Ucsf: Video I 82 Cardiac (Thorax Vascular)

Front 1

What is the ddx of mediastinal widening

Back 1

hemorrhage
tumor
pus
fluid
fat

Front 2

What are the CXR numbers for mediastinal widening

Back 2

>8cm or 25% of thorax

Front 3

What is the CXR measurment for widening of right paratracheal stripe

Back 3

>4mm

Front 4

What are the CXR signs of traumatic aortic injury

Back 4

mediastinal widening
generalized widening
abnormal aorta
mass effect froma a hematoma
apical cap
left hemothorax

Front 5

What are the top 3 cause of hemorrhage in the mediastinum following trauma

Back 5

venous bleeds
fx
aortic injury

Front 6

Where are the typical locations of TAI

Back 6

isthmus (90%)
Ascending aorta (5-10%)
descending aorta at the diaphrgam

Front 7

Where does ascending aorta TAI commonly occur

Back 7

at the ductus (site of attachement)

Front 8

Is a focal saccular outpouching with a narrow neck a typical sign of a pseudoaneurysm

Back 8

yes

Front 9

What are the direct signs of TAI

Back 9

pseudoaneurysm
intimal flap
wall irregularity

Front 10

What are the indirect signs of TAI

Back 10

hematoma

Front 11

What is the MC direct sign of TAI

Back 11

pseuoaneurysm

Front 12

What if the hemorrhage does not touch the aorta and there is a fat plane between hemorrhage and the aorta what is the MC etiology

Back 12

venous bleeding

Front 13

What is the next step if you see hemorrhage that touches the aorta and there is no fat plane and no direct sign

Back 13

angiography

Front 14

If the ascending aorta dilates what part of the mediastium does it overlie on CXR

Back 14

the right hilum

Front 15

What should you suspect if you see isolated dilation of the ascending aorta

Back 15

aortic stenosis

Front 16

What is the size of a normal thoracic aorta

Back 16

less than 4cm

Front 17

What is the size of a dilated or ectatic aorta

Back 17

4-5cm

Front 18

What is the size of a aneurysmal aorta

Back 18

>5cm

Front 19

What size aorta will require surgery

Back 19

>6cm (marfans less)

Front 20

Besides aortic stenosis what is a common cause of ascending aortic aneurysm

Back 20

HTN

Front 21

What is the ddx of aortic aneurysms (true)
7

Back 21

degenerative
post stenotic
htn
atherosclerosis
connective tissue
mycotic
syphillis
dissections (not true)

Front 22

What is a pseudoaneurysm

Back 22

saccular outpouching of the aorta

Front 23

What are common causes of aortic pseuodaneurysms
(top 4)

Back 23

traumatic
iatrogenic
mycotic
penetrating ulcer

Front 24

Name 4 acute aortic syndromes

Back 24

dissection
intramural hematoma
ulcerative plaque
penetrating ulcer

Front 25

Where does blood dissect during a dissection

Back 25

the media

Front 26

Is a dissection ever focal

Back 26

no, it will spread proximal or distal or both

Front 27

What are some causes of dissection

Back 27

htn
Connective tissue
penetrating ulcer

Front 28

What is the most worrisome feature of aortic dissection

Back 28

end organ ischemia

Front 29

What is the difference between an intramural hematoma and dissection

Back 29

blood in the wall WITHOUT A FLAP (there is no connection seen between the true lumen and the blood in the wall)

Front 30

Do some people say that a dissection and hematoma r a spectrum of the same disease

Back 30

yes

Front 31

What may cause the blood to accumulate in an intramural hematoma

Back 31

vasovasorum (not blood from the lumen)

Front 32

What are the causes of an intramural hematoma

Back 32

HTN, CTD, penetrating ulcer

Front 33

What is an intramural hematoma according to stat dx

Back 33

No intimal flap, spontaneous medial hematoma secondary to rupture of the vasa vasorum into the media
Hemorrhage due to rupture of vasa vasorum within aortic media, resulting in noncommunicating dissection, with typical absence of intimal tear

Front 34

What is a dissection according to stat dx

Back 34

Spontaneous intimal tear with propagation of subintimal hematoma

Front 35

Can an intramural hematoma leads to an aortic dissection

Back 35

yes

Front 36

Is an ulcerative plaque associated with future stroke

Back 36

yes

Front 37

Does an ulcerative plaque always cause problems

Back 37

no

Front 38

What are the potential problems caused by an ulcerative plaque

Back 38

embolization (ie brain)
transform to penetrating ulcer

Front 39

What is the definition of a pseudoaneurysm

Back 39

njury to all 3 layers of arterial wall, resulting in contained rupture with perfused sac that communicates with artery

Front 40

What is a penetrating ucler

Back 40

this is an ulcerative plaque that is so deep it is in the wall of the aorta itself (media or deeper)

