Thoracic Imaging 2003 - Society of Thoracic Radiology

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TUESDAY 142 Appendix: Common operations performed for congenital heart disease Palliative PA shunts Eponym Connection Indication Waterson-Cooley Ascending aorta to Right PA Lesions with decreased Blalock-Taussig (BT) Subclavian artery to PA Pulmonary flow: TOF, Potts Descending aorta to PA Pulmonic stenosis/atresia Glenn SVC to PA Creation/Enlargement of ASD Eponym Procedure Indication Blalock-Hanlon Surgical creation of an ASD D-transposition Rashkind Balloon atrial septostomy Corrective procedures Eponym Procedure Indication Mustard Creation of a common atrium, D-transposition Senning with intraatrial baffle directing systemic venous blood to the left ventricle (mitral valve) and the pulmonary venous blood to the right ventricle (tricuspid valve) Jatene Division of the great vessels D-transposition with reattachment of the aorta to the left ventricle and the main PA to the right ventricle. Reimplantation of the coronary arteries on the ascending aorta Rastelli Creation of an intraventricular D-transposition with PS tunnel shunting blood from the and VSD. left ventricle via a VSD to the DORV with PS. transposed ascending aorta TOF with pulmonary atresia combined with an extracaridac Truncus arteriosis types conduit connecting the right I and II ventricle to the pulmonary trunk Fontan Conduit from right atrium to PA Tricuspid atresia Single ventricles Ross Pulmonic valve reimplanted in Aortic valve disease aortic position, combined with requiring valve pulmonic homograft replacement Norwood Norwood I: PA transected, used Hypoplastic left heart to create neoaorta; Blalock- Taussig (BT) shunt; Atrial septectomy. Norwood II: Bidirectional Glenn with takedown of BT shunt. Norwood III: Completion of Fontan.
Imaging of the Pericardium Paul L. Molina, M.D. Professor of Radiology, Director, Radiology Residency Training Program, Vice Chairman of Education, University of North Carolina, Chapel Hill, North Carolina Objectives 1. Review the normal appearance of the pericardium, including the pericardial recesses, on both CT and MRI. 2. Learn the major clinical applications of CT and MRI in the evaluation of patients with suspected pericardial disease. 3. Review the CT and MRI findings in a variety of pericardial disease processes. Introduction Computed tomography (CT) is an established technique for evaluation of the pericardium and is generally considered complimentary to echocardiography in the assessment of complicated pericardial effusions, pericardial thickening, calcific pericarditis, pericardial masses and congenital anomalies. Magnetic resonance imaging (MRI) is also useful in the evaluation of pericardial disease. Advantages of MRI include its potential for tissue characterization, absence of ionizing radiation and need for intravenous contrast medium, and its ability to scan in any plane. These potential advantages, however, are at times outweighed by the disadvantages of higher cost, longer examination time, and inability to accurately identify calcification. Also, it may be difficult to adequately examine patients with arrhythmias because of the need for cardiac gating of MR studies of the pericardium. Normal Anatomy At least a portion of the normal pericardium, a double-layered fibroserous sac enveloping the heart and origin of the great vessels, is visible on CT and MRI in almost all patients. The normal thickness of the pericardium on CT or MRI is 1-2 mm. On CT it appears as a thin curvilinear density and on MR as a low signal intensity line. The decreased signal intensity of the pericardium is probably due to fluid flow during the cardiac cycle. The caudal half of the pericardium is commonly imaged, especially those portions overlying the anterolateral cardiac surface where the pericardium is surrounded by fat in the mediastinum and in the subepicardial region of the heart. The most distal portion of the pericardium, just before its insertion into the central tendon of the diaphragm and in front of the inferior surface of the right ventricle, may measure up to 3-4 mm in thickness due to accumulation of small physiological amounts of pericardial fluid. The dorsal aspect and the cephalad portion of the pericardium are infrequently seen because of the lack of sufficient surrounding fat in these areas. The pericardial cavity contains several recesses around the heart where normally small amounts of fluid can collect. An understanding of these recesses is important in order not to confuse fluid within them with mediastinal masses or enlarged lymph nodes. Pericardial Effusion Echocardiography currently remains the primary means of evaluating a patient for pericardial effusion. Its major