0:00

Okay. Well, thank you very much. And I'm just

0:03

going to start by saying that you

0:06

know, I'm gonna go over some cases today money in

0:09

the cases are fairly quick cases. So I'll try to get through quite

0:12

a bit quite a few cases. What I'm

0:15

going to do is I'm going to show you cases that you are likely to

0:18

encounter on a you know

0:21

weekly or even monthly basis and just

0:24

in looking at standard non-gated chest CT

0:27

and so many of us in France

0:30

really healthy are trained both in cardiac and in thoracic radiology

0:34

and some people reading test CT

0:37

or not unnecessarily trained in cardiac imaging but

0:40

I just want to show you a few cases that you should

0:43

be able to recognize or look for and there

0:46

are some other cases that are just interesting cases.

0:49

They're a little more advanced and I just show those

0:52

for interests for those of you who might be

0:55

starting at an even higher level. So but any

0:58

case what's go ahead?

1:00

Get started, you know just that my strategy in

1:03

looking at the heart on non-gated CT is just quickly almost

1:06

subconsciously go through all of

1:09

these things I of course look at the heart the heart size as

1:12

we all do I look for any calcification usually of

1:15

the pulmonary of the coronary arteries and as

1:18

well as the cardiac Chambers I look for

1:21

the origins of the of the Corning arteries to

1:24

make sure that there are no anomalous origins or horses. I look

1:27

at the mycardium. I Look to make sure there hasn't

1:30

been an old MRI or even an acute MI. I

1:33

look at the mycardium. Make sure there are no holes in the

1:36

marketing and look at some of those today. I look at

1:39

the cavities. The first thing I look at is whether there's thrombus or

1:42

any other sort of mass in the cavities. I look

1:45

for any connections like asd's and vsts.

1:48

I look at the valves. I like to make sure they're there isn't

1:51

calcification or thickening or any thrombus or vegetation and

1:54

I look at the pericardium, of course to make

1:57

sure that there is no paracordial effusion or thickening or

2:00

enhancement things like that. So let's just

2:03

go ahead and get started with a few cases here and some

2:06

of these I will not ask you what you

2:09

think. I'm Gonna Save the polling for questions on

2:12

some of the other cases, but I'd like

2:15

to just start with this particular case.

2:19

And let's take a look at this.

2:24

You're scrolling through this is a patient who is for

2:27

staging of cancer and she go

2:30

through you can notice that there are some lymph nodes some AP window once nodes.

2:33

You have higher lymph nodes and

2:36

some subparanal alternates, but the question arises what is

2:39

going on here with this big

2:42

lymph node. We have a lymph node there, correct

2:45

and we go up and it looks actually here

2:48

like it's less of a lymph node and something more infiltrated. It

2:52

looks like it's perhaps tubular. You're

2:55

wondering what what could this be? The first

2:58

thing you look for is the attenuation of

3:01

this and before you

3:04

start measuring it as if it's a lymph node, we want to actually look and

3:07

see what attenuation this is and I

3:10

can tell you I measure this and it measures near fluid attenuation

3:13

and I'll scroll up and show you the higher extent

3:16

of it and it goes all the way up in the high

3:19

rate paratracheal region here.

3:22

And so one idea is that this could be some sort

3:25

of mass some sort of infiltrative mass. Could

3:28

we think about lymphoma? Could we think about some sort of

3:31

infiltrated metastatic disease, but I

3:34

can tell you that it's really not that and this is something you should recognize for

3:37

what it is as we scroll down. We realize

3:41

that it's not always it fluid attenuation. But it also Blends in

3:44

with this which is

3:47

one of the pericardial recesses so you

3:50

can see this is fluid attenuation. It's around the

3:53

ascending aorta. And in this case

3:56

the recess extends all the

3:59

way up and the high right hair tracheal region and I

4:02

can show you this on the coronary format.

4:05

You can see it right here below that up a little bit.

4:09

You can see as you scroll through the reason you know that

4:12

this is not a lymph node, and it's not something like

4:15

a duplication cyst is that it Blends in with

4:18

the recess here the superior pericardial

4:21

recess and this is a well known entity that

4:24

sometimes is mistaken for a mass.

4:27

It can be taken for adenopathy can be mistaken

4:30

for a duplication cyst. I've seen things like

4:33

this sent through multiple pet CTS and

4:36

so forth, but this is a well-known entity.

4:39

I'll show you on my

4:43

PowerPoint presentation here. This was described in AJR

4:46

in many other Publications. This

4:49

is a publication from 2000 from 2000. It's

4:52

the so-called highwriting Superior paracordia recess

4:55

and I would I've seen so

4:58

many times that this is mistaken for something else that I

5:01

wanted to make sure you understand what this is and what

5:04

it looks like that he is it Blends in with the well

5:07

the better known Superior repair Carter recess.

5:10

Let me show you related case here in

5:13

my next.

5:15

Scrollable case let's scroll down to the heart.

5:19

And let's look at this slice and

5:23

I've seen this particular thing here. If you blow this

5:26

up a bit. I've seen this described as a

5:29

lymph node as a lung nodule as a

5:32

mass and you know, it outside hospitals. It's

5:35

always an hour outside Hospital these things occur, right? But

5:38

this is actually if you scroll

5:41

up this, of course, most of you know is connecting

5:44

to this fluid attenuation

5:47

thing that's wrapping around the inferior pulmonary

5:50

vein here. And this is also a parallel

5:53

recess if you measured this this would measure fluid attenuation

5:56

and this is the well known

5:59

interior pulmonary vein pericardial recess. And

6:02

so again, here's some pitfalls that

6:05

you should not mistake for things like lymph nodes or masses or

6:08

nodules. It just Blends right in if you were to

6:11

do A sagittal reformat, you can

6:14

see that this thing scroll to

6:17

the right will

6:19

A c shape around the pulmonary vein

6:22

it wraps around the pulmonary vein. And so there's really nothing else

6:25

that this could be. It's a pericardial recess.