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Case Study

Case Study. Gerrit Blignaut 24 February 2012. Patient 1: Cyanotic Give the diagnosis and specific radiological sign. Patient 2 Cyanotic. Patient 3 Cyanotic. Patient 4 Acyanotic. Types of cardiac lesions. 1: Acyanotic with increase pulmonary vasculature L>R shunt: VSD, ASD, PDA

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Case Study

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  1. Case Study GerritBlignaut 24 February 2012

  2. Patient 1: CyanoticGive the diagnosis and specific radiological sign

  3. Patient 2Cyanotic

  4. Patient 3Cyanotic

  5. Patient 4Acyanotic

  6. Types of cardiac lesions 1: Acyanoticwith increase pulmonary vasculature L>R shunt: VSD, ASD, PDA 2: Acyanoticwith normal pulmonary vasculature Outflow tract obstruction: AS, PS, CoA 3: Cyanotic with increase vasculature Mixture of systemic and pulmonary blood 4: Cyanotic with decrease vasculature Obstruction pulmonary flow R>L shunt

  7. Cyanotic: Increased vasculature Decreased vasculature • TGA • Truncusarteriosis • TAPVC • Tricuspid atresia • (T)Single ventricle Cardiac enlargement? No Yes Fallot tetralogy Ebstein anomaly Pulmonic atresia Tricuspid atresia

  8. No cyanosis Vasculature increased Vasculature normal Left atrial Enlarged? Aortic stenosis Pulmonic stenosis Coartation IAA No Endocardial cushion defect Atrial septal defect Yes Aorta enlargement? No = VSD AVSD/endocardial cushing defect Yes = PDA

  9. Patient 1:

  10. Tetralogy of Fallot • 4 Components • VSD • RVOT obstruction • Overriding aorta, • Right ventricular hypertrophy. • 10% of congenital cardiac lesions. • 25% has right sided aortic arch • Associated with TOF, rib anomallies and scoliosis.

  11. Patient 2

  12. Ebsteins anomaly • Downward displacement of the tricuspid valve into the inflow portion of the right ventricle. • Forms a common right ventriculoatrial chamber and causes TI. • TI: Dilatation of the RVOT and all proximal right heart structures. • Right atrium becomes enlarged, and a R>L shunt (through a patent foramen ovale or ASD.) • Cyanosis

  13. Associations: • Maternal lithium usuage. • Patent foramen ovale/ ASD 80%.

  14. Patient 3

  15. Transposition of great vessels • Infants of diabetic mothers. • Isolated in 90%, rarely associated with a syndrome • Pulmonary artery to the right of its normal location. • Obscured by the aorta on PA CXR. • Cardiovascular silhouette varies from normal to enlarged and globular. • Causes for narrowing superior mediastinum CXR • TGA • Thymic atrophy • Hyperinflated lungs

  16. Patient 4

  17. Coarctation of aorta • Posterior infolding of the aortic lumen. • Junction of the aortic arch and the descending thoracic aorta. • Narrowing of the lumen at insertion of ductus or ligamentumarteriosus. • Cause obstruction outflow from LV. • 7% of congenital cardiac lesions. • Clinical manifestations • CCF infancy -- hypertension with difference upper lower limbs.

  18. Coarctation syndrome: • Coarctation • PDA • VSD • Associations • Turner syndrome • CoW aneurysms • PDA aneurysm

  19. Localized coarctation • Left subclavian artery or the ligamentumarteriosum. • Dilatation of the left subclavian artery. • Collateral vessels forms to bypass the coarctation. • Rib notching 3/4 -8 (Desc aorta) • Costocervicaltrunk supply ½ intercostal arteries (usually spared).

  20. Tubular hypoplasia (Preductalcoarctation) • Narrowing beyond the origin of innominate artery. • Combined focal constriction before the level of the ductusarteriosus. • Associated with a deformed or bicuspid aortic valve. • R>L shunt via PDA or VSD

  21. PET

  22. Reference: • Classic Imaging Signs of Congenital Cardiovascular Abnormalities RadioGraphics2007; 27:1323–1334 • Primer p 117 – 140. • UniversitasiSite

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