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Cyanotic Congenital Heart Diseases, Etc.
Cyanotic Congenital Heart Diseases, Etc.
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• Loud ejection ACYANOTIC
murmur- L sternal
angle Increase PBF
• CXR FINDINGS:
o Boot RVH LVH / CVH
shaped
heart Atrial Septal Defect Ventricular Septal Defect
o Concave MPA
o Dec hilar and L to R Shunt w/ PHPN Patent Ductus Arteriosus
central pulmo
vessels PAPVR AVSD
o
Hyperexpanded hyperlucent lungs
o Thymic atrophy
CYANOTIC
o Rt aortic arch
Dec PBF
b) Tricuspid Valve Atresia
Case 8
• Dyspnea RVH LVH LVH / CVH
• Jugular pulsations
• Loud murmur along the L sternal border VSD w/ PS Tricuspid Atresia TA w/ Hypoplastic
PAs
• Mild cardiomegaly
Tetralogy of Fallot Pulmonary Atresia
• Dec pulmo bld flow Hypolastic RV TGA w/ PS
• Hyperlucent lungs
• Concave MPA Ebstein’s Anomaly
Single Ventricle w/
• Rt aortic arch PS
• RAE and RVE Eisenmenger
CYANOTIC
Increase PBF
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Teratoma Thymoma
Granular cell tumor Neurogenic Sarcoma
Neurofibroma Leiomyosarcoma
Lympahngioma Liposarcoma
Rhabdomyoma Synovial sarcoma
NOTES:
Most common location in
both Sarcoma and
Lymphoma: RA
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Rhabdomyoma METASTASES FROM AN ABDOMINAL ISLET CELL TUMOR
• Yellow-gray tumor that occur invariably in the
ventricles commonly in multiple locations
o Altered myocytes, often not discrete from
surrounding normal myocardium
• Associated w/ TUBEROUS SCLEROSIS
• MC: 1o cardiac tumor in children
o Cause cardiac failure from obstruction of
conduction pathways and ventricular
tachycardia
• Over 90% present before age 15, usually in the
first few days of life
• Tumors maybe unresectable at surgery
• About 50% of survivors will eventually develop
tuberous sclerosis
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• Most likely to be located posteriorly in the LA,
commonly in the presence of atrial fibrillation, or in
severely dysfunctional left ventricles. It can also be
found in the right side of the heart
• ACUTE THROMBUS will appear bright on both
T1 and T2-weighted images
• SUBACUTE THROMBUS will appear bright on
T1-weighted images with low signal intensity
areas on T2-weighted images due 2 the
paramagnetic effects of methemoglobin and
shortening of the T2 relaxation times.
• CHRONIC ORGANIZED THROMBUS will have Foreign body
low signal intensity on both T1 and T2- BULLET IN INTRAVENTRICULAR SEPTUM
weighted images due to depleted water with or
without calcification of the thrombus (similar to
adjacent parenchyma)
• Gadolinium contrast material is also useful for
differentiating thrombus from tumors, as the
former should not enhance.
1. Atheromatous Aorta
- Calcific in periphery
***EXTRACARDIAC MASSES can mimic cardiac tumors.
Pericardial and bronchogenic cysts, intrathoracic
neoplasms and rarely GI hernias may compress the
heart to mimic a cardiac mass.
Pericardial cysts
• Are congenital in origin and are usually found at
the right cardiophrenic angle, although they may
occur anywhere in the mediastinum.
• They are unilocular and contain water-based fluid
w/o internal septa
NOTES: Pericardial cyst – dark on TI,
bright on T2 2.
• They usually demonstrate the MRI character of Dilated
simple fluid and do not enhance after contrast
material administration
• They occasionally may contain relatively protein-
ascending aorta
aqueous fluid and thus may have high signal
intensity on both T1 and T2 weighted images
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3. Pseudoaneurysm
- does not go into the area of the aorta; does not
enhance
5. Aortic dissections
STANDFORD CLASSIFICATION:
1) TYPE A = the tear begins in the ascending
aorta and progresses throughout the vessel,
extending as far as the arteries in the leg
***Dissection extends into subclavian artery
Type A Dissection
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2 common congenital anomaly:
1. Diaphragmatic hernia
• Types: Morgagni – anterior defect
Bochdalek – posterior defect
• A Bochdalek hernia involves an opening
on the left side of the diaphragm. The
stomach and intestines usually move up
into the chest cavity; A Morgagni hernia
involves an opening on the right side of
the diaphragm. The liver and intestines
usually move up into the chest cavity.
