0:00

All right good. So those pitfalls out of the way, let's

0:03

bring this one up.

0:05

And I'm going to ask you a poll question in just a second. I'm going

0:08

to scroll through these cases and because we're we know we're

0:11

looking at the heart. It's going to be a limited field of view. So

0:14

I'll just start scrolling through and I want you to try to

0:17

identify the abnormality. There's a

0:20

lot of motion on this exam, which is always the

0:23

challenge with non-gated standard chest

0:26

CT.

0:27

But let's scroll back up.

0:30

And I want you to think about what part of the heart the

0:33

abnormality is in.

0:36

I'll scroll back up. I'll scroll back down.

0:39

And let's go ahead and open the poll here. And the

0:42

questions for the poll are always going to be the same. They're going

0:45

to be what is the location of the Army? Is

0:48

it going to be coronary arteries or graphs? Cardiac Chambers

0:52

septum

0:54

myocardium pericardium or Valves

0:57

and you'll see a couple cases today that

1:00

are more than one answer. So just

1:03

don't worry about it. Just choose the one that you want to

1:06

choose if you see multiple abnormalities.

1:09

Which one do you think it is?

1:11

We'll just give a couple more minutes.

1:14

or seconds

1:18

All right. Let's open or close the poll here.

1:22

And let's see the answers.

1:24

Okay good. So the votes that we have are

1:27

for coronary arteries or graphs and let's

1:30

go to the answer here. So you can see that although there's a

1:33

lot of motion you can see that there is an

1:36

artery that starts right here and it courses between

1:39

the pulmonic valve and the aorta

1:42

and it's actually the right corner artery right

1:45

there and it's coursing in the interior atrial

1:49

growth here on the right side and instead of

1:52

going into the place that should go into the right science throughout

1:55

Salva. It's actually coursing between the pulmonary

1:58

and the aorta and it's a rising from

2:01

the left side. And this looks like it's rising from the proximal

2:04

left corner artery or even from the science of el Salva

2:07

and let me show you the same patient a different

2:10

scan. This has less motion

2:13

and I'm gonna show you that

2:16

Here's the right corn artery it is as

2:19

you can see here rising from the left sinus of

2:22

el Salva. It has a so-called inter arterial course,

2:25

you can see the pulmonic valve right here and the order

2:28

right here and when an artery courses at this

2:31

level at the level of harmonic vulnerable below

2:34

sorry or above it's an interartreal

2:37

course and the significance is that this could potentially

2:40

cause a problem. It's a potentially

2:43

malignant course where this coronary can either

2:46

because it's in the wall running

2:49

in an intro so called intramural course and and

2:52

squeezed in the wall or because it squeeze

2:55

between the harmonic pulmonary artery and aorta.

2:58

It can actually be narrowed and cause ischemia now,

3:01

it's important to note that you're gonna see this normality and

3:04

patients who are in their 60s 70s

3:08

80s, and it's never caused any problem at

3:11

all and in general if you're seeing these patients who

3:14

are being image for other conditions.

3:16

Never had any symptoms. These can be very unlikely in

3:19

that setting to cause symptoms in the

3:22

future. But it's a good idea to mention this you need

3:25

to mention this and identify it. The younger the patient is

3:28

the more likely it is to cause symptoms

3:31

and then we're likely a surgeon would want to intervene upon this

3:34

but can tell you my experience. We see these a fair

3:37

amount and you know, they're usually

3:40

the ones that we're seeing that are not symptomatic around

3:43

in adults who are in the

3:46

middle-ager older population and these

3:49

have not causing any problems, but it's a good idea to be

3:52

able to identify them.