Front 41

Where are the classic locations of a penetrating ulcer

Back 41

the arch or the descending aorta

Front 42

What are 4 complications of a penetrating ulcer

Back 42

dissection
pseudoaneurysm
intramural hematoma
rupture

Front 43

Can an intramural hematoma convert to a dissection

Back 43

yes

Front 44

What does a pseudoaneursm look like

Back 44

a narrow neck, does not contain all walls, connections with true lumen

Front 45

What is the ddx of a posterior impression of the esophagus

Back 45

abberant right sublavian
abberant left sublavian (right aortic arch)
double aortic arch

Front 46

Describe the findings of an abberant right sublavian

Back 46

last vessel off the arch
posterior to the esophagus
diverticulum of kommerell

Front 47

Can both abberant left and right have an diverticulum of kommerell

Back 47

yes (dilation at origin of abberant vessel)

Front 48

What is the complication associated with a diverticulum of kommerell

Back 48

dysphagia

Front 49

What arch is classicaly larger in an double aortic arch

Back 49

the right

Front 50

Can one of the arches of a double aortic arch be hypoplastic

Back 50

yes

Front 51

What side does a double aortic arch descend

Back 51

the left side

Front 52

What is the MC type of aortic coarctation

Back 52

Juxtaductal (postductal)

Front 53

Is the juxtaductal type of coarctation focal

Back 53

yes

Front 54

What demographic typically gets the juxtaductal type of coarctation

Back 54

adults

Front 55

What clinical sign maybe found in an adult with juxtaductal coarctation

Back 55

different blood pressure in both arms

Front 56

What type of coarctation do infants get

Back 56

tubular (preductal)

Front 57

What is more severe the preductal (tubular) or juxtaductal (postductal)

Back 57

preductal (tubular)

Front 58

Why is preductal coarctation more severe

Back 58

it involves a more diffuse portion of the aorta

Front 59

What is a common presentation of a child with tubular coarctation

Back 59

CHF

Front 60

What are the CXR findings of coarctation
3

Back 60

aortic dilation
inverted 3 sign (juxtaductal)
rib notching

Front 61

What are the collaterals that may occur as a result of coarctatioin

Back 61

internal mammary
intercostal arteries

Front 62

Where is the focal constriction seen on MRI in juxtaductal coarctation

Back 62

distal to the ductus

Front 63

What causes rib knotching

Back 63

dilated intercostal arteries

Front 64

How do you quantitate the flow in a patient with coarctation

Back 64

velocity encoded cine just distal to the coarctation and at the diaphragm (should decrease in a normal person)

Front 65

What may cause stenosis of the great vessels of the chest

Back 65

takayasu arteritis
giant cell arteritis
radiation
williams syndrome (rare)
neurofibromatosis (rare)

Front 66

Where is the classic location that giant cell arteritis will affect

Back 66

coronaries

Front 67

What is called when you see an entire coronary vessels within 1 image

Back 67

curved multiplanar reformat

Front 68

What are 4 indications for CTA

Back 68

coronary artery disease
grafts
stents
anomalous coronary arteries

Front 69

What are the indications of CTA of the coronary arteries

Back 69

intermediate suspicion in a young person

discrepant pre-test probability and symptoms in older patient

Front 70

Why do we do CTA of a graft

Back 70

to look for stenosis

Front 71

What is considered a significant lesion on coronary CTA

Back 71

50%

Front 72

What do you recommend if the lesion is greater than 50%

Back 72

cardiac cath

Front 73

How do you judge stenosis on a CTA coronary

Back 73

minimal luminal diameter compared to pre or post

Front 74

What is a major pitfall of coronary CTA

Back 74

blooming artifact from calcification (looks bigger than it is)

Front 75

What are 3 potential courses of the RCA if it arises from the aorta

Back 75

infront of the RVOT
behind the aorta
INBETWEEN THE RVOT AND AORTA (MOST DANGEROUS)

Front 76

What are the potential complication of the RCA going inbetween the aorta and RVOT
(malignant course)

Back 76

arrythmia and
sudden death

Front 77

What if the origin of the LCA arises from the right side and goes posterior to the aorta

Back 77

it is not clinically significant

Front 78

Why is the myocardium black in a delayed enhancement image

Back 78

because it is an inversion recovery sequence and the myocardium is nulled by selecting the appropiate time to inversion (I think)

Front 79

short axis

Back 79

Front 80

vertical long axis

Back 80

Front 81

horizontal long axis

Back 81

Front 82

What is the ischemic pattern of enhancment

Back 82

subendocardial and may extend to transmural (vascular distribution)

Front 83

What is the non-ischemic pattern of enhancment

Back 83

intramyocardial and subepicardial

Front 84

What is the role of MR viability

Back 84

to determine if a vessel leading do an infarcted area will the myocardium regain function

Front 85

What is the measurement used to determine if it is worth opening up a vessel

Back 85

if there is residual myocardium (non-enhancing) greater than 5.5mm then open the vessel up OR ratio of viable myocardium to total wall thickness >50% (in a vascular distribution)

Front 86

What direction is the measurement made for determining if you will open up a vessel

Back 86

Front 87

What do you look for in hibernating myocardium

Back 87

wall thinning
motility dysfunction
NO residual enhancment

Front 88

Will a patient regain function from opening a vessel with hibernating myocardium

Back 88

yes