MediAI

A radiologist’s approach to quadricuspid pulmonary valve: CT diagnosis, four-cusp morphology, differential diagnosis, pulmonary regurgitation, pulmonary artery aneurysm, multimodality imaging, management, and prognosis. By Hwunjae Lee, MD, PhD Introduction A 43-year-old woman presented with sudden epigastric pain radiating to the back . That clinical description immediately raises an important diagnostic concern. Sudden severe upper abdominal or epigastric pain extending toward the back can represent acute aortic syndrome (AAS) , including aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, or aortic rupture. In an emergency setting, these potentially fatal conditions must be excluded rapidly. CT angiography was therefore performed. The aorta was unremarkable for an acute aortic catastrophe. There was no convincing aortic dissection, penetrating atherosclerotic ulcer, intramural hematoma, rupture, or pericardial effusion. However, the examination contained an une...

  A Radiologist’s Guide to Recognizing Myocardial Ischemia on Contrast-enhanced CT Clinical Hook A man in his late 40s arrived with sudden chest pain. The initial clinical question was not necessarily “Can CT diagnose myocardial infarction?” In an emergency department, the more immediate concern in a patient with acute chest pain may be to exclude other life-threatening conditions such as aortic dissection, pulmonary embolism, or another acute thoracic process. But the CT contained a second, potentially decisive message. The myocardium was not enhancing uniformly. A relatively hypoenhancing region extended through the left ventricular anterior wall toward the apex, with involvement of the interventricular septal and apical inferior myocardial regions. More importantly, the myocardial abnormality followed a recognizable coronary distribution. At the same time, the proximal left anterior descending artery demonstrated occlusion associated with noncalcified plaque. The diagnosis was a...

When Palpitations Are Not Just an Arrhythmia A man in his seventies presented with palpitations. At first glance, the clinical problem appeared straightforward. Palpitations in an older adult commonly lead to an electrocardiogram, ambulatory rhythm monitoring, and evaluation for ischemic or structural heart disease. But his chest radiograph contained a second message. The cardiac silhouette was enlarged, the main and central pulmonary arteries were prominent, and there was a suggestion of a small left pleural effusion. The combination raised a more important question: Why is the right side of the heart enlarged? That question changes the diagnostic pathway. The eventual CT examination demonstrated a complex but highly characteristic anatomy. The right upper pulmonary vein drained toward the superior vena cava, while the right middle pulmonary venous drainage also entered the right-sided circulation in association with a superior sinus venosus atrial septal defect. The right lower pulmo...