0:00

Okay, and this is a patient that you're seeing for chest

0:03

pain and let's scroll down

0:06

and I'm going to ask a whole question and just one second.

0:10

One thing to do on these cases is to adjust the windows that

0:13

you can have what's called a nice vascular window. You can

0:16

see the the tail of the heart

0:19

the coronary arteries and the chambers the

0:22

valves we can see that this

0:25

is a vascular window.

0:29

I'm going to show you this I'm going to blow this up just a little bit.

0:35

And let me scroll to the top of the screen.

0:41

All right. So, let's put up the whole question. What is

0:44

the most significant abnormality in this case? And I'll

0:47

move this to the side continue scrolling.

0:51

Is it going to be Corner arteries or graphs cardiac Chambers septum

0:54

my cardium haircardium or

0:57

valves?

1:05

And just take a few more seconds.

1:09

All right, what's show the poll? Let's close the

1:12

poll and show what you selected.

1:15

Okay, so people selected

1:18

both valves and pericardium those are both correct

1:21

in a way and I'll show you why this is

1:24

a person who had a mitral valve

1:27

replacement. And so there's definitely there was an abnormality

1:30

of the mitral valve and you could

1:33

also argue that perhaps even the buyer prosthetic

1:37

valve has a little bit of thickening there. So that would be a correct

1:40

answer the other answer. The one

1:43

that I think is a bit more significant here is the pericardium as

1:46

you come down. What's one of this a bit differently and

1:49

you can see that not only is their pericardial effusion, but

1:52

what's going on, you can see the leaves of

1:55

the pericardium here if I narrow the window, you

1:58

can see that the pericardium is thickened and enhancing and

2:01

let me scroll down to the very bottom of

2:04

the scan and you can see the leaves the pericardium this

2:07

Rule and pridal pericardium and then you

2:10

can see that they're thickens and there's fluid in

2:13

between. So this is a

2:14

Of pericarditis, and I wanted

2:17

to show this because it is such a

2:20

common abnormality at CT. It's responsible

2:23

for about 10% of all

2:26

of the cases of chest pain that

2:29

presents to the Ed and we don't always see these patients but

2:32

we do see a fair amount of paracorditis due to

2:35

causes like post-surgical pericarditis infectious

2:39

pericardias paracorditis can

2:42

be quite frequent and connected tissue diseases

2:45

such as lupus and let's take

2:48

a look at all the findings here. Not only do you see the pericardium well,

2:51

which you really shouldn't see

2:54

For the pericardium is thickened here and it's measuring

2:57

you know, the cost is set to be more than three millimeters

3:00

to be abnormal, but I can tell you that if

3:03

you see the paracardium at all, and it seems to be enhancing. You're

3:06

probably looking at pericarditis. There are

3:09

other findings of pericarditis here as well. You see some stranding

3:12

of the fat the fat is dirty around the

3:15

heart. So this is the so-called pericardial or

3:18

mediastinal fat. So that's very dirty. You see lymph

3:21

nodes that are hair cardiac

3:24

lymph nodes and cardio frenetic lymph nodes, they're enlarged and

3:27

then you can see some stranding sometimes in the

3:30

epicardial fat as well. The cardio fat is

3:33

the fat that's deep to the parentium here. So this

3:36

has all the findings of acute pericarditis. Now,

3:39

the reason that's important is you can

3:42

go on to look like this. Let me

3:45

show you the next slide here.

3:47

If you saw an more like this or CT like

3:50

this that had this morphology of the heart, you should

3:53

suggest a complication of haircuts and that's

3:56

a constrictive physiologic appearance and

3:59

although we can't really see physiology per se

4:02

looking at the static images. We can suggest that

4:06

when we see this morphology and that morphology is atrial

4:09

enlargement by atrial enlargement like this the

4:12

Atria look balloons. So to speak and you

4:15

see narrowing of the ventricles, especially the

4:18

right ventricle in this case and the left ventricle in

4:21

this case, you see some thickening of the cardium and

4:24

when you see this morphology, you should suggest the

4:27

possibility of constrictive paracorditis,

4:30

even if you don't see this morphology you

4:33

can sometimes pick up the physiologic

4:36

Phenom sequela on

4:39

Real Time Mr. And

4:42

on echocardiography, so but if

4:45

you see these appearances even

4:47

Standard non-gated chest CT usage suggest

4:50

that perhaps this patient could have constricted physiology.