0:01

Let's take a look at this lung cancer screening ct.

0:03

From the perspective of the soft tissue windows

0:05

and the information we can find as a low dose

0:10

non-contrast chest ct.

0:12

We have less tissue characterization without intravenous

0:15

contrast, and we have extensive image noise despite the fact

0:19

that the soft tissues are noisy.

0:21

Visualization of the lungs remains excellent

0:24

'cause we don't require as much x-ray exposure

0:28

to get good quality imaging

0:29

of the lungs since they're primarily filled with air.

0:32

So we accept this limitation of the soft tissue windows

0:35

and performing a screening examination done

0:38

for early cancer detection.

0:41

However, it is important that we look

0:43

for other essential findings

0:45

that may be significant to the patient.

0:48

As we're scrolling through this exam,

0:49

we're seeing numerous macroscopic

0:51

calcifications in the breast.

0:53

These are usually reported

0:54

as benign when they're larger and macroscopic.

0:59

As we're scrolling through the heart,

1:00

we're seeing some coronary arterial calcification.

1:03

You see here in the left anterior descending,

1:06

but mild in the overall extent of coronary calcification.

1:10

The ascending and de descend aorta look normal in diameter,

1:13

as does the main pulmonary artery.

1:15

We can easily measure that.

1:16

It's coming in at 31 32 millimeters.

1:19

That's in the normal range,

1:22

and we're seeing a lot of fatty tissue around the heart.

1:26

And people are familiar with lipomas hypertrophy

1:28

of the atrial septum.

1:29

That sort of looks like a bow tie shaped structure

1:32

with a fossa Vals being in the middle of the bow tie.

1:35

But this is quite extensive for lipoma hypertrophy

1:38

of the atrial septum,

1:40

but it's really just to show you

1:42

how extensive it can become.

1:43

And anatomically where you find increased epicardial fat.

1:48

Increased epicardial fat, as we know, is associated

1:50

with many forms of cardiovascular disease.

1:53

Not only do we see it in the atrial septum here in

1:57

that classic location, but we see it anterior to the heart.

2:00

Inside the pericardium, we see the thin line

2:03

of the pericardium here.

2:05

With all this increased epicardial fat anteriorly,

2:09

we see it posterior to the heart as well.

2:12

And when we look at it in the coronal plane,

2:15

it also shows us the extent

2:17

of this epicardial fat surrounding the heart.

2:21

When I see lipoma hypertrophy of the atrial septum

2:25

or increased epicardial fat, this is something

2:27

I include in my radiology reports, in our cardiothoracic um,

2:31

report templates section for the heart

2:34

and pericardium due to the increased recognition of this

2:37

as a cardiovascular risk factor.