Incidentally Detected Cardiovascular Abnormalities on Helical CT Pulmonary Angiography
Spectrum of Findings
Michael B. Gotway1,
Brian K. Nagai,
Gautham P. Reddy,
Rita A. Patel,
Charles B. Higgins and
W. Richard Webb
1
All authors: Department of Radiology, Thoracic Imaging Section, San Francisco
General Hospital, University of California San Francisco, Rm. 1X 55A, Box
1325, 101 Potrero Ave., San Francisco, CA 94110.
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Fig. 1. —60-year-old woman with rheumatic heart disease and pulmonary
varix. Axial contrast-enhanced CT scan through inferior aspect of heart
reveals dilatation of right inferior pulmonary vein (arrow),
consistent with pulmonary varix.
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Fig. 2. —50-year-old man with persistent left superior vena cava.
Axial contrast-enhanced CT scan reveals enhancing structure along left aspect
of mediastinum (arrow). As is most common pattern, this vessel
emptied into coronary sinus (not shown).
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Fig. 3A. —49-year-old man with left upper lobe partial anomalous
pulmonary venous return. Axial maximum-intensity-projection images reveal
convergence of several left upper lobe veins (curved arrows) into
single anomalous vessel (short arrow), which ascends along left
aspect of mediastinum to empty into left brachiocephalic vein.
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Fig. 3B. —49-year-old man with left upper lobe partial anomalous
pulmonary venous return. Coronal volume-rendered CT scan shows left upper lobe
anomalous pulmonary vein (arrows) as it courses along mediastinum to
empty into left brachiocephalic vein. a = aorta, LA = left atrium, P =
pulmonary artery, v = left brachiocephalic vein.
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Fig. 4A. —53-year-old woman with right upper lobe partial anomalous
pulmonary venous return and sinus venosus atrial septal defect. Axial
contrast-enhanced CT scan at level of aortic root reveals defect between
posterolateral wall of superior vena cava and anteromedial wall of right upper
lobe superior pulmonary vein (arrow). Defect high in interatrial
septum, near point of inflow from superior vena cava, was also present (not
shown). Atrial septal defect near site of inflow from superior vena cava
represents a form of sinus venosus atrial septal defect; partial anomalous
pulmonary venous drainage from right upper lobe nearly always coexists
[5].
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Fig. 4B. —53-year-old woman with right upper lobe partial anomalous
pulmonary venous return and sinus venosus atrial septal defect. CT scan more
caudal to A reveals second interatrial septal defect (arrow)
consistent with surgically proven ostium secundum atrial septal defect.
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Fig. 5. —52-year-old man with non-small cell lung carcinoma and
pulmonary embolus (arrowhead). Axial contrast-enhanced CT scan at
level of hilum reveals filling defect within left upper lobe pulmonary vein
(arrow). Cranial images (not shown) showed left suprahilar mass and
mediastinal adenopathy. Patient's diagnosis was bronchogenic carcinoma with
pulmonary vein tumor thrombus.
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Fig. 6. —48-year-old man status post right lung transplant for
pulmonary fibrosis. Axial contrast-enhanced CT scan through lower heart
reveals discontinuity of interatrial septum (arrow), consistent with
ostium secundum atrial septal defect. This finding was confirmed with
echocardiographic bubble study.
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Fig. 7A. —28-year-old man with transposition of great vessels. Axial
contrast-enhanced CT scan through root of great vessels shows that aorta (a)
originates from morphologic right ventricle, and pulmonary artery (p)
originates from morphologic left ventricle. Note that aorta is anterior to and
right of pulmonary artery.
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Fig. 7B. —28-year-old man with transposition of great vessels. CT scan
more caudal than A shows surgical conduit (curved arrow)
routing blood from superior vena cava to posteriorly located right ventricle.
Atrioventricular discordance was not present in this case, consistent with
d-transposition of great vessels. Large atrial septal defect was present (not
shown). This lesion had been treated with baffle.
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Fig. 8. —Axial contrast-enhanced CT scan in 38-year-old man shows
irregular filling defect with nodular enhancement (arrow) originating
from anterior portion of right atrium, representing primary intracardiac
angiosarcoma.
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Fig. 9. —54-year-old man with pulmonary hypertension. Axial
contrast-enhanced CT scan at ventricular level shows right atrial and
ventricular dilatation. Note that interventricular septum bows toward left
(arrow), indicating elevated pulmonary arterial pressure.
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Fig. 10. —39-year-old woman with pacemaker and cardiomyopathy. Axial
contrast-enhanced CT scan (20-sec injection delay; window width = 440 H;
window level = 40 H) through lower heart. Imaging volume began at level of top
of aortic arch. Images at this level were acquired approximately 30 sec after
injection of contrast agent was begun. Note poor left heart and aortic
opacification and intense opacification of right heart. Aorta is usually well
opacified by this time. Echocardiography confirmed poor ventricular ejection
fraction. a = aortic root, L = left atrium.
