Tag Archives: imaging

Introduction The acute aortic syndrome refers to a spectrum of potentially life-threatening emergencies encompassing intra-mural haematoma, penetrating aortic ulcer and acute aortic dissection, each with different pathophysiological mechanisms.1 Of these, acute dissections comprise 85–95% of acute aortic syndrome, with an annual incidence of 3–4 per 100,000 in the UK and US.2 According to the Stanford classification, type A aortic dissection (ATAD) involves the aorta proximal to the left subclavian artery origin, whereas type B dissections occur distal to this landmark. The disruption of aortic wall integrity in ATAD with proximal extensi

Presentation A 52-year-old woman with a background of alpha-1-antitrypsin deficiency and severe emphysema underwent transthoracic echocardiography (TTE) that demonstrated an apparent right atrial mass adhering to the inter-atrial septum. She was referred for transoesophageal echo (TOE) to investigate further. Additionally, she had been noted to desaturate on exercise, raising the possibility of intra-cardiac shunting. She was thus also referred for saline-bubble contrast TTE. Figure 1. Transthoracic echocardiography immediately following transoesophogeal echocardiogram. Apical four-chamber view at end-diastole demonstrating normal left ventri

The problem Diagnostic coronary angiography died some time ago, so why has it still not yet been buried alongside the exploratory laparotomy? The problem is clear: despite over half a century of experience, almost two-thirds of those undergoing elective diagnostic angiograms do not have obstructive coronary artery disease.1 Even in contemporary National Health Service (NHS) cardiac catheter laboratories, non-flow limiting coronary disease or angiographically normal coronary arteries remain common findings. Coronary angiography is now, arguably, the last invasive procedure to be performed with primarily diagnostic intent on this scale. How do

Emerging evidence In an issue of Circulation: Cardiovascular Imaging, Xie et al.1 performed a systematic review and meta-analysis to validate the prognostic importance of CAC scoring in non-triggered thoracic CT. The authors of this study performed a meta-analysis of five studies that compared CAC obtained using non-gated CT scans versus gated CT scans. This study demonstrated an excellent correlation between the two techniques with a pooled Cohen κ agreement being 0.89 (95% confidence interval [CI] 0.83–0.95). While this is promising, the authors have also highlighted some discrepancy between the two techniques, and this is important to

Introduction Figure 1. Chest X-ray (antero-posterior projection) demonstrating a septic lesion (thick arrow) Despite the significant improvements in both diagnostic and therapeutic procedures in recent years, infective endocarditis (IE) remains a medical challenge due to poor prognosis and high mortality. IE varies according to the initial clinical manifestations, underlying cardiac disease, micro-organisms involved and the associated complications. Echocardiographically, the majority of patients demonstrate vegetations on a single valve, while demonstration of involvement of two valves occurs much less frequently; triple-valve involvement is

The case study in this issue (see pages 46–7) demonstrates a potential use of CT scanning in the diagnosis of a patient with endocarditis. Electrocardiogram (ECG)-gated multi-detector cardiac computed tomography (MDCT) scanning has been proposed by many to have potential in the evaluation of endocarditis by demonstration of vegetations, complications (coronary artery occlusion, fistulae) and peripheral embolism.3 The major limitations of the technique include availability, spatial resolution, failure to demonstrate leaflet perforations and lack of haemodynamic information (table 1). Further, CT findings have not been correlated with clinica

Case 1 A 49-year-old woman with an unremarkable past medical history presented to her local hospital with irregular palpitations and two syncopal episodes. On both occasions she had regained consciousness without any neurological features, neither as prodrome nor in recovery. Examination revealed a diastolic murmur. Electrocardiogram (ECG) and chest X-ray were normal. A transthoracic echocardiogram (TTE) revealed a 2–3 cm mass in a non-dilated left atrium. Her transoesophageal echocardiogram showed the mass to be located close to the right, lower pulmonary vein but suggested the point of attachment to be the posterior wall rather than the a