0:00

All right. Let's go to the next case moving right along.

0:03

Let's pull it up. And here's a little bit more of a a general

0:06

chess case as well as a cardiac case

0:09

and I'll start from the top and I want you to take a careful look notice

0:12

how this is a non contrast CTE now

0:15

scroll down through the heart.

0:20

And you can see something odd going on with the herd.

0:23

I'll scroll back up.

0:30

Okay, and let's open the polling questions now and see

0:33

what people think about the

0:36

Abnormality, where is the most significant abnormality

0:39

here?

0:46

All right, just take one or two more seconds to finish

0:49

up.

0:54

Okay, let's close that poll and see what people think.

0:58

Okay. So everyone who voted said pericardium and

1:01

that's that's great because what we're seeing here and

1:04

the clue is the look both

1:07

the location of the heart and the orientation the heart notice

1:10

how the heart looks like. It's rotated in the clockwise

1:13

Direction. It's sort of being diverted toward.

1:16

The left side is rotate toward the

1:19

left or clockwise. If you come up you notice another

1:22

Telltale sign here. Let me go to the one windows.

1:27

You notice that there is lung here where you

1:30

will not notice long on any other scan between the

1:33

aorta and the pulmonary artery insinuating itself

1:36

right there. And that's a Telltale sign

1:39

of this condition or not even condition. But

1:42

variant this is absence of

1:45

partial absence of the pericardium. You

1:48

can see that the pericardium is present on

1:51

the right side, but we don't see a complete pericardium

1:54

on the left side. You can see wispy things

1:57

here, but there's nothing that looks like a normal territorium. So

2:00

this is an congenital abnormality partial absence

2:04

of the pericardium. It leads to this

2:07

sort of leftward rotation of the heart and can

2:10

lead to a very abnormal chest ready graph and I have

2:13

a reconstruction of this radiograph the

2:16

CT that looks like a pseudo radiograph right here.

2:19

You can see that it has these so cold Snoopy Dog

2:22

appearance of the heart that is rotated in

2:25

a

2:27

A leftward direction sort of clockwise rotation

2:30

and it looks somewhere like Snoopy the

2:33

mouth of Snoopy in the ears of Snoopy ears. So

2:36

remember that the larger the

2:39

defect of the pericardium the less likely it is

2:42

to cause any sort of significant abnormality like

2:45

herniation. So when you have

2:48

small defects in the hurting them, they're either surgically created

2:51

or congenital parts of the heart can

2:54

actually herniate on commonly or rarely through

2:57

those defects. But when you have large gapsulin pericardium

3:00

that of course is not as likely to

3:03

happen. So larger defects are actually less likely

3:06

to encounter complications like herniation so

3:09

good. So partial absence of the pericardium was

3:12

that case