst

Rare congenital abnormalityMost common benign pericardial massAsymptomaticIncidental finding on chest radiographyThin, smooth walls, no internal septa, attached to pericardium directly or by a pedicle Imaging Round or oval in shapeFrequently at cardiophrenic angles, mainly rightChest X-raySharply demarcated mass, well circumscribed, abnormal prominence of cardiac border in right cardiophrenic angleCTWell defined mass with fluid density No enhancement…

Cardiac rhabdomyoma

40% of benign neoplasms in infants and childrenUsually seen less than 1 year ageAssociated with tuberous sclerosis in 50% casesArrhythmias usually presenting featureInoperable – being deep seated, poorly demarcated and multipleMost regress spontaneously  Imaging Intramural, more common in ventriclesSmall and multipleAvg 3 to 4 cm in diameterECHO: iso to hyper echoic CT: enhancing lesions, when multiple,…

Cardiac lipoma

Slow growing neoplasm of mature adipose tissueArise from epicardium, myocardium or endocardium, even interatrial septumCommon in right atrium at level of interatrial septumEpicardial location, narrow attachment point and growth into pericardial space is typical Imaging CTWell circumscribedHomogeneous fat attenuation (-50 to -150 HU)Occasionally show internal soft tissue septaD/D: lipomatous hypertrophy of interatrial septum. Accumulation of…

Cardiac myxoma

Most common benign tumor25% of primary cardiac neoplasmsCommon in womenAsymptomatic in some Triad of findingsPeripheral embolic phenomenaSymptoms and signs of mitral valve obstructionFever, anemia, raised ESR, clubbingFamilial myxomas<10% of all myxomasMedian age 20 yearsMultiple myxomas at atypical locationsSpotty skin pigmentation and endocrine abnormalities in Carney complex Imaging 90% solitarySize from 1 to 15 cmArise in left…

Pseudocoarctation of aorta

elongated aortic arch bulges posteriorly above the point it is fixed by the ligamentproduces 3 sign similar to true coarctation in a frontal radiographno accompanying hemodynamic obstruction

Aortic atresia

associated with hypoplastic left heart syndromeascending aorta smaller than brachiocephalic arteryblood flows from heart to aorta via pulmonary trunk and persistent ductus. Arch fills retrogradenormal origin of brachiocephalicscoronaries arise from ascending aorta survival depends on PDA patencyNorwood operation: converts morphological right ventricle into systemic ventricle, anastomosing pulmonary trunk to ascending aortablood flow to pulmonary arteries…

Pericardial cyst

due to persistence of blind ending ventral parietal pericardial recessescyst that communicates with pericardial space – pericardial diverticula imaging well definedoval or occasionally lobulatedright cardiophrenic angle (70%)left cardiophrenic angle (20%)sometimes higher up in mediastinumclear fluid MR: low to intermediate on T1, high on T2 with no post Gado enhancement

Congenital absence of pericardium

rare and usually asymptomaticmost common: complete absence of left pericardiumassociated 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 signrotation of cardiac axis to the left side


two layers: parietal and visceralnormal fluid < 50 mlleft atrium partially covered by pericardiumnormal thickness < 2 mmpericardial 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 aorta


free air around mediastinal structuresblunt or penetrating trauma, esophageal perforation, iatrogenic, pulmonary infections, gas forming organisms, cocaine inhalation, air extension from pneumothoraxair per se is of no clinical significant in mediastinum, maybe mild substernal pain imaging ring around artery sign: air around usually right pulmonary arterysail sign: elevation of thymusair anterior to pericardium on lateral…

Fibrosing mediastinitis

sclerosing mediastinitis or mediastinal fibrosisfibrous tissue and collagen in mediastinum sequel to infection from histoplasmosis or tuberculosissarcoidosis, autoimmune diseases, retroperitoneal fibrosis, radiation, drugs (methysergide maleate)SVC obstruction, obstruction to central pulmonary artery or veinstwo types: focal or diffuse. Focal in tuberculous/ histoplasmosis. Diffuse in idiopathic form, associated with retroperitoneal fibrosisfocal: calcified. diffuse: non calcified infiltrative imaging…

Acute mediastinitis

rare but life threatening high morbidity and mortalitymost common causes: post op complications, esophageal perforation (Boerhaave syndrome)Esophageal perforation usually occurs just above gastro esophageal junctionleakage from esophagus due to a necrotic neoplasmextension of infection from neck, retroperitoneum or intrathoracic structuresill, high fever, tachycardia, chest pain imaging Chest Xray widening, ill-defined mediastinal outlinestreaks or collections of…

Mediastinal masses

anterior mediastinum Morgagni herniaaortic aneurysmcystic hygromadiaphragmatic eventrationthymic tumorsretrosternal thyroid massgerm cell tumor lymph nodes (lymphoma)pericardial cystpericardial fat padsternal masses middle mediastinum hernia (hiatus/aortic)aortic aneurysmlymph nodes (sarcoid, TB, lymphoma, metastases)foregut duplication cystsneurenteric cystmediastinal paragangliomascarcinoma bronchusfatty mediastinal tumors / mediastinal lipomatosis posterior mediastinum Bochdalek herniaaortic aneurysmmyeloma / metastasesdiaphragmatic eventrationsympathetic ganglion cell tumorsperipheral nerve tumorslateral thoracic meningocele extramedullary…

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…