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Giagnostico Por Imagenes Diagnostico Por Imanes Universidad Andina del Cusco

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Universidad Andina del Cusco

Giagnostico Por Imagenes Diagnostico Por Imanes Universidad Andina del Cusco

a) Bilateral hilar lymphadenopathy
b) Aneurysm of the ascending aorta
c) Pericardial effusion
d) Bilateral pneumothoraces
e) Bilateral pulmonary emboli
That’s correct!
There are bilateral pulmonary emboli within branches of the right and left
pulmonary arteries (white arrows). The main pulmonary artery (MPA)
does not contain thrombus, and the ascending aorta (AA) and
descending aorta (DA) are unremarkable.
Acute pulmonary emboli appear as partial or complete filling defects,
centrally-located within the contrast-enhanced lumina of the pulmonary
arteries.
Over 90% of pulmonary emboli develop from thrombi in the deep veins
of the leg, especially above the level of the popliteal veins. They are
usually a complication of surgery, prolonged bed rest or cancer.
lOMoARcPSD|5735817
Question 2
This 57-year-old male presented to the ER with chest pain. What is your
interpretation of this enhanced chest CT scan?
lOMoARcPSD|5735817
a) Duplication of the inferior vena cava
b) Aortic dissection
c) Right lower lobe mass
d) Hiatal hernia
e) Concentric hypertrophy of the left ventricle
That’s correct!
There is a Type B dissection involving the descending thoracic aorta as
evidenced by a displaced intimal flap (arrows). The inferior vena cava
(IVC), left ventricle (LV) and right ventricle (RV) are labeled. The wall of
the left ventricle (*) is normally thicker than that of the right ventricle.
The dome of the liver (L) is partially imaged and should not be confused
with pleural effusion or other lung pathology.
On both MRI and CT, the diagnosis of aortic dissection rests on
identification of the intimal flap that separates the false (original) from
the false lumen (canal created by the dissection).
In general, Type A (ascending aortic) dissections are treated surgically
whereas Type B (descending aortic dissections) are treated medically
Question 3
This is a 63-year-old man with a chronic cough. The most likely diagnosis from
this noncontrast CT scan of the chest is:
lOMoARcPSD|5735817
a) Emphysema
b) Pulmonary laceration
c) Bronchiectasis
d) Accessory left minor fissure
e) Multiple septic emboli
That’s correct!
This CT chest image displayed with lung windows demonstrates multiple
bullae localized to the fibrous septa and pleural surfaces (black arrows)
involving the upper lobes, which is characteristic of the paraseptal form
of emphysema.
Paraseptal emphysema involves the distal airways, alveolar ducts, and
sacs. The subpleural location of these cystic spaces leads to increased
risk of pneumothorax in these patients.
On chest CT, emphysema shows focal areas of low density in which the
cystic areas lack visible walls except where bounded by interlobular
septa. CT can be helpful in evaluating the extent of emphysematous
disease and in planning for surgical procedures designed to remove
bullae to reduce lung volume.
lOMoARcPSD|5735817
Question 4
You are shown 2 images from an enhanced chest CT of a 45-year-old with chest
pain. What is the most likely diagnosis?
a) Pulmonary embolism
b) Mediastinal adenopathy
c) Traumatic aortic injury
d) Right aortic arch
e) Duplicated superior vena cava
That’s correct!
There is a right aortic arch (A) with an aberrant left subclavian artery
(arrow). The aortic arch (A), ascending aorta (AA), and descending aorta
lOMoARcPSD|5735817
(DA) are labeled. There is a single superior vena cava (S), and the main
(M) and left (L) pulmonary arteries are normal. Although it is normal to
see the ascending aorta to the right of the main pulmonary artery, the
aortic arch and the descending aorta should not normally be to the right
of midline.
The most common variety of right aortic arch is this, with an aberrant left
subclavian, which only rarely has associated congenital heart disease
(CHD). However, the mirror-image type of right aortic arch almost always
has associated CHD, usually Tetralogy of Fallot.
This patient had no evidence of CHD.
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Giagnostico Por Imagenes Diagnostico Por Imanes Universidad Andina del Cusco

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