When, Why, and How to Examine the Heart During Thoracic CT: Part 2, Clinical Applications
John F. Bruzzi1,2,
Martine Rémy-Jardin1,
Damien Delhaye1,
Antoine Teisseire1,
Chadi Khalil1 and
Jacques Rémy1
1 Department of Radiology, Hospital Calmette, Boulevard Pr. J. Leclerq, Lille
59037, France.
2 Present address: Department of Thoracic Imaging, The University of Texas M. D.
Anderson Cancer Center, Box 57, 1515 Holcombe Blvd., Houston, TX
77030-4095.
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Fig. 1A —Contrast-enhanced CT scans of thorax (360° rotation, no cardiac
gating) in 45-year-old man evaluated for chronic obstructive airways disease.
High-resolution 1-mm-thick axial slices through right upper lobe at level of
tracheal bifurcation obtained at lung parenchymal window settings (window
center: -600 H; window width: 1,600 H). Thickening of septal lines
(arrows) and of peribronchial walls (arrowheads) is
characteristic of interstitial pulmonary edema. In certain situations,
irregular thickening of lymphatic vessels in interstitium can mimic other
diseases such as lymphangitic carcinomatosis or sarcoidosis.
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Fig. 1B —Contrast-enhanced CT scans of thorax (360° rotation, no cardiac
gating) in 45-year-old man evaluated for chronic obstructive airways disease.
Six months after treatment of cardiogenic pulmonary edema, CT abnormalities
are no longer seen.
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Fig. 2 —Contrast-enhanced CT scan of thorax in 49-year-old man with
recurrent congestive heart failure. Axial 5-mm-thick image at level of both
ventricles shows dilated left ventricle with relative preservation of
myocardial thickness (arrow), evoking possibility of dilated and
hypertrophic cardiomyopathy of left ventricle. Such an appearance would be
compatible with mixed ischemic and alcoholic cardiomyopathy.
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Fig. 3 —Axial contrast-enhanced CT image obtained without cardiac gating in
52-year-old man with atypical chest pain and hypertension shows focal area of
poor enhancement in subendocardial region of anterior wall of left ventricle
(arrow), which is consistent with ischemic or infarcted myocardium in
territory of left anterior descending coronary artery.
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Fig. 4A —Contrast-enhanced thoracic CT scans in 63-year-old man evaluated for
extension of right upper lobe carcinoma (360° rotation, no cardiac
gating). Axial 1-mm-thick image at level of cardiac apex (window center: 50 H;
window width: 350 H) shows aneurysm of left ventricular apex that was
discovered incidentally on CT performed for investigation of exertional
dyspnea. Aneurysm is characterized by spherical aspect of left ventricular
apex. Involved myocardium (arrow) is thinned.
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Fig. 4B —Contrast-enhanced thoracic CT scans in 63-year-old man evaluated for
extension of right upper lobe carcinoma (360° rotation, no cardiac
gating). At slightly more caudal level, 5-mm-thick axial image shows local
thrombus in aneurysm (arrow) that was formed as result of local
dyskinesis.
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Fig. 5 —ECG-gated cardiac CT examination of heart, performed on 16-MDCT
scanner, in 34-year-old man with recurrent hemoptysis resulting from severe
cystic bronchiectasis. Axial oblique maximum-intensity-projection 5-mm-thick
image at mediastinal soft-tissue window setting shows abnormally dilated
bronchial artery coursing toward left anterior descending coronary artery in
retrocardiac region (arrow). Images at slightly more caudal level
confirmed coronary artery-to-bronchial artery anastomosis.
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Fig. 6 —CT scan obtained for evaluation of chronic thromboembolic disease in
38-year-old woman with primary pulmonary hypertension (360° rotation, no
cardiac gating). Axial 5-mm-thick image at level of ventricles (window center:
50 H; window width: 350 H) shows marked dilatation of right ventricular lumen;
partial posterior convexity of interventricular septum (arrow);
dilatation of right atrium, coronary sinus (star), and inferior vena
cava; and minor pericardial effusion (arrowhead).
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Fig. 7 —CT scan obtained for evaluation of chronic thromboembolic disease in
45-year-old woman (360° rotation, no cardiac gating). Axial 1-mm-thick
image at level of ventricles (window center: 50 H; window width: 350 H) shows
pericardial effusion, ventricular dilatation, and moderate hypertrophy of
right ventricular myocardium (arrows) resulting from chronic
pulmonary artery hypertension and consequent right ventricular decompensation.
Pulmonary arteries in basal segments of right lower lobe (arrowheads)
are smaller than their counterparts in left lower lobe, consistent with
sequelae of chronic pulmonary thromboembolic disease.
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Fig. 8 —Contrast-enhanced CT scan of thorax (360° rotation, no cardiac
gating) in 55-year-old man hospitalized for pyrexia and shortness of breath.
Axial 5-mm-thick image (window center: 50 H; window width: 350 H) at level of
left atrium depicts prominent intraluminal soft-tissue mass (arrow)
that was proven at subsequent surgery to be intraatrial myxoma. Note extensive
consolidation and pleural effusion in left lung resulting from superimposed
pneumonia.
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Fig. 9 —Contrast-enhanced CT scan of thorax (360° rotation, no cardiac
gating) for evaluation of abnormality of cardiomediastinal silhouette on
standard chest radiograph in 45-year-old man. Cystic tracheobronchial mass
(star) is seen compressing superior vena cava (arrow) and,
on adjacent slices (not shown), displacing right main pulmonary artery
inferiorly and indenting roof of left atrium. Whether cystic lesion is intra-
or extrapericardial is uncertain. Arguments in favor of intrapericardial
nature include origin from region of subaortic pericardial reflections,
whereas two signs arguing against infra- or retrocarinal position are
compression of superior vena cava and inferior displacement of right pulmonary
artery. Mass was subsequently confirmed to be intrapericardial hydatid
cyst.
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Fig. 10 —Unenhanced CT examination of thorax for evaluation of spontaneous
left-sided pneumothorax in 35-year-old woman depicts incidental discovery of
congenital pericardial defect over left side of heart (arrow). Note
minor intrapericardial pulmonary herniation between ascending aorta and
pulmonary trunk, which is displaced anterolaterally.
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Fig. 11A —Congenital left-sided pericardial defect suspected on
posteroanterior chest radiograph of 38-year-old man. Excessive mobility of
heart is shown on two unenhanced CT images obtained with cardiac gating
(temporal resolution, 250 msec) at level of inferior pulmonary veins with
patient in supine (A) and left lateral decubitus (B) positions.
Note cardiac levorotation and increased contact between left ventricle and
anterolateral thoracic wall in left lateral decubitus position (B).
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Fig. 11B —Congenital left-sided pericardial defect suspected on
posteroanterior chest radiograph of 38-year-old man. Excessive mobility of
heart is shown on two unenhanced CT images obtained with cardiac gating
(temporal resolution, 250 msec) at level of inferior pulmonary veins with
patient in supine (A) and left lateral decubitus (B) positions.
Note cardiac levorotation and increased contact between left ventricle and
anterolateral thoracic wall in left lateral decubitus position (B).
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Copyright © 2006 by the American Roentgen Ray Society.