advantages include the ease of the examination and the portability of the equipment, along with the absence of exposure to ionizing radiation. Both CT and MRI are also useful for establishing the diagnosis of pericardial effusion and are usually reserved for those patients who have technically inadequate sonographic studies or in whom there is a discrepancy between clinical and echocardiographic findings. A pericardial effusion generally is recognizable on CT as an increase in thickness of the normal band-like pericardium. Most commonly, the fluid has a near-water density value and represents a transudate. Near soft-tissue density collections may occur with an exudative or purulent effusion or a hemopericardium. Blood in the pericardium may be isodense with the cardiac muscle and therefore administration of intravenous contrast media may be required for diagnosis, demonstrating enhancement of the myocardium with no alteration of the surrounding hemopericardium. On MRI a simple pericardial effusion usually is characterized by low signal intensity on short TR/TE images; its signal intensity increases on longer TR or longer TE images. Hemorrhagic pericardial effusions often contain areas of mixed, medium and high signal intensity that may vary with the age of the effusion. On supine CT and MRI scans, small pericardial effusions usually collect dorsal to the left ventricle and behind the left lateral aspect of the left atrium. Larger effusions extend ventrally in front of the right ventricle and right atrium. In massive pericardial effusions, the heart appears to float within the distended pericardial sac and fluid extends cephalad to surround the origin of the great vessels. The over-distended pericardium may project caudally and compress the diaphragm and upper abdominal organs. Encapsulated pericardial effusions can occur when fibrous adhesions seal off portions of the pericardial space; dorsal and right anterolateral loculations are most common. Occasionally the encapsulated fluid will bulge toward the heart and can result in the hemodynamics of cardiac tamponade or constrictive pericarditis. With inflammatory pericarditis and effusion, the pericardium itself may enhance following the intravenous administration of contrast media. Pericardial Thickening The pericardium can respond to injury by fibrin production and cellular proliferation in addition to fluid output. All three mechanisms can occur concomitantly or independently. Pericardial thickening may result from proliferation of fibrin deposits or organized blood products or through neoplastic invasion. Pericardial thickening from 0.5 to 2.0 cm or greater can occur and may be focal or involve the entire pericardium. Generally, the maximal thickening occurs ventrally. The thickened pericardium usually is smooth but can be nodular in neoplastic disease. Distinction from a small exudative or bloody pericardial effusion may be difficult. Constrictive Pericarditis Versus Restrictive Cardiomyopathy CT and MRI have shown value in differentiating constrictive pericarditis from restrictive or infiltrative cardiomyopathy (e.g., amyloidosis). This distinction is often quite difficult clinically, 143 TUESDAY
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The Society of Thoracic Radiology T
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Dear Friends, Welcome to Miami Beac
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Continuing Medical Education Credit
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Warren B. Gefter, MD University of
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Ernest M. Scalzetti, MD SUNY Upstat
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Registration Hours Saturday, March
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Program Committee Ella A. Kazerooni
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Small Airway Disease Americana 3 Mo
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Benjamin Felson Memorial Lecture Am
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Session 2-B Concurrent Session Clin
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Workshops (choose 1) 1:00 - 1:45 D1
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Sunday
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March 2, 2003 General Session Sunda
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SUNDAY 46 One type of direct-readou
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CT-PET Imaging Suzanne Aquino, M.D.
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SUNDAY 58 an accompanying decreased
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SUNDAY 60 Radiofrequency Ablation i
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SUNDAY 62 17. Sewell PE, Vance RB.
