0:00

Case number 15 for this for the

0:03

time being the history is being withheld and let's

0:06

watch the video playing.

0:09

So this video is a 4 chamber View.

0:12

cine bright blood image it shows two atria,

0:15

the two ventricles in the two atria and

0:19

unlike for everyone to observe the wall motion of the ventricles here.

0:23

Particularly in the septal region now. I'm going to close this movie

0:26

and go to another movie. Actually. Let's

0:30

look at the black blood image here. These are two

0:33

black blood images and the short access plane.

0:36

There is a normality here and we're going

0:39

to go to further images. Now. These

0:42

two images are cine images obtained in free breathing.

0:45

The one on the right is is

0:48

performed in deeper inspiration compared to

0:51

the one on the left.

0:52

Black blood images still captures from

0:55

a from a real-time acquisition

0:58

and I'm going to play a short axis video in

1:01

a minute.

1:02

Okay, so here is what's known as real-time

1:05

Imaging share my screen again.

1:09

And in real time Imaging what we do is we ask

1:12

the patient take a deep breath.

1:14

And we image constantly. Well,

1:17

the patient is taking a deep breath in and out and we're looking

1:20

for abnormalities in one specific and atomic region

1:23

of the heart.

1:24

So I'm going to let this video play.

1:27

While we take some poll questions here.

1:31

Can you come to the first question, please? What is the correct diagnosis?

1:35

It's either of these five.

1:37

So the participants were

1:40

divided between

1:43

three diagram between four diagnosis the correct diagnosis Constructor periconditis

1:46

notice that in this video as the patient

1:49

takes a deep breath. The septum moves paradoxically towards the

1:52

left ventricle. This is what's known as a several bounce or paradoxical

1:55

simple motion and it's a feet and it indicates the

1:58

physiology of constrictor pericarditis given the

2:01

fact that the patient has I'm going to go go back

2:04

to the city go to the

2:06

go to the still images here in a minute notice that

2:10

this patient has circumferential periodontal thickening the normal period should

2:13

be about two to three millimeters and thickness in this

2:16

patient. It measures more than that the normal pericardium just

2:19

as a rule of thumb should be about pencil thing should be able to draw it around

2:22

with your pencil or one or two millimeters thick. It's

2:25

much thicker in this case.

2:26

This is a patient who has constricted pericardo

2:29

circumferential thickening of the pericardium abnormal septal

2:32

motion.

2:34

You're going to show the short axis image again.

2:36

Here. This is a series of short axis

2:39

images obtained share this any image clip here. So

2:42

as you can see on the on the shot axis stack, there's eight

2:45

shot axis images notice the

2:48

paradoxical simple motion and diced in diastoli. The

2:51

septum becomes flattened in most paradoxically towards

2:54

the left ventricle. That's because the right ventricular filling presses are

2:57

elevated. There's restriction by the by the thicken pericardium and

3:00

Industry as the right ventricle is filling in

3:03

pretty clean inspiration the subtermost paradoxically towards

3:06

opposite side this apple curve, which you should always be convex towards the

3:09

right to ventricle. And in this case, it's flattening and moving paradoxical towards

3:12

the last frontal industry a feature constrictorian conditis

3:15

in combination with the anatomical features

3:18

of thicken pericardium is finding

3:21

indicates constrictorianitis.

3:23

Okay, can we have the next question pertaining a

3:26

pertaining to this case, please? The basic difference between a

3:29

spinacho and grain Echo image a very basic

3:32

question, which has been posed here.

3:35

Okay, the correct answer for me

3:38

if participants takes take the poll.

3:42

It's a black blood images are Spinnaker images bright blood image is

3:45

a great images in general contact mine was a combination

3:48

of black and bright blood images correct answer is Pinnacle images

3:51

require refocusing pulse spinach images

3:54

require 180 degree refocusing pulse fact the

3:57

alpha the gradient echo images not require that instead we

4:00

use Alpha palsy refoc refocus the protons. The

4:03

answer is the last term Last Choice

4:06

spinachary images require a 180 degree focusing part.

4:09

It's been images by virtue of physics and

4:12

by which of the 180 by the washout effect the spin

4:15

washout effect. The blood is black. So this the black

4:18

blood images that we saw earlier are Spinnaker images.

4:21

The bright blood image is a great images.

4:23

Senegrating Echo Imaging known as steady state repossession

4:26

Imaging is the standard cardiac Mr. Sequence used for

4:29

cine Imaging so you can see the pericardium is thicken here paradoxical simple

4:32

motion towards a left ventricle in diastole

4:35

indicating constrictive pericarditis.