A 38-year-old male presents with a history of mitral valve prolapse with intermittent chest pain with increased physical exertion. Treadmill stress test equivocal with limiting chest pain but normal ECG with stress. Coronary CT angiogram was ordered for further risk stratification.

1-2

Preview Case

A 70-year-old male presents with a history of recurrent probable cardiac chest pain.

1-3

Preview Case

A 52-year-old female presents with a history of coronary artery disease status post CABG, hypertension, mixed hyperlipidemia and spontaneous coronary artery dissection of the left main to LAD and LCX, with worsening chest pain.

1-4

Preview Case

A 47-year-old male presents with a history of prior tobacco use. New onset intermittent substernal chest pain with increased physical exertion. Coronary CT angiogram was ordered for further risk stratification.

1-5

Preview Case

A 49-year-old male presents with a history of hyperlipidemia and family history of early coronary artery disease. New onset of chest pain with exertion.

0 / 5 Cases

Worklist 2

2-1

Preview Case

A 53-year-old male presents with a history of mitral valve regurgitation with repair and paroxysmal atrial fibrillation. Request for Cardiac CT to assess pulmonary vein anatomy prior to planned pulmonary vein isolation.

2-2

Preview Case

A 58-year-old male presents with a history of intermittent chest pain with exertion. There is family history of early coronary artery disease with his father having a myocardial infarction at the age of 65 years.

2-3

Preview Case

A 68-year-old male presents with a history of recurrent chest pain. Stress test equivocal with ST-T wave changes suggestive of ischemia at peak exercise but no evidence of ischemia on SPECT imaging.

2-4

Preview Case

A 61-year-old male presents with recurrent chest pain and abnormal resting ECG.

2-5

Preview Case

A 66-year-old male with exertional chest pain. History of hypertension, mixed hyperlipidemia, and diabetes mellitus type 2.

0 / 5 Cases

Worklist 3

3-1

Preview Case

A 17-year-old male presents with a history of Kawasaki disease two years prior with non-diagnostic echocardiogram for involvement of the coronary arteries. Evaluation requested to assess candidacy for military enlistment.

3-2

Preview Case

A 65-year-old male presents with a history of hyperlipidemia and tobacco use and complains of new onset of chest pain with exertion. Family history of early coronary artery disease.

3-3

Preview Case

A 65-year-old female presents with a history of diabetes, hypertension, and paroxysmal atrial fibrillation. Request for cardiac CT to assess pulmonary vein anatomy prior to planned pulmonary vein isolation.

3-4

Preview Case

A 54-year-old female presents with a history of hypertension presents with new onset of chest pain with exertion. Family history of early coronary artery disease.

3-5

Preview Case

A 53-year-old male presents with a history of mixed hyperlipidemia and hypertension presenting with recurrent chest pain and an abnormal stress myocardial perfusion scan.

0 / 5 Cases

Worklist 4

4-1

Preview Case

A 49-year-old male presents with a history of tobacco use, hypertension, and mixed hyperlipidemia with new onset of chest pain.

4-2

Preview Case

A 56-year-old female presents with chest pain and detectable high sensitivity troponin.

4-3

Preview Case

A 58-year-old male presents with a history of hypertension, mixed hyperlipidemia, and chest pain with exertion.

4-4

Preview Case

A 48-year-old male presents with a history of chest pain and mixed hyperlipidemia.

4-5

Preview Case

A 32-year-old male presents with recent abnormal ECG and echocardiogram.

0 / 5 Cases

Worklist 5

5-1

Preview Case

A 41-year-old male presents with chest pain. Family history of early coronary artery disease with myocardial infarction in his mother at 55 years of age.

5-2

Preview Case

A 52-year-old male presents with a history of hypertension, aortic valve stenosis hyperlipidemia undergoing perioperative evaluation for aortic valve surgery.

5-3

Preview Case

A 58-year-old male presents with shortness of breath with exertion. Resting regadenoson myocardial perfusion SPECT revealed inconclusive findings of reversible ischemia on the basal to mid anterolateral segments versus possible wall attenuation artifact.

5-4

Preview Case

A 64-year-old female presents with a history of aortic valve regurgitation and aortic root aneurysm status post prior cardiac surgery experiencing symptoms of chest pain and shortness of breath with activity.

5-5

Preview Case

A 55-year-old male presents with a history of hypertension, mixed hyperlipidemia, and chest pain with exertion. Disclaimer about missing slices: Several axial slices are absent due to a technical error during scan acquisition. Despite this limitation, the primary finding is fully captured and adequately imaged.

0 / 5 Cases

Worklist 6

6-1

Preview Case

A 35-year-old male presents with a recent abnormal ECG and echocardiogram with evidence of right ventricular dilatation, persistent shortness of breath, and chest pain.

