0:00

All right, let's go on to the next case and

0:03

this is case 11 and 12. And

0:06

I also have a pet for this case. But let's

0:09

go to the the CT images

0:12

first.

0:15

And let's start up here with the coronary arteries and there's a little bit of

0:18

coronary calcification.

0:25

But I want you to look at the whole heart and there's a little pericardial effusion.

0:28

That's great.

0:29

He picked up on that.

0:37

They're back up and come back down.

0:45

In this case, I'll I'll show you that this is

0:49

in the chamber here and on some of these cases you may

0:52

have been wondering, you know, oh, is there a thrombus in the heart? Here's another

0:55

one here. And of course, these are papillary muscles and you should

0:58

know that there are two main halfway muscle bundles. This is

1:01

the antilateral capillary muscle bundle that's close to the entrilateral wall.

1:04

And then this is the intermedial or

1:08

post remedial papillary muscle down here. So those are not

1:11

thrombine, but let's open the polling question. What is

1:14

the major abnormality on this on this particular

1:17

case?

1:18

Let's pull this up. I'll keep scrolling through the

1:21

case.

1:25

So again, I've sort of given you the pericardium.

1:36

Alright, so, let's see what people thought about this. Where is

1:39

the location of the most significant abnormality and

1:42

let's close the poll.

1:45

And let's see what people thought so people thought myocardium good

1:48

so everyone picked my cardium

1:51

and so what's wrong with myocardium. So as I

1:54

said, we want to look for thrombise. So let's see if

1:57

there's any thrombus in the left ventricular cavity there isn't but my

2:00

cardium looks strange doesn't it? And let's

2:03

bring up the the pet here. Let me scroll to the heart

2:06

so you can see the left ventricle right

2:09

here and it's very odd. There's a lot

2:12

of ftg uptake in the septum in the story

2:15

in the Apex here and looking at the Apex on the

2:18

CT images. You see that the Apex is thickens and

2:21

if you compare the Apex to the rest

2:24

of the the mycardium at the mid ventral and at

2:27

the base, you see that this is

2:30

abnormally thickened at the Apex and not only that but it

2:33

looks like there's narrowing of the cavity at

2:36

the Apex.

2:38

And this is exactly where the ftg uptake

2:41

is most focal and highest right here at the Apex. So

2:44

what is this? This is apical variant of

2:47

hypertrophic cardiomyopathy and

2:50

you can actually see this on non-gated

2:53

CTS. If you look carefully if it's significant if it's

2:56

severe enough you'll see this thickening and you can

2:59

see that there's a little bit of decreased enhancement

3:02

of The myocardium as

3:05

well should suggesting some sort of abnormality of

3:08

The myocardium at the at the Apex. So

3:11

this is one of the many forms of

3:14

hypertrophic Harding myopathy remember it

3:17

can involve the hard diffusely. It

3:20

can involve just the septum. We can

3:23

involve just a lot of wall. I'll show you the more common

3:26

type here. Let me pull this case up.

3:30

And let me scroll down to the heart on this case.

3:36

and I will

3:38

Assume that down a bit, but look at

3:41

this. This is a really bad asymmetric septal

3:44

hypertrophy. You can see that these

3:47

septum is at least two and a half centimeters thick

3:50

here, maybe three or more and compare that

3:53

to the lateral wall. It's just very abnormally thickened. So

3:56

one of my goals for showing these cases is to get

3:59

you to look at the thickness of The myocardium.

4:02

Look at the enhancement of The myocardium on every case because

4:05

there are many many cases that you're going to be able

4:08

to to diagnose or at

4:11

least suspect on non-gated CTS like

4:14

this and of course cases, like this would be definitely diagnosed

4:17

a cardiac Mr. And echocardiography, but

4:20

you could be the first one to suspect these

4:24

abnormalities. And actually there's a case from a

4:27

few months ago where we actually were the first

4:30

to suspect this on a non-gate is CT and the patient

4:33

was diagnosed with high hypertrophic obstructive

4:36

cardiomyopathy with a

4:38

Asymmetric septal, hypertrophy, so

4:41

it's a real it's very important to

4:44

look at these things on non-gated CT.