0:00

And I have a case here. One of the only cases here that

0:03

I could not locate to provide

0:06

you a scrollable stack here. I'm giving

0:09

you a self-scrolling stack

0:12

so to speak and I'd like to tell me what is

0:15

the most significant abnormality on

0:18

the CT. This is a woman who came in with chest

0:21

pain to the ER. This is a non-gated

0:24

CT that was done and a very dramatic CT

0:27

and I'll put up the poll question. Now if we would where is

0:31

the most significant agormality here? And actually there

0:34

are multiple every so you may be correct if you

0:37

guess a couple of different things here.

0:41

I'll give you just a couple of minutes as that Scrolls by to

0:44

take a look.

0:50

Alright, let's open the or close the poll that is and see

0:53

what people thought about this case.

0:56

So some people said cardiac Chambers and some

0:59

people said pericardium.

1:02

All right. Well, let me tell you what I see. So let's

1:05

take a look at The myocardium here. So the

1:08

my program should be you know from enhancing but

1:11

look at this this whole region of the LV Apex and the

1:14

septum the apical septum and mid septum. It's actually

1:17

not enhancing very well at all.

1:20

So look at that area that whole area non-enhancing. Well

1:23

compared to the rest of the mycardium now as

1:26

the the aortic valve Scrolls by

1:29

look at that Big Bowl along the aortic

1:32

valve. So let me show you what what happened here. This is

1:35

a big profusion defect in the

1:38

LED territory. And this was caused and

1:41

you can narrow the windows and see that this is a big perfusion defect

1:44

where the LV micronym is not enhancing as

1:47

well as the rest of the normally enhancing my cardium and

1:50

this is Led vascular territory and

1:53

you can see that I can

1:56

reformat this and this demonstrate that further and this

1:59

was actually due to

2:02

A thrombus along the aortic valve

2:05

you can see the thrombus right there in this patient. You

2:08

already had some pre-existing valve disease. So we're looking at

2:11

an acute myocardial infarct that was

2:14

caused by a thrombus symbolizing to the

2:17

LED and you can sort of see that there that the LED was not enhancing

2:20

very well. So this this is

2:23

something you're going to see if you look for it you're going to see this on a

2:26

fairly frequent basis if you're looking

2:29

at Imaging from the ER especially and how's that

2:32

that pattern different from an old mine?

2:35

Well, this is actually a I'll move

2:38

this out of the way for a second.

2:40

This is actually an old am I and you can see that there are

2:43

several signs that this is old rather than acute MI. You

2:46

can see the fatty change of the submentocardial left

2:49

ventricle. You can see that the wall

2:52

is thin here. This is the normal wall the septum.

2:55

This is the thin wall of the Apex here. And so

2:58

this is a chronic Mi or old am I you

3:01

can also see in chronic end Forex calcification like

3:04

this but contrast that to case like this

3:07

and I'll show you that this is a patient you

3:11

had chest pain who came in had a in an abdominal

3:14

CT and you saw this perfusion defect and

3:17

notice how the mycardium here is not thin compared

3:20

to the rest of my cardigan, but it

3:23

is not enhancing very, well. It's not enhancing

3:26

as well as the normal myocardium.

3:28

And look you can window this and make it look even more dramatic you

3:31

can do reformats on it. So this is another patient

3:34

who had a cute Mi who came in to have an

3:37

abdominal CT. And the reason for the pain was actually

3:40

the acute MI a cardiac

3:43

cause and this patient at calf had

3:46

a hundred percent occlusion of the LED.

3:48

Let's take a look at this case. This this patient came in

3:51

with with abdominal pain.

3:53

And had a really thicken Loop of bowel

3:56

right here. And the reason for that is this abnormality

3:59

up here. If you look at the the base of

4:02

the heart, you see this huge area of Admiral enhancement

4:05

of The myocardium and you can

4:08

see in the scroll scrolling stack that the normal

4:11

icardium is here and this is a huge perfusion defect

4:14

in RCA territory. And if you could look right

4:17

there at the Apex, you can see that there is a

4:20

thrombus here that was responsible for embolizing and going

4:23

to you know, mesenteric arteries and

4:26

causing this ischemic bowel. So you're going to

4:29

see these you're gonna see these acute Mice from

4:32

from time to time. So just wanted to make sure you had seen a

4:35

couple of these cases.