0:00

Okay in this next case, I'm going to demonstrate a patient

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with a ramus intermedius what we

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expect to see with a ramus is that the left main instead

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of bifurcating into the LED and circumflex instead

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tryificates into three vessels?

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The led the ramus and the circumflex. So in

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this case you can see

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Here's the left main on the axial image. Here's the LED coming off.

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Here's another Branch here in the middle. That's the ramus

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branch. And then here's your third branch here the circumflex

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now, sometimes they can get kind of crowded there.

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And so it's hard to say is it?

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A very high branching of an obtuse marginal or

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diagonal Branch or is it a ramus and it's

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a bit subjective. But at least for me as long as it's winded a

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millimeter to of the bifurcation and I'll

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usually call it a ramus branch.

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Ramus branches and and even diagonal branches are sometimes

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well seen with nip reconstruction.

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So here I just switched to a thin MIP.

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And you can see that you can really appreciate that traffication nicely

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when using the net break instructions.

1:06

You can also see that this patient has a little

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bit of very mild calcification here in the

1:12

LED and has some small diagonal

1:15

Branch here and then a larger modern sized

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diagonal Branch there.

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In cases with the left dominant circulation with

1:23

the ramus. Sometimes these nips can be quite helpful.