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SUNDAY 64 cal ventilation will be r
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SUNDAY 66 radiologic, and histopath
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SUNDAY 68 application. The untreate
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SUNDAY 70 The Expanded Spectrum of
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SUNDAY 72 Hypersensitivity Pneumoni
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SUNDAY 74 Small Airway Diseases Mic
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SUNDAY 76 The “Head-cheese Sign
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SUNDAY 78 “Holes” in the Lung:
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SUNDAY 80 Pleural Effusions Gerald
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SUNDAY 82 Asbestos Related Pleural
Page 57 and 58: SUNDAY 84 Other Pleural Neoplasms S
Page 59 and 60: SUNDAY 86 Image-Guided Therapy of M
Page 61 and 62: Notes 88
Page 63 and 64: March 3, 2003 General Session 7:00
Page 65 and 66: Cardiac MRI: Established Indication
Page 67 and 68: Cardiac MRI: New Developments Gauth
Page 69 and 70: 5. The volume of contrast medium re
Page 71 and 72: Acute Aortic Syndrome Ernest M. Sca
Page 73 and 74: as well as separation of the cusps
Page 75 and 76: Pulmonary Veins: Imaging for Radiof
Page 77 and 78: Imaging of Cardiopulmonary Support
Page 79 and 80: plied to the hollow fibers by an ex
Page 81 and 82: swelling of the entire leg, calf sw
Page 83 and 84: Multi-channel Pulmonary CTA: New Te
Page 85 and 86: terminate scintigrams, CT correctly
Page 87 and 88: CT Strucural and Functional Imaging
Page 89 and 90: curves (TDCs) are generated by manu
Page 91 and 92: 7. Crawford T, Yoon C, Wolfson K, e
Page 93 and 94: 80. Fleischmann D, Rubin GD, Bankie
Page 95 and 96: 127 MONDAY
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Page 99 and 100: REFERENCES Bergin CJ, Rios G, King
Page 101 and 102: Notes 134
Page 103 and 104: March 4, 2003 General Session 7:00
Page 105 and 106: Adult Manifestations of Congenital
Page 107: will usually display the limbs of t
Page 111 and 112: Cardiomyopathy Martin J. Lipton, M.
Page 113 and 114: TUESDAY 150 Nuclear Cardiology Upda
Page 115 and 116: TUESDAY 152 ties. The predominant 1
Page 117 and 118: TUESDAY 154 Imaging protocols: Util
Page 119 and 120: Manpower Shortage in Radiology: Sol
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Page 127 and 128: NIBIB Update for Thoracic Radiology
Page 129 and 130: vertically along the right atrium t
Page 131 and 132: Multidetector Pediatric Chest CT: P
Page 133 and 134: The Spectrum of Pulmonary Infection
Page 135 and 136: Immune deficiency occurs frequently
Page 137 and 138: TUESDAY 180 The Internet and the Pr
Page 139 and 140: TUESDAY 182 Workshop A1: Lymphoma:
Page 141 and 142: TUESDAY 184 Digital Images: Camera
Page 143 and 144: TUESDAY 186 Analysis of Mediastinal
Page 145 and 146: Unusual Manifestations of Lung Canc
Page 147 and 148: Wednesday
Page 149 and 150: March 5, 2003 General Session Wedne
Page 151 and 152: WEDNESDAY 208 principle is that “
Page 153 and 154: WEDNESDAY 210 years and a current o
Page 155 and 156: WEDNESDAY 212 lesions generally mim
Page 157 and 158: WEDNESDAY 214 capable of studying t
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WEDNESDAY 216 Small T1 Lung Cancer:
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WEDNESDAY 218 REFERENCES Seely JM,
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WEDNESDAY 220 Therefore, radiologis
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WEDNESDAY 222 sectional area varies
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WEDNESDAY 224 Lung Cancer Staging A
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Metastatic Disease to Lung Gordon L
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Thoracic Metastates from Osteosarco
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STR tutorial: Use of MD CT reconstr
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ogenic edema, fat embolism, heroin
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WEDNESDAY 236 Pulmonary Arterial Hy
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WEDNESDAY 238 pathological process,
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Thursday
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THURSDAY 250 Pulmonary Tuberculosis
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THURSDAY 252 1. Clinical criteria:
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THURSDAY 254 AIDS patients are also
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THURSDAY 256 Viral Infection on HRC
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THURSDAY 258 Imaging of Coccidioido
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THURSDAY 260 from the laryngeal sur
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THURSDAY 262 Inflammatory Diseases
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Virtual Endoscopy in the Thorax: Pr
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Notes 269 THURSDAY
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SECOND LEVEL THIRD LEVEL
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