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Fig. 11. —68-year-old woman with cardiomyopathy. Axial
contrast-enhanced CT scan near cardiac apex reveals biventricular thrombi
(arrows) in patient with cardiomyopathy (ejection fraction =
15%).
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Fig. 12A. —51-year-old man with positive antinuclear antibody titer and
presumed connective tissue disease. Axial contrast-enhanced CT scan reveals
focal dilatation of left pulmonary artery (arrow), consistent with
aneurysm.
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Fig. 12B. —51-year-old man with positive antinuclear antibody titer and
presumed connective tissue disease. Three-dimensional
shaded-surface—display image clearly shows aneurysm
(arrows).
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Fig. 13A. —23-year-old woman with Osler-Weber-Rendu disease.
Contrast-enhanced CT scan just superior to left pulmonary hilum reveals
enlarged pulmonary vasculature (arrow) supplying pulmonary
arteriovenous malformation.
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Fig. 13B. —23-year-old woman with Osler-Weber-Rendu disease.
Contrast-enhanced CT scan at level superior to A shows dilated
peripheral arteries and veins (arrow).
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Fig. 13C. —23-year-old woman with Osler-Weber-Rendu disease.
Volume-rendered CT image delineates spatial relationships of abnormal
vasculature (arrows).
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Fig. 14. —50-year-old man with pulmonary artery sarcoma. Axial
contrast-enhanced CT scan through left pulmonary artery reveals irregular,
ployploid filling defect (arrow) within left pulmonary artery. Biopsy
of left lower lobe mass revealed sarcoma.
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Fig. 15. —38-year-old woman with patent ductus arteriosus.
Contrast-enhanced CT scan at level of undersurface of aortic arch reveals
enhancing structure connecting proximal left pulmonary artery and proximal
descending thoracic aorta (arrow), representing patent ductus
arteriosus.
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Fig. 16A. —42-year-old man with pulmonic stenosis. Axial CT scan after
contrast media injection shows narrowing (arrow) and subsequent
dilatation of main pulmonary arterial segment.
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Fig. 16B. —42-year-old man with pulmonic stenosis. Coronal
maximum-intensity-projection image reveals enlarged main pulmonary artery
segment (arrow). Right pulmonary artery is normal in size.
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Fig. 17. —Axial contrast-enhanced image through right pulmonary artery
in 30-year-old man reveals absence of proximal left pulmonary artery.
Diminutive left interlobar pulmonary artery (arrowhead) is
reconstituted from bronchial collateral vessels (arrows). Note
hypoplastic left thorax.
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Fig. 18. —Axial contrast-enhanced CT scan through mid heart in
50-year-old man shows fat density within septum between atria
(arrows), consistent with lipomatous hypertrophy of interatrial
septum.
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Fig. 19. —72-year-old woman with cardiomyopathy. Contrast-enhanced CT
scan through heart just inferior to level of right pulmonary artery reveals
low-attenuation filling defect within left atrial appendage (arrow),
representing thrombus.
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Fig. 20. —68-year-old man with left ventricular aneurysm after
myocardial infarction. Axial contrast-enhanced CT scan through cardiac apex
reveals thinning of apical myocardium with small focus of contrast material
projecting beyond ventricular lumen representing true left ventricular
aneurysm (arrows).
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Fig. 21. —35-year-old woman with shortness of breath. Contrast-enhanced
axial CT scan through heart shows loculated pericardial fluid (arrow)
along right cardiac border, compressing right atrium and ventricle. Note that
combination of enhancing parietal pericardium and pleura creates plane that
clearly separates pericardial and pleural (P) fluid collections.
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Fig. 22. —Axial CT scan in 58-year-old woman shows high-attenuation
pericardial effusion, suggesting hemorrhage. Pericardiocentesis revealed
hemorrhage due to metastatic breast carcinoma.
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Fig. 23. —48-year-old woman with constrictive pericarditis. Axial
contrast-enhanced CT scan through ventricles shows pericardial thickening
(arrow), consistent with constrictive pericarditis. Pericardial
abnormality consists entirely of thickening; no pericardial fluid is present.
Note enlarged right atrium and flattened interventricular septum.
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Fig. 24. —42-year-old woman with partial absence of left pericardium.
Axial contrast-enhanced CT scan at level of main pulmonary artery segment
reveals pulmonary parenchyma extending into aortopulmonary window
(arrow), which is normally covered by pericardium and subjacent fat.
Note leftward cardiac rotation.
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Copyright © 2001 by the American Roentgen Ray Society.