6-2

Preview Case

A 58-year-old female presents with a history of diabetes mellitus type 2, mixed hyperlipidemia and family history of early coronary artery disease experiencing increased shortness of breath and intermittent chest pain with exertion.

6-3

Preview Case

A 53-year-old male presents with a history of tobacco use and recurrent chest pain. Graded exercise treadmill was equivocal with limiting chest pain but no ischemic ECG changes.

6-4

Preview Case

A 28-year-old male presents with a history of intermittent chest pain with exertion.

6-5

Preview Case

A 69-year-old male presents with a history of hypertension, mixed hyperlipidemia, and pre-diabetes with new onset of shortness of breath and chest tightness with exertion.

0 / 5 Cases

Worklist 7

7-1

Preview Case

A 74-year-old male presents with a history of coronary artery disease status post CABG (anatomy unknown), hypertension, and mixed hyperlipidemia with worsening chest pain.

7-2

Preview Case

A 42-year-old male presents with a history of recent myocardial infarction. Status post invasive coronary angiogram with findings of possible spontaneous coronary artery dissection vs. vasospasm vs. acute plaque rupture of a diagonal branch.

7-3

Preview Case

A 72-year-old male presents with a history of hyperlipidemia, hypertension, and diabetes mellitus type 2 with new onset of chest pain with exertion.

7-4

Preview Case

A 59-year-old male presents with a history of hyperlipidemia, hypertension tobacco use, and diabetes mellitus type 2, with new onset of acute chest pain with exertion. An acute coronary syndrome is ruled out with negative cardiac biomarkers and no evidence of ischemia on ECG.

7-5

Preview Case

A 43-year-old male presents with a history of hypertension, and paroxysmal atrial fibrillation. Request for Cardiac CT to assess pulmonary vein anatomy prior to planned pulmonary vein isolation.

0 / 5 Cases

Worklist 8

8-1

Preview Case

A 49-year-old male presents with a history of hypertension, mixed hyperlipidemia, and coronary artery disease with chest pain on exertion.

8-2

Preview Case

A 62-year-old female presents with pre-diabetes and hypertension with new onset of chest pain with exertion.

8-3

Preview Case

A 69-year-old male presents with a history of coronary artery disease status post CABG (anatomy is unknown), and hypertension with worsening chest pain.

8-4

Preview Case

A 68-year-old male presents with a history of coronary artery disease status post CABG, hypertension, and mixed hyperlipidemia presenting with worsening chest pain.

8-5

Preview Case

A 62-year-old female presents with a history of aortic valve stenosis status post bioprosthetic surgical aortic valve replacement, hypertension, mixed hyperlipidemia, and diabetes mellitus type 2 with symptoms of chest pain and shortness of breath with activity.

0 / 5 Cases

Worklist 9

9-1

Preview Case

A 72-year-old male presents with a history of coronary artery disease status post CABG, hypertension, and mixed hyperlipidemia with worsening chest pain despite improved medical therapy.

9-2

Preview Case

A 22-year-old male presents with recent abnormal ECG and echocardiogram with evidence of right ventricular dilation.

9-3

Preview Case

A 65-year-old female presents with a history of diabetes, hypertension, and prior coronary artery bypass surgery with new onset of chest pain with exertion.

9-4

Preview Case

A 39-year-old male presents with a history of anomalous coronary artery involving the RCA s/p CABG due to chest pain with ischemia, presents for recurrence of chest pain. Request for CCTA to assess for arterial graft patency.

9-5

Preview Case

A 68-year-old male presents with a history of obesity, hyperlipidemia, hypertension, and diabetes mellitus type 2, coronary artery disease with prior PCI to the LAD and LCX with new onset of chest pain with exertion.

0 / 11 Units

Worklist 10: TAVR

TAVR Section Introduction

Introduction to TAVR CT: What Every Radiologist Must Know

Wk 10, Case 1 - Review

Wk 10, Case 2 - Review

Wk 10, Case 3 - Practice - Question 1

Wk 10, Case 3 - Practice - Question 2

Wk 10, Case 3 - Review

Wk 10, Case 4 - Practice - Question 1

Wk 10, Case 4 - Review

Wk 10, Case 5 - Practice - Question 1

Wk 10, Case 5 - Review

Course Evaluation

Cardiac CT Practice Cases

Wk 8, Case 2 - Practice - Question 4

HIDE

A 62-year-old female presents with pre-diabetes and hypertension with new onset of chest pain with exertion.

What is the most appropriate CAD-RADS score?

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Faculty

Giovanni E. Lorenz, DO

Cardiothoracic Radiologist

San Antonio Military Health System (SAMHS)

Emilio Fentanes, MD

Director of Cardiac Imaging, Department of Cardiology

Brooke Army Medical Center