BeBAKEY CLASSIFICATION: • Common in the left side
1) TYPE I – involves the ascending aorta, aortic • Shifting of mediastinum to contralateral
arch and descending aorta (similar to Type A of side
Standford) • Gastric bubbles
2) TYPE II – confined to the ascending aorta
(similar to Type A of Standford) 2. Congenital Cystic Adenomatoid Malformation
3) TYPE III – confined to the descending aorta (CCAM)
distal to the left subclavian artery (similar to • Multiples areas of lucencies
Type B of Standford) • Gastric bubbles
a) Type IIIa = refers to dissections that • Intact hemidiaphragm
originate distal to the left subclavian artery • No shifting of medial structures
but extend both proximally and distally,
• In Ultrasound: peristalsis is seen in
most above the diaphragm
diaphragmatic hernia
b) Type IIIb = refers to dissection that
originate distal to the left subclavian
artery, extend only distally and may extend
below the diaphragm. Congenital Cystic Adenomatoid Malformation
(CCAM)
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• ROENTGENOGRAPHIC FINDINGS:
a) Mild to moderate overaeration Pulmonary Interstitial Pneumonia
b) Symmetric parahilar patches or streaks
c) Occasionally mild cardiomegaly / pleural
effusions
d) RT lung maybe more opacicied than the
LFT
e) The chest film returns to normal by 48-72
hrs of age
• Transient tachypnea of the newborn: Usually
has non homogeneous pulmonary opacities, a
normal lung volume and may have pleural fluid
• Transient tachypnea of the newborn/Wet Lung
(TTN): Supine chest radiograph of the newborn Pulmonary Interstitial
demonstrating mild cardiomegaly and bilateral Pneumonia
reticulonodular densities that radiate from the with
hila. There is atelectasis in the upper lobes. PNEUMOMEDIASTINUM
History
• Premature rupture of the membranes(PROM)
2. Preterm baby del via during labor
NSD DOB • Shortly after birth tachypnea, retratctions, and
• Small lung volume cyanosis maybe evident
• A finely granular • Infants are often afebriel and occasionally are
(ground glass) hypothermic
• Air bronchograms • Supine chest radiograph at the 5hrs of lives
extending peripherally demonstrate diffuse bilateral granular
infiltrates
• SURFACTANT
DEFICIENCY 3. Neonatal Pneumonia
DISEASE/HYALINE • Group B strep
MEMBRANE DISEASE
pneumonia –
OF NEWBORN/IDOPATHIC RESPIRATORY
nonhomogenous
DISTRESS SYNDROME
pulmonary opacities
• MMC: respiratory
• May have pleural fluid
distress in newborn
• Lung volume is normal
infants
• It occurs in premature • COMMON
infants and also infant of PATHOGEN:
DM mothers a) Stap aureus
• Deficiency of pulmonary b) E.coli
surfactant superimposed • The infants are often afebrile & occasionally
on structural immaturity hypothermic
of the lungs • Short after birth tachypnea, retractions and
• Usually has a uniform cyanosis may be evident
distribution of • Radiographic findings:
pulmonary opacities, o Symmetric pulmonary opacities
never has pleural effusions, has a decreased o Hyperaeration are seen
lung volume o Pleural effusion may be seen
• Complications: o Group B streptococcal pneumonia,
1. Pulmonary interstitial pneumonia or pulmo reticulogranular densities
interstitial emphysema (PIE) o Consolidation occurs, it usuall is
- interstitial infiltrates multilobular
- low set hemidiaphragm
- lungs are hyperaerated
2. Pneumomediastinum
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4. FT del via NSVD, • A pneumopericardium may be difficult to
thickly meconium distinguish from a pneumomediastinum as
• Supine chest both may have a “continuous diaphragm sign.”
radiograph from In a pneumopericardium, air will never dissect
day one of live above the level of the main pulmonary artery,
which is the superior extent
demonstrates
bilateral, irregular
coarse infiltrates
Meconium Aspiration
Syndrome
• Usually has nodular patchy non homogenous
densities and may have pleural effusion and an
increased lung volume
Pneumopericardium
• Supine chest radiograph from day one of life • Supine chest radiograph shows air outlining the
demonstrates bilateral, irregular coarse heart, but not extending above the great
infiltrates vessels
• Pneumopericardium, air will never dissect
• Similar to neonatal pneumonia (except there is above the level of the main pulmonary artery,
premature rupture of membranes in neonatal which is the superior extent of the pericardium.
pneumonia) In a pneumomediastinum, air can dissect all
the way up the mediastinim into the neck
• Preterm chest x-ray: Ground glass
appearance with air bronchogram
Pneumomediastinum (PMS)
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Epiglottitis
• History: A 2 year old boy is brought to the
emergency department at 2:30 am
• Complaining of throat pain, not drinking,
drooling, difficulty swallowing, coughing,
naseal congestion, and fever
• The throat pain, difficulty drinking, and drooling
started in the afternoon and have worsened
over the night. He has had the coughing and
nasal congestion for 3 days now
• The black arrow points to the tip of the Atelectasis or 20 to Hilar lymphadenopathies
epiglottis and the white arrow points to the pre- • Manifests with fever
epiglottic space (vallecula) • Chest x-ray: segmented opacities in right
middle lobe
• The
epiglottis should normally be thin or triangular
in appearance. In this view, it appears to be Cystic Fibrosis
rounded and somewhat thumb-like, which is • Hx: 11 y/o male being evaluated for a surgical
similar to the classic radiographic description procedure
of epiglottitis
• Chest x-ray: hyperlucent with multiple
infiltrates
Tuberculosis Nodules in hilum
• History: 4 year old female exposed to active
tuberculosis by a sibling
Empyema
TB • Hx: 7 year old male
with fever and
nonproductive
cough
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• Right upper lobe consolidation and a large right
pleural effusion
• Chest x-ray: complete opacified right lung
Pulmonary Abscess
• An enhanced chest CT exam shows a large
right pleural effusion with an enhancing rim
with associated consolidation and atelectasis of
the lung
• Enhancement of pleura
Pulmonary abscess
• Hx: an 8 year old male with fever, cough, and
bad breath
• Multi-cavitary lesions
Subpulmonic Effusion
- hemidiaphragm elevated when comparted to left
7 x 7.5 x 8 cm intrapulmonary
fluid collection in the right lower
lobe with thick nodular walls and
air fluid level
Round Pneumonia
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Lymphoma
- Bilateral nodular opacities, smooth border,
mediastinal pathology
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